전층각막이식술 후 발생한 고안압증 환자에서 이식 실패로 이행하는 위험인자

주종수,이유경,주천기,Jongsoo Joo,You Kyung Lee,Choun-Ki Joo 대한안과학회 2012 대한안과학회지 Vol.53 No.3

Purpose: To assess the risk factors proceeding to graft failure in post-keratoplasty ocular hypertension patients. Methods: In 35 eyes diagnosed with post-keratoplasty ocular hypertension (graft failure: 13 eyes; graft survival: 22 eyes), relationships between graft status at the observation time and pre-keratoplasty diagnosis, lens status, history of graft failure, donor size, difference between donor and recipient graft size, donor corneal endothelial cell count, post-keratoplasty intraocular pressure (after 1 week and maintenance intraocular pressure after surgery), and number of antiglaucomatic agents were investigated. The relative risks of each factor to induce graft failure were also evaluated. Results: Previous graft failure history, pre-existing pseudophakic bullous keratopathy and aphakia/pseudophakia showed statistically significant high probabilities of proceeding to graft failure (p < 0.05). In particular, the intraocular pressure 1 week after the graft was statistically higher (p < 0.05) in the graft failure group (24.31 ± 8.82 mm Hg) than in the graft survival group (16.81 ± 6.69 mm Hg). Conclusions: Strict management of intraocular pressure in the early phase of penetrating keratoplasty could contribute to reducing graft failure in post-keratoplasty ocular hypertension patients. J Korean Ophthalmol Soc 2012;53(3):385-389

각막이식 삼중수술의 임상적 결과와 이식실패의 위험인자

정태선,문형진,유인천,윤경철,Tae Sun Jeong,Hyung Jin Moon,In Chon You,Kyung Chul Yoon 대한안과학회 2007 대한안과학회지 Vol.48 No.12

Purpose: To evaluate the clinical results of corneal triple procedure, as well as the causes and the risk factors for graft failure. Methods: Indications, survival period of graft, causes of graft failure, and risk factors for failure in 29 patients (29 eyes) who had undergone penetrating keratoplasty combined with cataract surgery and intraocular lens (IOL) implantation were retrospectively analyzed. Results: The most common primary indication of corneal triple procedure was bacterial keratitis (24%), followed by corneal trauma, herpes simplex keratitis, and graft failure. The average survival period of corneal graft in corneal triple procedure was 29.2±23.2 months. The most common cause of graft failure was allograft rejection (56.3%). The risk factors of graft failure by an univariate analysis were preoperative unfavorable diagnosis (bullous keratopathy, corneal ulcer, and trauma), corneal neovasculization, intraoperative additional procedure (anterior vitrectomy, synechiolysis, and anterior chamber irrigation), immune rejection, and postoperative glaucoma, but were unrelated to methods of cataract surgery, graft size, or IOL position. In a multivariate analysis, graft rejection and corneal neovascularization were identified as risk factors for graft failure in patients undergoing triple procedure. Conclusions: Corneal graft in corneal triple procedure had various success rates according to the many factors. Risk factors for graft failure included graft rejection and corneal neovascularization.

Biomechanical effects of stitches on the intra-articular mid-substance of quadruple hamstring-tendon grafts for anterior cruciate ligament reconstruction – a pilot comparative cadaveric study

