A Single Center Experience of ABO Incompatible Kidney Transplantation / 대한이식학회지

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for end stage renal disease. However, the relative shortage of organs for transplantation (from human leukocyte antigen- or ABO incompatible [ABOi] living donors) has led to ABOi KT as an accepted method to expand the pool of living kidney donors. To date, reports of the outcomes of ABOi KT are limited; therefore this study aims to evaluate the outcomes of ABOi KT in recipients. METHODS: We identified 45 patients who underwent live-donor ABOi KT between February 2007 and November 2011 at Maryknoll Medical Center. All of them were treated according to the scheduled protocol of plasmapheresis with low dose intravenous immunoglobulin, and low dose rituximab- or tacrolimus-based triple immunosuppressant regimens. Clinical parameters and the incidence of rejections in these patients were analyzed. RESULTS: We had three cases (6.6%) of biopsy-proven acute antibody-mediated rejections and one case (2.2%) of acute cellular rejection, all of which were successfully treated. The median follow-up duration was 20 months (range, 2~59). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube method: median immunoglobulin G titer/immunoglobulin M titer 64 [range, 8~4,096]/16 [range, 2~256], respectively). Although there was no patient death, one patient lost his graft due to nonadherence to immunosuppressants. CONCLUSIONS: Our analysis of ABOi KT has shown excellent and promising outcomes. These practices may therefore represent an acceptable option for expanding the pool of living kidney donors.

Multiple Renal Artery Anastomosis in Kidney Transplantation: Clinical Outcome / 대한이식학회지

PURPOSE: Kidney transplantation with multiple renal arteries has been associated with higher incidence of vascular and urologic complications. Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively, so it would be clearly in the best interests to the recipients whether to include these individuals as organ donor candidates. There is an increasing requirement to use such kidneys and it is not unusual trend any more. Some authors insist the vessel anastomosis time (2nd warm ischemia time) exceeding 35 minutes may attribute to the development of acute tubular necrosis (ATN). There are various methods in anastomosis of multiple renal arteries but vascular and urologic complications depend on the technical surgical skills or methods of the vascular anastomosis. METHODS: A retrospective study was assessed for 454 kidney transplantations performed in the department of surgery, Maryknoll Medical Center between August, 1990, and May 2007. Study groups are divided into four groups according to anastomosis METHODS: Group I, a single-artery anastomosis (n=387) and others, multiple-artery anastomosis (Group II~Group IV) includes extracorporeal (Group II), intracorporeal (Group III) artery anastomosis, and polar artery ligation (Group IV). RESULTS: Among those groups, there are no significant differences in 2nd warm ischemia time, serum creatinine level, recipient and graft survival rate, acute tubular necrosis, acute rejection rate, blood pressure change, and urologic and vascular complication. CONCLUSION: Kidney transplantation of multiple renal arteries is not a difficult challenge any more and it is now more important to find out the better way and better result.

Normal Variation of Hepatic Artery / 한국간담췌외과학회지

PURPOSE: World wide studies have reported many cases of the normal variants of the hepatic artery in healthy individuals. Unfortunately, there are few medical reports in Korea, this study presents the results and analysis of the anatomical variants in the hepatic artery. METHODS: This study analyzed the blood supply of the liver in 131 patients who had received hepatic angiography and superior mesenteric angiography from January 1996 to September 2003 at the Maryknoll general hospital. RESULTS: The hepatic artery pattern with a normal hepatic artery pattern was observed in 101 out of 131 cases (77.1%) ; the right and left hepatic arteries arising from the proper hepatic artery, which arising from the common hepatic artery. The normal variations in the hepatic artery pattern were observed in 30 out of 131 cases (22.9%) ; the replaced right hepatic artery arising from the superior mesenteric artery was observed in 14 out of 131 cases (10.7%). The replaced left hepatic artery arising from the left gastric artery was observed in 6 out of 131 cases (4.6%). The common hepatic artery arising from the superior mesenteric artery was noted in 4 out of 131 cases (3.1%). The accessory left hepatic artery arising from the left gastric artery was observed in 1 out of 67 cases (0.7%). Other variants were noted 5 out of 131 cases (3.8%). CONCLUSION: Knowledge of the patterns and frequency of the variants in hepatic artery is increasing with the larger number of national reports on the hepatic artery variants, which can be great help in surgical operations, hepatic arterial embolization, or liver transplant.

