Study on the extensibility of platelet donor gene database in Shaanxi / 中国输血杂志

【Objective】 To analyze the commonality and characteristics between voluntary blood donors and hematopoietic stem cell donors in this region, and explore the potential for integration and development between China Marrow Donors Program (CMDP) and voluntary blood donors, especially platelet donor databases, so as to improve recruitment success rate and inventory rate. 【Methods】 The database modeling and comparison methods were used to screen and stratify the matching and integration degree between the voluntary blood donors in recent 10 years and the marrow donors in the Shaanxi Branch of CMDP. The frequencies of HLA-A,-B alleles, HPA alleles and haplotypes were calculated with Arlequin 3. 5. 2. 2 software, and the matching probability of different platelet donor reserve pools was conducted according to the phenotypic frequencies. 【Results】 Among the voluntary donors with known HLA genotypes in this region, according to their blood donation behavior,the active blood donors excavated were divided into the first, second, third and fourth echelons of platelet donor reserve pools, with 696, 2 752, 9 092 and 12 028 donors, respectively. The first echelon had the highest proportion of 10-50 times of platelet donations and 10-20 times of whole blood donations, with 13.65% and 26.01%, respectively. The second echelon had 10-20 times of whole blood donations and 10-50 times of platelet donations, accounted for 15.04% and 1.38%, respectively, which were significantly different from other echelons' blood donation characteristics (P<0.05). With a database size of the existing platelet donor bank adding the first and second echelons (n=4 955), there was a 69.02% probability of matching at least one donor with matching HLA-A-B phenotype. When considering the matching ABO and HPA phenotypes, the probability of finding at least one donor with fully matching HLA, HPA and ABO isotype (type B as an example) was 48. 73%. 【Conclusion】 The three groups of whole blood donation, apheresis platelet donation and marrow donation in Xi'an area have a large cross-distribution. Compared with expanding the storage capacity from scratch, the active blood donors in CMDP database are the largest back-up force of platelet donors. While expanding the effective storage capacity, it can minimize the cost of building platelet donor bank and the demand for resources.

Unrelated Hematopoietic Stem Cell Donor Recruitment of the Korean Red Cross: 20 Years Experience / 대한수혈학회지

BACKGROUND: The National unrelated hematopoietic stem cell (HSC) donor program started in 1994. The Korean Red Cross (KRC) has participated in this program from the start as a recruiting organization. Results of 20 years of donor recruitment were analyzed to make suggestions to manage potential donors more effectively and improve retention rate. METHODS: Statistics on registration, deregistration, and donation of potential HSC donors registered in the Korean Network for Organ Sharing (KONOS) registry from 1994 to 2013 were analyzed. For donors recruited by the KRC, gender and age distribution, and reasons for self-withdrawal were also analyzed. RESULTS: As of 2013, a total of 265,307 potential HSC donors have been registered in the KONOS registry, among which 38.8% have been recruited by the KRC. Rate of self-withdrawal from the registry was lower for the KRC than the mean of all recruiting organizations (15.9% vs 21.8%). Reasons for withdrawal were objections by family members (34.9%), medical conditions (28.8%), change of donors' mind (21.7%), and other personal reasons (14.6%). The overall retention rate during the 20 year period for KRC was 63.7% which was higher than that of KONOS (58.1%). CONCLUSION: The lower self-withdrawal rate and higher retention rate of donors recruited by the KRC are the result of continuous education of donors to maintain their willingness to donate not only during recruitment but also after registration. This study will help to improve the retention rate and manage registered donors more effectively.

Proposal for an Ideal Management System for Hematopoietic Stem Cells in Korea

In Korea, the donor program for unrelated hematopoietic stem cell transplantation was started in 1994. Although the government has supported this program with a budget for donor recruitment, there is currently no organized administrative structure to coordinate the practical affairs for the hematopoietic stem cell (HSC) donor program. Therefore, we analyzed the current status of the administrative systems and practical affairs for the HSC donor programs of Korea, the USA and Japan and we propose the ideal management system for the HSC donor program in Korea.

