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Use of Bortezomib as Anti-Humoral Therapy in Kidney Transplantation
양근석,박영재,주익현,김지일,문인성,최범순,박철휘,양철우,김용수,정병하 대한의학회 2014 Journal of Korean medical science Vol.29 No.5
This study aimed to investigate the effect of bortezomib in the desensitization andtreatment of acute antibody mediated rejection (AAMR) in kidney transplantation. Ninepatients who received bortezomib therapy for desensitization (DSZ group, n = 3) ortreatment of AAMR (AAMR group, n = 6) were included in this study. In the DSZ group, 2patients required DSZ owing to positive cross match and 1 owing to ABO mismatch withhigh baseline anti-ABO antibody titer (1:1,024). Bortezomib was used at 1, 3, 8, and 11days from the start of the treatment. In the AAMR group, 3 patients showed full recoveryof allograft function after bortezomib use and decrease in donor specific anti-HLAantibody (HLA-DSA). However, 3 patients did not respond to bortezomib and experiencedallograft failure. In the DSZ group, negative conversion of T-CDC (complement-dependentcytotoxicity) was achieved, and HLA-DSA was decreased to lower than a weak level(median fluorescence intensity [MFI] < 5,000) in 2 patients. In the case of ABO mismatchkidney transplantation, the anti-A/B antibody titer decreased to below the target ( ≤ 1:16)after bortezomib therapy. Therefore, bortezomib could be an alternative therapeuticoption for desensitization and treatment of AAMR that is unresponsive to conventionaltherapies.
양근석 대한영상의학회 1995 대한영상의학회지 Vol.32 No.1
Purpose : The purpose of this study was to evaluate the patency, procedure related complications andeffectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. Materialsand Methods : We retrospectively reviewed the clinical results, duration of survival, patency rate andcomplication of the Wallstent application on 33 patients who had obstructive jaundice by the malignant lesion inrecent 3 years. One or two step procedures were mainly taken with 10mm diameter Wallstents. Grouping according toplace the stent at the hilum or not, and grouping according to place the stent through the ampulla or not weredone to evaluate the difference of the patency and survival rate between the groups. Results : Biliaryendoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure relatedshort-term complication rate was about 18.1% (n=6/33). complications were fever (n=4), cholecystitis (n=1) andsepsis (n=1), Long-term complications were mainly obstruction (n=9/31) of the Wallstent during the follow-upperiod. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237) daysormong those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survuval rates were 93.5% atthe second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th monthand 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5thmonth, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients withstent occlusion. Significant statistical difference could not be found between the groups according to placing thestent at the hilum and according to placing the stent though the ampulla. Patency rates were higher than survivalrates in the follow-up period. Conclusion : Wallstent application provides good palliation with little discomfortand few complications in the patients with malignant obstructive jaundice.