The Effect of Donor Age on the Outcome of One HLA-haplotype Mismatched Living Related Kidney Transplantation / 대한내과학회지

OBJECTIVES: Renal transplantation has become the ther apy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the num ber of ideal kidneys available for transplantation, increas ing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal def inition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we per formed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mis matched living related kidney transplantation. METHODS: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(> OR =55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retro spectively reviewed. Patient death with a functioning graft was considered graft loss. RESULTS: Demographic characteristics between 2 groups were similar. The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regard less of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly dif ferent (91.4% and 63.9% vs 92.7% and 79.3%, respec tively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). CONCLUSION: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kid neys may be used from donors over 55 years old on con dition that the donors undergo complete and exhaustive work-up.

A Case of Nodular Diabetic Glomerulosclersis and Proliferative Retinopathy without Diabetes Mellitus / 대한신장학회잡지

Nodular glomerulosclerosis was first described by Kimmelstiel and Wilson in 1936. Diabetic retinopathy and nephropath y are manifestation of the microangiopathy associated with diabetes. The severity of diabetic nephropathy and the occurrence of retinopathy correlate with the duration of clinical diabetes. However, there have been few reports of patients presents presenting with the classic lesions of diabetic microangiopathy in the absence of a known history of diabetes. These reports raise questions regarding the relationship and significance of carbohydrate intolerance to these pathologic abnormalities. A 34-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic disease is reported. Renal biopsy showed the nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) characteristic of diabetes. Direct opthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.

A Case of Primary B-cell Lymphoma of the Centrol Nervous System after Renal Transplantation: A Case Report / 대한내과학회지

Primary lymphoma of the central nervous system is a rare disease, occurring spontaneously and/or in conjunction with immunosuppressive state. Its incidence is increasing according to the increment of organ transplantation and AIDS. Recently we experienced a case of primary lymphoma occurred in central nervous system after renal transplantation in a 58-year-old women who had complained of persistent headache and left hemiparesis. CT scan of the brain showed two hyperdense mass lesions in right frontal and right basal ganglia areas. Immunohistochemical stain of the excised mass lesion revealed that tumor cells were derived from B cells. The patient was treated with discontinuance of immunosuppressive drug and irradiation, but expired due to pneumonia.