Wonhyun Cho

Initial Report of the Korean Organ Transplant Registry: The First Report of National Kidney Transplantation Data

PURPOSE A national organ transplant registry is an indispensable organizational requirement for patient care, research, and planning. Even though the Korean Network for Organ Sharing (KONOS) has established a database for a waiting list, organ allocation, and incidence of organ transplantation since 2000, an integrated registry including post-transplantation data is needed for better understanding of organ transplantation. Recently, the Korean Society for Transplantation (KST) and the Korean Center for Disease Control (KCDC) designed a web-based organ transplant registry, named the Korean Organ Transplant Registry (KOTRY). As an initial project of KOTRY, we retrospectively analyzed kidney transplantations (KTs) performed in 2009 and 2010. METHODS A total of 2292 KTs (91.9%) from 46 hospitals (80.7%) were collected and analyzed. Ninety-five elements related to KT were selected and analyzed. RESULTS Proportions of male recipients and retransplantations were 58.4% and 7.1%, respectively. Even though glomerulonephritis was the most common cause of end-stage renal disease (ESRD) (28.4%), the number of diabetic nephropathy cases was increasing. The living donor (LD) to deceased donor (DD) ratio was 1.69:1. Because of a serious organ shortage in Korea, DD kidneys with a low initial estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m(2) (21.2%) and expanded criteria donors (ECDs; 18.3%) are frequently used. Other noticeable findings are the increasing number of wife donors and ABO-incompatible (ABOi) transplants for O(+) recipients. CONCLUSIONS The epidemiological profile of transplantation is different from country to country. The number of organ transplantations in East Asian countries is rapidly growing, however, there are few epidemiological data about this region in the literature. With the establishment of KOTRY, it was possible to present the first nationwide epidemiological data of Korean KTs.

Acute Colitis Associated With Dengue Fever in a Renal Transplant Recipient

Dengue fever is a significant health problem for international travelers to all endemic area. Dengue fever is characterized by a sudden onset of fever, headache, rash, myalgia, and joint pain. Infection with the dengue virus is detrimental to a immunosuppressed renal transplant patients. Herein we report a 29-year-old woman living-related renal transplant recipient returning from Southeast Asia with dengue fever presenting as acute colitis. The patient traveled to Southeast Asia for 1 week. She developed watery diarrhea in the second week after the onset of symptoms of dengue fever. Laboratory findings were leukopenia, thrombocytopenia, and elevated serum transaminase levels. Sigmoidoscopic features showed nonspecific acute colitis. She improved after 10 days of hospitalization with intensive supportive care and continuous tacrolimus monotherapy. Altered clinical symptoms are manifested in immunologically naïve adults. Manifestation of unusual symptoms does not exclude dengue virus infection in renal transplant recipients.

Cilostazol inhibits high glucose- and angiotensin II-induced type 1 plasminogen activator inhibitor expression in artery wall and neointimal region after vascular injury

Increased expression of plasminogen activator inhibitor-1 (PAI-1) in vascular tissues is a potential factor linking diabetes to restenosis after percutaneous coronary intervention. Recent studies have shown that cilostazol, a selective type 3 phosphodiesterase inhibitor, prevents neointimal hyperplasia and in-stent thrombosis in patients with diabetes after coronary angioplasty and stent implantation. However, the molecular mechanism of this drug has not been fully elucidated. We examined whether cilostazol inhibits PAI-1 expression in vascular smooth muscle cells (VSMCs) and neointimal hyperplasia. We found that cilostazol effectively inhibits angiotensin II-, high glucose- and TGF-beta-stimulated PAI-1 expression in vivo and in vitro. Cilostazol attenuated PAI-1 expression in neointimal regions and inhibited neointimal hyperplasia after balloon injury. Cilostazol inhibited PAI-1 expression by multiple mechanisms including downregulation of TGF-beta, JNK and p38 signaling pathways. Cilostazol also inhibited transactivating activity at the PAI-1 promoter by Smad3, leading to a suppression of PAI-1 gene transcription. Taken together with its antiproliferative effect on VSMCs, this may explain how cilostazol exerts its antithrombogenic effects after angioplasty and stent implantation.