Saur Maurise,Clavert Philippe,Bonnomet François,Favreau Henri,Ehlinger Matthieu 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background: There is little data in the literature regarding the preparation methods of the intra-articular portion of quadruple hamstring-tendon grafts for anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the biomechanical properties of a sutured transplant to that of a non-sutured transplant. The hypothesis was that adding stitches to the intra-articular portion of the graft increased its resistance. Method: A comparative cadaveric study was carried out on five pairs of knees. The average age of the cadavers was 68 years. The exclusion criterion was past knee surgery. In the Sutured Group (SG) two stitches were made on the grafts. No stitches were made on the grafts of the Non-sutured Group (NSG). A tensile failure test was carried out using an Instron® loading machine. The maximal load to failure and stiffness were recorded and we observed the mode of failure for each graft. Statistical analysis was performed using the Wilcoxon rank sum test. Level of significance was set at p < 0.05. Results: The hypothesis proposed was not confirmed; adding stitches to the intra-articular portion of the fourstrand hamstring-tendon graft does not increase its biomechanical properties. The maximal load to failure was 233.5 N ± 40.6 (186.7–274.5 N) for the NSG, 19.6% higher than for the SG which was 195.2 N ± 42.9 (139.0–238.2 N). Nevertheless, the difference observed was not statistically significant (p = 0.188). The stiffness of the grafts for the NSG was 23.5 N/mm ± 5.3 (17.8–29 N/mm) and 19.7 N/mm ± 5.5 (13.2–24.7 N/mm) for the SG grafts. Overall stiffness values for the NSG were 19% higher than those of the SG; however, the results were not statistically significant (p = 0.438). The failure mode was a rupture at the fixation point except for one sample from the SG which failed at an intra-articular stitch. Conclusion: Whilst the initial hypothesis was not verified, nevertheless, the maximal loads to failure and stiffness were approximately 20% higher when there were no intra-articular stitches compared to the situation where stitches were added to the intra-articular portion of the graft. This was a cadaveric pilot study and, therefore, whilst we are not able to extend our results to clinical practice, the outcomes would indicate the need for further development of this and related protocols deriving from the question of whether there is weakening the graft when adding stitches to its midsubstance. These results remain to be confirmed by further research.

대퇴동맥과 원위부 동맥간 이식편에 발생된 협착에 있어 Duplex Scan Parameters와 ABI의 비교 분석

강동백,권정남,박동은,채권묵,김은아,소병준 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.2

Purpose: Early traditional methods of surveillance to detect failing graft relied on recurrence of symptoms, change of pedal pulses, or a decrease in the Ankle-Brachial Index (ABI). More recently, graft surveillance with Duplex scan which has become an appropriate first-line alternative has been shown to be effective in identifying the patency of threatened femorodistal graft. The purpose of this study was to determine the relationship and significance among ABI change, run-off resistance score, and Duplex scan parameters in femorodistal graft bypass. Method: Among 52 patients who received femorodistal bypass, thirty-one femorodistal grafts (19: above knee, 12:below knee) which had followed up for more than 2 years were followed up by ABI at regular interval and Duplex scan at 2 year. Those were grouped according to the grade of ABI decrease as follows; Group Ⅰ: <0.1 ABI decrease, Group Ⅱ: 0.1≤ ABI decrease<0.15, Group Ⅲ: 0.15 ≤ABI decrease < 0.2, Group Ⅳ:≥0.2 ABI decrease. Peak systolic flow velocity (PSFV) ratio, luminal diameter at near proximal and distal anastomosis, mean body graft velocity (cm/sec) were evaluated. Runoff resistance score was calculated by the finding of the pre-operative angiogram. Result: In proportion to the severity of ABI decrease, proximal and distal peak systolic flow velocity (PSFV) ratio and stenosis (%) increased, mean body graft velocity decreased. Significant statistical difference between groups were shown as follows; Group Ⅱ and Ⅳ: distal PSFV ratio (2.17 vs 2.95, P=0.02), proximal stenosis (32.8% vs 47.4%, P=0.026), distal stenosis (21.7% vs 62.8%, P=0.007), mean body graft velocity (81 cm/sec vs 46 cm/sec, P=0.02) Group Ⅲ and Ⅳ: distal PSFV ratio (2.29 vs 2.95, P=0.02), distal stenosis (40.5% vs 62.0%; P=0.03), body flow velocity (70 cm/sec vs 46 cm/sec, P=0.02). The higher runoff resistance score was, the more distal PSFV ratio, distal stenosis increased, but proximal stenosis, PSFV ratio, and mean body graft velocity did not change significantly. Conclusion: This study shows that higher decrease in ABI (>0.2) is well correlated with critical Duplex parameters. Longer graft patency and economic benefit may be obtained by active evaluation of failing graft using by Duplex scan when the ABI decrease is more than 0.2 in femorodistal graft bypass at regular examination.

