Insulin Secretion and Insulin Resistance Trajectories over 1 Year after Kidney Transplantation: A Multicenter Prospective Cohort Study

방준배,오창권,김유선,김성훈,유희철,김찬덕,주만기,소병준,이상호,한상엽,정철웅,김중경,이수형,전자영 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.4

Background: We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under tacrolimus-based immunosuppression regimen during 1 year after transplantation. Methods: This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index [IGI]) and resistance (homeostatic model assessment for insulin resistance [HOMA-IR]) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM. Results: PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM. Conclusion: In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation.

간 우후구역 이식편을 이용한 성인 생체 간이식의 유용성

방준배,김봉완,왕희정,김태규,심주현,호속광 대한이식학회 2015 Korean Journal of Transplantation Vol.29 No.3

Background: The aim of this study is to evaluate the feasibility of living donor liver transplantation (LDLT) using an right posterior sector (RPS) graft selected by liver volumetry of living donors. Methods: From April 2008 to August 2014, 132 LDLTs were performed in our hospital. Of these, 20 recipients (15.1%) received an RPS graft. Perioperative data of LDLTs using an RPS graft were analyzed retrospectively. Results: Mean of the Model for End-stage Liver Disease score of the 20 recipients was 12.1±6.2. The mean right liver volume was 72.4%±3.1% of total liver volume (TLV) and the mean volume of RPS was 38.2%±5.3% of TLV. Anatomical anomalies were found in the portal vein (PV) of 14 donors (70%), in the hepatic artery of one donor (5%), and bile duct of seven donors (35%). All donors were discharged with normal liver function. Two donors (10%) developed bile leakage after RPS donation. None of the recipients experienced complication associated with hepatic artery and PV anastomosis. One recipient had in-hospital mortality due to pneumonia. The remaining 19 recipients were discharged with good graft function. Four recipients (20%) developed biliary stricture and one (5%) had a liver abscess during follow-up. Conclusions: The RPS donor had a high incidence of abnormal anatomy of PV. LDLT using an RPS graft might have high incidence of biliary complications. We think that selection of an RPS graft 뇌사 장기 공여자의 부족으로 인하여 국내에서는 생체간이식이 활발히 시행되고 있으며, 생체 간이식은 수혜자와 공여자의 수술 전 충분한 검사, 적절한 수술 술기 그리고 수술 후 관리가 조화롭게 이루어질 때 안전하게 시행될수 있다(1). 성공적인 생체 간이식을 위하여는 생체 공여자로부터 적절한 이식편의 선택이 필수적이다(2). 생체 간이식 공여자는 수술 후 잔존 간 용적이 전체 간 용적의 최소 30% 이상이 될 경우 안전한 공여가 가능하며, 생체 간이식 수혜자에게는 이식편의 크기가 이식편대비수용자체중분율(graft to recipient body weight ratio, GRWR)이 최소 0.8% 이상 되어야 한다고 생각된다(3). 현재 성인간 생체 간이식은 대부분 간 우엽 또는 좌엽을 이용하여 시행되고 있다. 그러나, 간 좌엽 용적이 간 전체 용적의 30% 미만의 해부학적인 구조를 가지는 공여자의 경우에는 공여자안전의 우려로 간 우엽의 공여가 어렵다. 또한 이 경우 간좌엽 이식편을 사용하게 되면 충분한 GRWR을 얻을 수없는 확률이 높다. 이렇게 공여자의 간 우엽 용적이 비 정상적으로 클 경우 간 우후구역(right posterior sector)을 이용한 생체 간이식을 고려해 볼 수 있다(4-6). 간 우후구역은 Couinaud의 간 해부학적 구역 6, 7번 구역 및 우간정맥을 포함하는 부분으로 이루어져 있다(7). 간 우후구역을 이용한 생체 간이식은 2001년 Sugawara 등(8)에 의해서 처음 보고되었으며, 간 우후구역이 생체 간이식의 공여자 범위를 확대할 수 있는 유용한 대안이라고소개하고 있다. 2001년 첫 보고 이후 뇌사자 장기 이식이상대적으로 적은 일본 및 국내에서 간 우후구역을 이용한성인 생체 간이식이 이루어지고 있다. 하지만 간 우후구역을 이용한 생체 간이식은 여전히 그 유용성에 논란이 있다. 공여자 간 용적의 크기가 공여에 적절한 크기라 하더라도, 우후구역 이식편의 유입혈관 및 담도는 이차 분지(second-order branch)이므로 해부학적으로 안전한 구득이기술적으로 어렵다고 생각되며, 구득 후 수혜자에게 시행될 이식편 혈관과 담도의 문합에 있어서 상당한 난이도를요할 것으로 생각되기 때문이다(5,6,9,10). 또한 간 우후구역을 이용한 생체 간이식의 수술 후 성적에 대한 보고가적은 것도 우후구역을 이용한 생체 간이식의 유용성에 논란의 이유가 될 것이다. 본 연구에서는 그동안 본원에서시행되어온 간 우후구역 이식편을 이용한 생체 간이식의데이터 분석을 통하여, 수혜자 및 공여자의 성적을 조사하고 성인간 생체 간이식에서 우후구역 이식편의 유용성을알아보고자 한다.