Delayed Presentation of Arteriovenous Fistula and Pseudoaneurysms in a Renal Transplant Patient 10 Years After Percutaneous Allograft Biopsy

A 51-year-old man was admitted with microscopic hematuria at 10 years after living donor renal transplantation. In order to distinguish between acute tubular necrosis and acute rejection, a graft biopsy was performed under ultrasound guidance at 1 month posttransplantation. Doppler sonography revealed 3 pulsatile cystic masses and an arteriovenous fistula (AVF) in the lower kidney pole. Selective transplant renal angiography revealed 3 pseudoaneurysms with an AVF supplied by a lobular artery in the lower pole. The diagnosis was AVF with pseudoaneurysm, which developed secondary to percutaneous renal allograft biopsy. Interventional treatment was performed because of the high risk for pseudoaneurysm rupture. The AVF and pseudoaneurysms were treated successfully by percutaneous transluminal embolization; renal function remained stable after embolization.

Successful Treatment of Disseminated Adenovirus Infection With Ribavirin and Intravenous Immunoglobulin in an Adult Renal Transplant Recipient: A Case Report

Disseminated adenovirus infection in recipients of renal transplants is a rare but often fatal complication. We present a case of a 32-year-old woman who underwent renal transplantation from a deceased donor. Ten months after transplantation, she presented with dysuria, hematuria, and febrile illness. Despite the use of antibiotics, the patients symptoms continued and worsened and the serum creatinine level was increased. The results of urine and serum polymerase chain reaction were positive for adenovirus. Renal biopsy revealed viral interstitial nephritis. The patient was treated with ribavirin, intravenous immunoglobulin, and reduction in immunosuppression. Her symptoms progressively improved from 7 days after the treatment. Serum and urine polymerase chain reaction for adenovirus became negative 10 and 21 days after the treatment, respectively. She remained in good health with excellent allograft function 6 months later.

Basiliximab does not reduce the early rejection incidence in high-risk kidney recipients under tacrolimus-based immunosuppression.

This study sought to evaluate the benefit of addition of basiliximab to tacrolimus-based immunosuppression among high-risk renal transplantations. We retrospectively analyzed the clinical data of the basiliximab induction group (n = 55) and a risk-matched control group (n = 57). Graft survivals rates at 1, 3, and 5 years were 100%, 98.1%, and 91.8%, respectively, for the control and 96.2%, 93.9%, and 76.4%, respectively, for the basiliximab group (P = .083). Patient survivals rates at 1, 3, and 5 years were 98.3%, 98.3%, and 98.3%, respectively, for the control group and 98.2%, 94.2%, and 94.2%, respectively, for the basiliximab group (P = .277). Biopsy-proven acute rejection (AR) within 12 months occurred among 24.6% and 18.2% for the control and induction groups, respectively (P = .492). Serum creatinine levels at 1, 3, 6, and 12 months were 1.23 +/- 0.30, 1.38 +/- 0.41, 1.47 +/- 0.61, and 1.44 +/- 0.67 mg/dL, respectively, among the control and 1.24 +/- 0.28, 1.40 +/- 0.38, 1.40 +/- 0.36, and 1.63 +/- 1.62 mg/dL, respectively, among the induction group. In conclusion, this study showed that the addition of basiliximab to tacrolimus-based immunosuppression did not further improve the results of high-risk kidney transplantations in terms of reducing AR, prolonging graft survival, or improving renal function.

Use of early postoperative MAG3 renal scan to predict long-term outcomes of renal transplants.