Donor Exchange (Swap) Program in Renal Transplantation / 대한이식학회지

PURPOSE: Currently, donor supply for transplantation is in serious shortage. In Korea, numbers of patients with end- stage renal failure have been increasing, while patients who could have a graft kidney are limited because of donor organ shortage. To alleviate this problem, donor exchange (Swap) program was launched in Korea. After the success of direct Swap program between two families, we have developed the Swap-around program to expand the donor pool by enrolling close relatives, spouses, friends of potential recipients and motivated voluntary donors. Herein, we report our results of Swap program. METHODS: Medical records of 918 renal recipients who have undertaken a transplantation surgery between January 1995 to December 2002 in our units, were retrospectively reviewed in terms of donor-recipient relationship and way of donor recruit, episode of acute rejection, and 5-year patient and graft survival. RESULTS: Transplantation was performed in 90 patients (9.8%) by way of Swap program. The percentage Swap patients among the number of unrelated donor renal transplant has been increasing: 4.2% in 1995, 10.4% in 1997, 40.0% in 2000, 44% in 2002. Five year patient/graft survival rates were 92.1%/90.6% in 90 Swap recipients, which were comparable to 94.3%/90.0% in other kinds of living unrelated recipients (n=240), and 94.5%/90.7% in HLA 1-haplotype mismatched related recipients (n=454). Among the groups, incidence of acute rejection was comparable. CONCLUSION: We could achieve some success in reducing the organ shortage with Swap program in addition to current unrelated living donor programs without jeopardizing the graft survival. Potentially exchangeable donors should undergo careful and strict medical and social evaluation as a pre-requisite to rule out the commercialism and conserve health of potential donor and recipients. Expanding Swap program to a regional or national pool could be an option to reduce donor organ shortage in the near future.

Exchange-donor Program in Renal Transplantation: A single center experience

BACKGROUND: A shortage of kidney donors has produced a progressively increasing gap between the supply of cadaveric kidneys and the demand for cadaveric transplants. Thus, efforts to expand the donor pool have included the use of the living related and unrelated kidney donors in Korea. In certain countries like ours, cadaveric kidney sources are very limited for various reasons, therefore, the living kidney donors have been a major source for uremic patients in our hospital. We propose a new program for donation, in which is an exchange-donor program. It is a program in which the donation is not commercial, but voluntary, thus overcoming the shortage of cadaveric donors, and giving the opportunity for transplant to as many uremic patients as possible. METHODS: Between Jan. 1991 and Dec. 1997, 411 living-donor renal transplants were performed in our hospital. Of those, 61 patients received grafts from exchange donors. We compared the graft survival rate of the exchange-donor transplantations with that of the living related donor transplantations based on the recipient's age and sex, the donor's age and sex, human leukocyte antigens (HLA) mismatching, and the frequency of acute rejection. RESULTS: Fifty-nine (59) of 61 patients were still alive in Dec. 1997, with a median follow-up of 31 months (6-76 months), and the mean serum creatinine level was 1.64 mg/dL. The graft survival rates of the exchange-donor renal transplantations at 1 and 5 years were 92.12% and 80.27%, respectively, and there were no significant differences compared with those of the living related renal transplantations (p=0.1424). The graft survival rates at 1 and 5 years were 93.75% and 81.25%, respectively, for those with more than one HLA-haploidentical pair, and 91.89% and 78.76% for those with less than a one-haplotype match, respectively. The frequency of acute rejection was 37.7% in the exchange-donor group. The renal function of the exchange donors after the donation was not altered, and the postoperative complication rate was 1.6%. CONCLUSIONS: The results show that the graft survival rates of the exchange-donor program were similar to those of the living related renal transplantations, and that the good graft survival rates for the exchange-donor group could not be attributed to better HLA matching. We propose an exchange-donor program that will be able to expand the donor pool and overcome the shortage of cadaveric organ donors.

Establishment of Cord Blood Stem Cell Bank in Korea / 대한소아혈액종양학회지

PURPOSE: The needs of stem cell transplantation are increasing in Korea under the circumstance of medical insurance coverage since 1996. But allogeneic bone marrow transplants have the limitation in acquisition of matched donor because of small number of siblings in modern society. Although unrelated stem cell transplantations were made possible in Korea with the establishment of Korean Marrow Donor Program, less than one third of patients who need stem cell transplantation are seeking the matched donors through this program and it still takes too much time and efforts. In this clinical setting, cord blood offers an exciting alternative to traditional sources of stem cells. To implement the widespread clinical use of cord blood stem cells, it is necessary to establish the cord blood bank from which stem cell specimens are obtained. METHODS: To establish the cord blood bank in Korea, we started to develop the proper methods to obtain the cord bloods. Various ways of collecting the cord bloods, separation of red blood cells and storage methods were tried and the standard recommendations were made. RESULTS: Mean volume of collected umbilical cord blood was above 70mL by open or closed method in vaginal delivery and cesarean section. Among the RBC depletion methods by using 3% gelatin, Ficoll-Hypaque, or modified Ficoll-Hypaque method, 3% gelatin sedimentation showed the best result in viability and number of mononuclear cells(MNC), CD34+ cell, and day 14 CFU-GM. The recovery rate after freezing-thawing MNC was higher in the group of using 10% DMSO and programmed freezer starting from 4degrees C than in the group of using mixed with DMSO and hydroxyethyl starch and without programmed freezer. Nine patients underwent cord blood transplantation until December 1998. Among them, 6 patients showed the long-term successful engraftment. CONCLUSION: We have developed simple, efficient, and reproducible methods for collection, processing, and storage of cord blood to establish the cord blood bank. There are some administrative issues including the legal and financial problems that possibly will be resolved by the support of the government and the medical team.