일반연제 발표 : 부인종양학 1 ; 자궁경부 조직 검체에서 발견된 인유두종 바이러스 16형 E6, E7 발암유전자의 변이 양상

방준배,조영래,박일수,이윤순 대한산부인과학회 1999 대한산부인과학회 학술대회 Vol.84 No.-

포스타 : 일반 부인과학 ; 산부인과 영역에서 경피적 혈관 색전술(Transcatheter Arterial Embolization)의 이용

박철민,방준배,김삼식,김대한,이택후,조영래,전상식,박일수,이윤순 대한산부인과학회 1998 대한산부인과학회 학술대회 Vol.82 No.-

일반연제 발표 : 산과학 1 ; 태아의 stress 호르몬과 산염기 상태에 미치는 분만방법의 영향

김대한,방준배,이택후,조영래,전상식 대한산부인과학회 1997 대한산부인과학회 학술대회 Vol.80 No.-

Design Study of the LEBT for the Post Accelerator of the RAON

이유미,방준배,김은산 한국물리학회 2015 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.66 No.3

The low-energy beam-transport (LEBT) line for the post accelerator is required to deliver effectivelythe beam produced by the electron-cyclotron resonance ion source (ECR-IS). This LEBT wasdesigned and optimized to transmit a 58Ni8+ ion beam with an energy of 5 keV/u at the entranceof the LEBT. This line consisted of a 90-degree dipole, a pair of solenoids, electrostatic quadrupolesand a multi-harmonic buncher. The designed LEBT showed a root-mean-squared (RMS) envelopeand total length of less than 14 mm and 7 meters, respectively. This paper presents the results forthe optics design and the beam tracking that were obtained by using TraceWin and TRACK codes.

Cytokine mRNA Expression of various Superficial Lesions of Endometriosis

이택후,김일규,방준배,조영래,전상식 대한산부인과학회 1998 대한산부인과학회 학술대회 Vol.82 No.-

태아 스트레스 호르몬들과 산ㆍ염기 상태에 대한 분만 방법의 영향

김대한(DH Kim),방준배(JB Bang),김진홍(CH Kim),김삼식(SS Kim),이택후(TH Lee),전상식(SS Jeon),조영래(YL Cho) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

