Case Report of Kidney Paired Donation (KPD) with Desensitization: the Strategy and Experience of 3-Way KPD in Samsung Medical Center

As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings. Patients who are both difficult-to-match due to broad sensitization and hard-to-desensitize because of donor conditions can often be successfully transplanted through a combination of KPD and desensitization. According to the existing data, KPD can increase the number of KTs from living donors with excellent clinical results. This is also a cost-effective treatment as compared with dialysis and desensitization protocols. We carried out 3-way KPD transplantation with one highly sensitized, positive cross match pair and with two ABO incompatible pairs. Herein we report our first successful 3-way KPD transplantation in a single center. To maximize donor-recipient matching and minimize immunologic risk, KPD programs should use proper algorithms with desensitization to identify optimal donor with simultaneous two-, three- or more complex multi-way exchanges.

Technique for orthotopic liver transplantation in cynomolgus monkeys (Macaca fascicularis)

PURPOSE: Recent studies investigating new strategies to modulate the immune system have utilized animal models of liver transplantation (LT). However, the anhepatic phase (AHP) remains a crucial problem in LT. The aim of the present study is to introduce a technique for successful orthotopic LT in cynomolgus monkeys using an early-reperfusion strategy. METHODS: Orthotopicallo-LT was performed with seven donor/recipient pairs of cynomolgus monkeys. RESULTS: In 2 recipients, liver allografts were perfused after suprahepatic inferior vena cava (SHIVC), portal vein (PV), and infrahepatic inferior vena cava (IHIVC) anastomosis. To reduce the time of AHP in five recipients, liver allografts ware perfused after SHIVC and PV anastomosis while the IHIVC was not anastomosed. In the latter strategy, the AHP was reduced from 46 minutes to 31 minutes and a 24-hour survival rate of 80% was achieved. CONCLUSION: Our results indicate that an early-reperfusion strategy can be successfully used to establish a LT model in cynomolgus monkeys with a consistently high rate of animal survival.

The surgical approach for the inferior vena cava leiomyosarcoma including the confluence of right renal vein: A case report of patch venoplasty with right renal vein reimplantation after complete tumor resection

Surgical approaches for leiomyosarcoma of the inferior vena cava (IVC) are based on tumor location. Radical resection for the IVC leiomyosarcoma involving the renal vein has traditionally included nephrectomy with renal vein ligation or kidney autotransplantation. A 51-year-old woman was admitted for elective surgery for the tumor of IVC. At surgery, the tumor was located in front of IVC, abutted with right renal vein. After the tumor resection, IVC reconstruction involved the patch cavoplasty with cryopreserved cadaveric vein graft and the implantation of the right renal vein into the inferior IVC. The patient recovered fully without any postoperative complications including kidney function change. This technique could be adopted for tumors located in front of IVC involving renal veins, provided complete resection of the tumor with a comfortable resection margin is possible.

The Long-term Outcomes of Kidney Transplantation from Donation after Circulatory Death during Brain Death Donor Evaluation in a Single Center in Korea / 대한이식학회지

BACKGROUND: While the number of deceased donor donations has increased in Korea, the organ shortage remains a major limitation for kidney transplantation. Donation after circulatory death (DCD) can be an option to expand the donor pool. In this study we evaluated the short and long term survival of grafts and patients and assessed the risk factors for graft failure. METHODS: In a single center, from August 1997 to December 2013, 28 cases of recipients who received kidney transplantation from DCD were enrolled. Information about donor and recipient factors, graft conditions, and transplant outcomes was collected through review of medical records. We calculated overall graft and patient survival rates and the risk factors for graft failure according to donor criteria and whether or not delayed graft function (DGF) occurred. RESULTS: There was no primary non-function, but DGF developed in 67.9% (19/28). Graft losses occurred in five patients during a median follow-up period of 68.2 months (4~204). There was no significant difference in graft survival rates depending on the donor criteria and the occurrence of DGF. In addition, there were no noteworthy risk factors for graft failure among donor age, donor creatinine, extended criteria donor, recipient age, warm ischemic time, cold ischemic time, and DGF. CONCLUSIONS: In this study, despite the high incidence of DGF, the long-term graft and patient survival in kidney transplantation from DCD were acceptable. Therefore, DCD can be an alternative to expand the donor pool and to shorten the waiting time.

High pretransplant HBV level predicts HBV reactivation after kidney transplantation in HBV infected recipients

PURPOSE: HBsAg-positive kidney recipients are at increased risk for mortality and graft failure. The aims of this study were to identify the outcomes of HBsAg-positive recipients who received preemptive antiviral agents after successful kidney transplantation and to analyze risk factors for HBV reactivation. METHODS: We retrospectively reviewed the medical records of 944 patients performed kidney transplantation between 1999 and 2010. RESULTS: HBsAg-negative recipients were 902 patients and HBsAg-positive recipients, 42. Among HBsAg-positive recipients, HBV reactivation was detected in 7 patients and well controlled by switch or combination therapy. Graft failure developed in only one patient due to chronic rejection regardless of HBV reactivation but no deaths occurred. All patients were alive at the end of follow-up and none developed end-stage liver disease or hepatocellular carcinoma. There was statistically significant difference in graft survival between HBsAg-positive recipients and HBsAg-negative. Multivariate analysis identified increased HBV DNA levels (>5 x 10(4) IU/mL) in the HBsAg-positive kidney transplant recipients as a risk factor for HBV reactivation (P = 0.007). CONCLUSION: Effective viral suppression with antiviral agents in HBsAg-positive renal transplant recipients improves patient outcome and allograft survival. Antiviral therapy may be especially beneficial in patients with high HBV DNA levels prior to transplantation.

Intra-abdominal bronchogenic cyst: report of five cases

An intra-abdominal bronchogenic cyst (BC) is a very rare congenital anomaly caused by abnormal budding of the developing tracheobronchial tree. Intra-abdominal BCs are reported as retroperitoneal masses in most cases, many of which are located on the left side of the midline, the perigastric area, the left adrenal gland, or the superior body of the pancreas. Intra-abdominal BCs are frequently misdiagnosed due to the rarity, location, and variable cystic content. We report five patients with intra-abdominal BCs who underwent surgery in a single institution.

Radical resection of intestinal blue rubber bleb nevus syndrome / 대한외과학회지

Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic vascular disorder characterized by multiple venous malformations involving many organs. BRBNS can occur in various organs, but the most frequently involved organs are the skin and gastrointestinal (GI) tract. GI lesions of BRBNS can cause acute or chronic bleeding, and treatment is challenging. Herein, we report a case of GI BRBNS that was successfully treated with a combination of intraoperative endoscopy and radical resection.