OBJECTIVES A Tc-99m mercaptoacetyltriglycine renal scan has been used to evaluate perfusion and excretory function of renal allografts. A Tc-99m mercaptoacetyltriglycine renal scan has been reported to correlate with early allograft outcomes. This study was done to determine whether a Tc-99m mercaptoacetyltriglycine renal scan has any relation with long-term renal transplant outcomes. MATERIALS AND METHODS A total of 311 consecutive kidney transplant recipients were included in the study. All had Tc-99m mercaptoacetyltriglycine renal scans on posttransplant days 3 and 7. Patterns of the renography curve was graded as follows: 0=normal perfusion and excretion; 1=normal perfusion, reduced excretion; 2=normal perfusion, flat excretion; and 3=reduced perfusion and rising curve. Early postoperative Tc-99m mercaptoacetyltriglycine scintigraphy findings were correlated with serum creatinine values, acute rejection episodes, and long-term graft survival. RESULTS A Tc-99m mercaptoacetyltriglycine renography of a deceased-donor kidney transplant showed a significantly higher grade on both days 3 and 7 than did live-donor kidney transplant (P < .001). Serum creatinine was positively correlated with the renography grades on days 3 and 7. The acute rejection rate was higher in the renography on days 3 and 7. Grade 2 renography on day 3 showed a significantly higher graft failure rate compared with the other grades (8.8% vs 8.6% vs 31.6% vs 7.3%; P = .014). Also, the renography showed the worst 5-year graft survival rate (95.9% vs 93.3% vs 89.5% vs 94.1%; P = .019). There were no differences in the graft failure rate or in graft survival rate according to the Tc-99m mercaptoacetyltriglycine renography grades on day 7. CONCLUSIONS Our data show that a Tc-99m mercaptoacetyltriglycine renography grade correlate not only with early postoperative kidney function and incidence of acute rejection, but also with long-term outcomes of a renal allograft. A grade 2 renography pattern, with normal uptake and flat excretion, indicates a dismal prognosis for the long-term allograft survival.

Rectal carcinoid tumor in a renal transplant patient.

Malignancy represents a leading cause of morbidity and mortality in patients with a long-term surviving graft. Carcinoid tumor is a common primary endocrine tumor in the general population that is rare in transplant recipients. Our present report focused on a 48-year-old man who received immunosuppressive therapy based on cyclosporine and steroids. Twelve years after renal transplantation, he suffered watery diarrhea and abdominal discomfort. Colonoscopy showed a hard, sessile mass at 5 cm from the anal verge; endoscopic ultrasound showed a 13-mm homogenous hypoechoic mass. Upon endoscopic biopsy, the histological examination revealed a carcinoid tumor. Immunosuppresion was reduced and we performed endoscopic mucosal resection of the rectum. His clinical course has been good with no demonstrated recurrence.

Current status of renal replacement therapy in Korea.

Hemodialysis (HD), peritoneal dialysis (PD), and transplantation are the three main replacement therapies for end-stage renal disease (ESRD). To be successful, dialysis requires advanced machines and transplantation requires an adequate number of donor organs. Since the late 1960s, when HD and PD were introduced, the number of dialysis centers and machines has continuously increased. More than 300 hospitals and clinics perform renal replacement therapy in Korea. Newly developed advanced dialysis machines and dialyzers have improved patient survival and quality of life. The development of nephrology as a subspecialty has also contributed to improvement in the treatment of ESRD. In Korea at the end of 2000, HD comprised 62% of renal replacement therapy, PD comprised 22%, and transplantation comprised 16%. In the field of transplantation, there has been tremendous improvement in outcomes and posttransplantation management. This improvement is due to newly developed, potent immunosuppressant medication, improved surgical skill, and improved methods of organ procurement and preservation. To review the current status of renal replacement therapy in Korea, the annual report of the Korean Society for Transplantation and Nephrology is reviewed and summarized in this article.

Case of Adult Mumps Infection After Renal Transplantation

Viruses are the most common cause of opportunistic infections, important complications of transplantation. Mumps infection in renal transplant recipients is uncommon. This report focused on a 23-year-old woman who received immunosuppressive therapy based on tacrolimus, prednisolone, and mycophenolate mofetil for renal transplantation. Sixteen months after transplantation, she was admitted with pain and swelling in both infra-auricular areas. Laboratory findings demonstrated positive mumps IgM and IgG antibodies and an increased serum amylase level. Computed tomography revealed both parotid glands to be diffusely enlarged. After the diagnosis of mumps parotitis, the patients immunosuppression was reduced and the clinical course was satisfactory.