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특집/공여자 교환을 통한 신장이식 프로그램의 현황과 발전방향
허규하,김범석,김유선 대한의사협회 2008 대한의사협회지 Vol.51 No.8
The shortage of donor organs is one of the major barriers of transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, a swaparound program has been developed. Recently, a web-based (computerized) algorithm to facilitate donor kidney exchange was devised and tested in multi-center settings. An excellent longterm outcome was achieved by using the donor exchange program as an option to reduce the donor organ shortage. Herein, we discussed on the current status of the exchange donor renal transplantation in Korea, a couple of problems we have had, and future directions we have to head and make better to improve organ donation activities.
The Effect of Bortezomib on Antibody-Mediated Rejection after Kidney Transplantation
이주한,허규하,김범석,박용정,이재근,임범진,정현주,김유선 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.6
Purpose: Recently, bortezomib has been used to treat antibody-mediated rejection (AMR) refractory to conventional treatmentsuch as plasmapheresis, intravenous immunoglobulin, and rituximab. The authors aimed to describe their experiences whenbortezomib was used to treat refractory AMR. Materials and Methods: Eleven refractory AMR episodes treated with bortezomib were included in this study. The patients receivedone or two cycles of bortezomib (1.3 mg/m2) on days 1, 4, 8, and 11. Results: Bortezomib effectively reduced antibodies against various targets, including human leukocyte antigen (HLA) class I andII, ABO blood group antigen, and angiotensin II type 1 receptor. Antibodies were depleted or reduced significantly in eight AMRepisodes. Overall, there was a significant improvement in the mean estimated glomerular filtration rate (eGFR) at 3 months aftertherapy (36.91±22.15 mL/min/1.73 m2) versus eGFR at time of AMR diagnosis (17.00±9.25 mL/min/1.73 m2; p=0.007). All six early-onset AMR episodes (within 6 months post-transplantation) showed full recovery of allograft function. Additionally, three ofthe five late-onset AMR episodes (>6 months post-transplantation) showed improved allograft function. Conclusion: Anti-humoral treatment based on bortezomib might be an effective strategy against refractory AMR caused by varioustypes of antibodies. Notably, this treatment could be more effective in early-onset AMR than in late-onset AMR.