To evaluate the effect of delivery mode on fetal stress hormones and acid-base status and also to investigate the relationship between fetal acidemia and these hormones. 44 women with term pregnancies were studied. All had singleton, healthy pregnancies. Twenty five women were delivered by spontaneous vaginal route, 10 by vacuum extraction and 9 by elective caesarean section. Umbilical cord blood samples were obtained immediately following the delivery. Blood gas (pH, pCO2, pO2) and hormonal analysis (ACTH, cortisol, dehydroepiandrosterone sulfate) were done in arterial and venous cord blood samples respectively. The cord blood ACTH values were higher in the vacuum extracted group compared to the normal spontaneous vaginal delivery group and caesarean section group (p<0.05). There was also a significant effect of mode of delivery on fetal plasma cortisol levels among three study groups (p<0.05). In contrast, the mean umbilical cord plasma DHEAS levels were similar for all three study groups. High pO2 levels were found in caesarean section group compared to other two groups (p<0.05). Low pH group had higher cortisol and ACTH level compared to high pH group. In conclusion, method of delivery may affect acid-base and stress hormonal status of human fetus.

Cytomegalovirus-Associated Hemophagocytic Syndrome Diagnosed by Liver Biopsy in a Kidney Transplant Recipient

최은지,이수현,오창권,김영배,방준배 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.3

Hemophagocytic syndrome (HPS) is a rare but potentially life-threatening disease in kidney transplant recipients, and is caused by systemic proliferation of macrophages actively phagocytizing other blood cells in the bone marrow, lymph nodes, and the spleen. Here, we report a 40-year-old male kidney transplant recipient who presented with fever, bicytopenia, and elevated liver enzymes 2 months after transplantation. Given that cytomegalovirus antigenemia and real-time polymerase chain reaction tests were positive, liver biopsy was performed under an assumption of cytomegalovirus-induced hepatitis. Hepatic histology revealed multifocal microabscess with cytomegalovirus inclusion bodies, marked Kupffer cell hyperplasia, and erythrophagocytosis by activated macrophages. As laboratory findings such as hyperferritinemia, elevated serum lactate dehydrogenase, low natural killer cell activity, and high soluble interleukin-2 receptor were also compatible with HPS, the recipient was diagnosed as having cytomegalovirus-induced hepatitis combined with reactive HPS. Following intravenous ganciclovir therapy with continuous administration of tacrolimus and corticosteroid, the symptoms resolved and laboratory findings were normalized. As far as we know, this is the first report of cytomegalovirus-induced hepatitis combined with reactive HPS in a kidney transplant recipient that is diagnosed by liver biopsy.

뇌사기증자 신장 분배제도의 현황

김미나,김세란,이수형,오창권,방준배 대한이식학회 2017 Korean Journal of Transplantation Vol.31 No.3

Background: This study was conducted to analyze the current system for allocation of deceased donor kidney transplantation in Korea, which includes an incentive regulation for candidates registered at the Hospital-based Organ Procurement Organization (HOPO). Methods: Between January 2011 and November 2016, there were 2,655 deceased donors in Korea. During the same period, there were 21,247 current candidates and recipients of kidney, pancreas and simultaneous pancreas-kidney transplants. We analyzed data from all of these donors, candidates, and recipients. Results: Mean waiting times for organ allocation of each priority differed significantly (2nd priority group, 1,701±974 days; 3rd priority group, 1,316±927 days; 4th priority group, 2,077±1,207 days). Additionally, HOPO candidates/deceased donor ratios were very different from each other (maximum, 49; minimum, 0.6). The number of deceased donors in region 1, 2, and 3 were 1,623, 429, and 603, respectively, while the number of transplantations in each region was 3,095, 597, and 1,165, respectively. The candidates registered at region 1 HOPO moved the longest distances on average for transplantation, and this value differed significantly different from that of other regions (56.18±91.9 km vs. 24.66±28.0 km vs. 26.20±37.3 km, P<0.05). Conclusions: The incentive system of current allocation system for deceased donor kidney in Korea does not coincide with the purpose of the ‘Declaration of Istanbul’ and unnecessary social costs have occurred. Therefore, we should make an effort to change our current allocation system to the geographic sequence of organ allocation system.