Is Pretransplant Bladder Augmentation Using Hydrostatic Pressure of Contracted Bladder in Chronic Renal Failure Really Effective? / 대한이식학회지

PURPOSE: Kidney transplantation is definite treatment in chronic renal failure (CRF). But CRF patients have contracted bladder due to disuse atrophy and fibrosis of bladder mucosa and muscle. Contracted bladder results in CRF itself and failure of transplantation. And this causes many difficulties in ureteroneocystostomy. So many authors suggest that preoperative bladder augmentations of contracted bladder (cystoplasty) using intestine increase success rate in kidney transplantation. But these methods have been usually studied in pediatric transplantation. Preoperative hydrostatic bladder dilatation is nonoperative treatment usually used in interstitial cystitis and hemorrhagic bladder tumor. METHODS: Since January 1996, we newly attempted pretransplant bladder augmentation using hydrostatic pressure in 22 CRF patients who had contracted bladder diagnosed through preoperative voiding cystourethrogram (VCUG). RESULTS: Pre-augmented average bladder volume was 87.7 mL (60~100 mL) and post-augmented bladder volume was 210.5 mL (100~250 mL). There was no complication associated with pretransplant bladder augmentation itself, and there was no transplanted kidney loss. CONCLUSION: These results suggest that pretransplant bladder augmentation using hydrostatic pressure be useful in kidney transplantation of CRF patient who had contracted bladder.

Malignancy in Renal Transplant Recipients / 대한이식학회지

PURPOSE: Survival rate after renal transplantation has increased in according to the prolonged graft survival due to a development of new immunosuppressive agents and operative techniques. Therefore, the develpment of malignancy in renal transplant recipients has become the major cause of morbidity and mortality. METHODS: The retrospective analysis was performed in 4 patients with malignancy among the 315 patients who underwent kidney transplantation in our hospital from August 1990 to March 2001 and 1 patient with malignancy who underwent kidney transplantation in other hospital and was followed up in our hospital. RESULTS: In five malignancy, 3 were adenocarcinoma in stomach, 1 lobular carcinoma in breast and 1 squamous cell carcinoma in uterine cervix. The mean age of these patients at diagnosis of malignancy was 48.4 (35~60) and the average interval between renal transplantation and diagnosis of malignancy was 69.8 months. Surgical resection was done in all five patients. Chemotherapy was performed in 1 patients with advanced gastric cancer and 1 patient with breast cancer. Four patients are now alive and one patient was lost during follow-up period. CONCLUSION: We reviewed the incidences and types of malignancy after renal transplantation in our hospital. Regular screening and careful surveillance are highly recommended in patients after renal transplantation.

Clinical Analysis of 500 Consecutive Laparoscopic Cholecystectomies / 한국간담췌외과학회지

BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment of benign gallbladder disease. It requires the skill of a trained surgeon, and its safe performance. The advantages of laparoscopy are less postoperative pain, absence of cosmetic damage, shorter recovery times, and decreased length of hospital stays compared with conventional open surgery. METHODS: We reviewed 500 consecutive laparoscopic cholecystectomies retrospectively at the department of general surgery of Maryknoll Hospital from February 1992 to May 1999. RESULTS: There were 175 males and 325 females(M:F=1:1.86) with ages ranged from 21 to 78 years (mean: 50.0 year). Preoperatively, 72 patients underwent endoscopic retrograde cholagiography and 7 patients underwent endoscopic sphincterotomy due to common bile duct stone. Mean operation time was 73.7 minutes. Operative cholangiogram was attempted in 8 patients. Conversion to open cholecystectomy during operation was done in 8 cases(1.6%) and leading causes were severe adhesion, uncontrolled bleeding, suspected malignancy, bile duct injury. Operative Complications occured in 18 patients(3.6%): bile duct injury 1, postoperative bleeding 1, bile leakage 4,subcutaneous emphysema 1, abdominal wall hematoma 3, wound infection 8. There was no operative mortality. The length of hospital stay ranged from 2 to 15 day with average of 4.7 day. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective operation in patients with benign gallbladder diseases.

Surgical Complications in 250 Renal Transplants: Clinical Course and Outcome / 대한이식학회지

The surgical technique of renal transplantation has been well established, but surgical complications are not uncommon and still be important factors in postoperative mortality and morbidity. From August 1990 to May 1998, we performed 250 consecutive renal transplantations at Maryknoll hospital. The authors analyzed the kinds and incidences of surgical complications in a single center by using information from hospital records. The results were as follows: 1. The overall surgical complication rate was 9.6% (24 episodes in 250 cases). 2. These were composed of 6 vascular, 8 urologic, 4 lymphatic, and 6 wound complications. 3. Vascular complication included renal artery stenosis in 1 case and bleeding and hematoma in 5 cases. 4. Urologic complication included urine leakage in 4 cases, ureter stenosis in 2 cases and bladder stone in 2 cases. 5. Lymphatic complication was all lymphoceles. 6. One case in which renal artery stenosis had occured progressed to graft loss after 4 years later. There was no complication related mortality. 7. 1 year, 3 year and 5 year graft survival rate was 97.2%, 94.8% and 90.0%, respectively. and patient survival rate was 98.0%, 95.6% and 94.7%, respectively.

Living-Donor Renal Transplantations, Analysis of Risk Fanctors Influencing the Outcome of 190 Cases

We have performed 190 renal transplantations from August 1990 to June 1996. No cadaveric donor was used and all except one were first grafts. We conducted a clinical analysis, especially concerning the factors affecting acute rejection and graft function at 1 year. The results were as follows : 1) The mean ages of donor and recipient were 35.3 years and 37.4 years respectively. The ratio of male to female was 1.4 : 1 and 1.5 : 1, respectively. 2) One hundred and six cases(55.8%) were living unrelated donors and eighty four cases(44.2%) were living related donors. 3) One hundred and sixty six potential recipients were given 3 donor specific transfusions(DST), started about 5 weeks prior to transplantation with cyclosporin coverage. Six of these patients(3.6%) developed sensitization by DST that precluded the subsequent transplantation and the remaining 160 patients received the kidney from the blood donors. Another 28 recipients were given DST 24 hours prior to operation. 4) Most of initial acute rejection episodes(71 episodes, 95%) appeared within the first month of post-transplantation. 5) We analyzed the possible factors affecting the incidence of acute rejection. Donor age and HLA incompatibility were significant statistically(p<0.05). 6) Multiple regression analysis showed that a number of acute rejection episodes(p<0.001) was the only independent risk factor for the graft function at 1 year. 7) Overall graft and patient survival rate were 97.2% and 98.6% at 1 year, 94.1% and 95.5% at 3 years.

Analysis of Clinical Manifestations in Surgical Treatments for Hepatolithiasis

Hepatolithiasis is said to exist when stones are present in the right or the left hepatic ducts or their tributaries. Although it is a pathophysiologically benign disease, it causes frequently serious problems-recurrent cholangitis, liver abscess, obstructive jaundice, liver cirrhosis, and sepsis - and has challenged surgeons. Until recently, its fundamental pathogenetic mechanisms have not been elucidated, but bile duct stenosis, bile stasis, and secondary infection are considered as important pathogenetic factors. Therefore, the ultimate goal of the treatment is directed to the correction of these factors. We were retrospectively reviewed 119 cases of patients with hepatolithiasis treated by various surgical methods from Jul. 1989 to Dec. 1996 at the Department of Surgery of Maryknoll Hospital, Pusan. There were 72 women and 47 men, and the mean age was 45.5 years. Thirty-nine patients (32.8%) had previous histories of operations related to biliary stone diseases - cholecystectomy (n=13), T-tube choledocholithotomy (n=21), choledochoduodenostomy (n=9), Roux-en-Y choledochojejunostomy (n=6), and transduodenal sphincteroplasty (n=1). Operative procedures were 24 (20.2%) lithotomy, 60 (50.4%) drainages, and 35 (29.4%) hepatectomies and determined by the location of the stones, the general condition of the patient, and the anatomical change (stenosis or cystic dilatation) in intrahepatic duct. Postoperative complications occurred in 33 (27.7%) patients : wound infection (n=23), atelectasis (n=5), intra-abdominal bile collection (n=3), choledochocutaneous fistula (n=2), hemobilia (n=1), and adhesive ileus (n=1). Residual stones were detected in 39 (32.7%) patients by T-tube cholangiography, ultrasonography, computed tomography. The instances of residual stones was the lowest (17.1%) for hepatectomy compared to 45.8% for a lithotomy and 39.3% for a drainage. The follow-up study showed symptom improvement in 91.5% of the patients with a hepatectomy compared to 58.3% for a lithotomy and 71.7% for a drainage which was statistically significant(P<0.05). Since incomplete stone removal in hepatolithiasis and presence of stenosis in intrahepatic duct frequently require a repeat operation or other invasive management, the authors conclude that a hepatectomy, as an initial treatment for hepatolithiasis, is a safe, satisfactory treatment where possible.

A clinical review of intrahepatic stones

No abstract available.

The influence of linoleic acid and ursolic acid on mouse peritoneal macrophage activity / 대한면역학회지

No abstract available.

A clinical review of upper gastrointestinal bleeding

No abstract available.

Reoperation for benign biliary tract disease

No abstract available.