Prevention and Management of Small-for-Size Syndrome of Liver Transplantation

Nam-Joon Yi 이화여자대학교 의과학연구소 2022 EMJ (Ewha medical journal) Vol.45 No.2

Small-for-size syndrome (SFSS) is a critical complication of partial liver transplantation, particularly in adult-to-adult living donor liver transplantation (ALDLT) using a small graft. Minimally required liver graft size for a successful ALDLT is classically 40% of a standard recipient’s liver volume or 0.8% of recipient body weight. Recent progress in perioperative care and technical improvement push the lower limit of safe graft size to 25% of the recipient’s standard liver volume or 0.6% of the graft versus recipient weight ratio although this is an ongoing debate. The clinical manifestations of SFSS include various symptoms and signs related to graft dysfunction and portal hypertension in patients with small grafts. The risk factors for SFSS include poor preoperative patient condition, including portal pressure, surgical techniques to reduce portal pressure, and graft quality and size. Hence, various approaches have been explored to modulate inflow and pressure to a small graft and to decrease the outflow block to alleviate this SFSS as well as the selection of a patient and graft. Additionally, recent research and efforts to prevent and treat SFSS are reviewed.

Effect of Institutional Kidney Transplantation Case-Volume on Post-Transplant Graft Failure: a Retrospective Cohort Study

오혜원,장은진,김가희,유석하,이한나,임태윤,김한솔,류호걸 대한의학회 2019 Journal of Korean medical science Vol.34 No.40

Background: The impact of institutional case volume to graft failure rate after adult kidney transplantation is relatively unclear compared to other solid organ transplantations. Methods: A retrospective cohort study of 13,872 adult kidney transplantations in Korea was performed. Institutions were divided into low- (< 24 cases/year), medium- (24–60 cases/ year), and high- (> 60 cases/year) volume centers depending on the annual case volume. One-year graft failure rate was defined as the proportion of patients who required dialysis or re-transplantation at one year after transplantation. Postoperative in-hospital mortality and long-term graft survival were also measured. Results: After adjustment, one year graft failure was higher in low-volume centers significantly (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.26–1.78; P < 0.001) and medium-volume centers (aOR, 1.87; 95% CI, 1.57–2.23; P < 0.001) compared to high-volume centers. Low-volume centers had significantly higher mortality (aOR, 1.75; 95% CI, 1.15–2.66; P = 0.01) than that of high-volume centers after adjustment. Long-term graft survival of up to 9 years was superior in high-volume centers compared to low- and medium-volume centers (P < 0.001). Conclusion: Higher-case volume centers were associated with lower one-year graft failure rate, lower in-hospital mortality, and higher long-term graft survival after kidney transplantation.

Beneficial Role of Low-Dose Antithymocyte Globulin in Unrelated Stem Cell Transplantation for Adult Patients with Acquired Severe Aplastic Anemia: Reduction of Graft-versus-Host Disease and Improvement of Graft-versus-Host Disease-Free, Failure-Free Surv

Park, S.S.,Kwak, D.H.,Jeon, Y.W.,Yoon, J.H.,Lee, S.E.,Cho, B.S.,Eom, K.S.,Kim, Y.J.,Kim, H.J.,Lee, S.,Min, C.K.,Cho, S.G.,Kim, D.W.,Min, W.S.,Lee, J.W. AMERICAN SOCIETY FOR BLOOD AND MARROW 2017 BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Vol.23 No.9

Stem cell transplantation (SCT) from an unrelated donor (URD) is often considered in patients with severe aplastic anemia (SAA) whom immunosuppressive therapy failed and matched sibling donor is not available. To reduce the incidence of graft-versus-host disease (GVHD) in URD SCT, introducting antithymocyte globulin (ATG) into the conditioning regimen has been proposed. Although ATG was shown to play a role in reducing GVHD in a cohort with diverse hematologic diseases, its role in SAA remains uncertain. The aim of this study was to determine the efficacy and toxicity of ATG in URD SCT for adult patients with SAA. We investigated 83 adult patients with SAA who underwent URD SCT between 2003 and 2014. The transplantation strategy consisted of total body irradiation (total 800 cGy) and cyclophosphamide (total 100 mg/kg to 120@?mg/kg), followed by tacrolimus and a short-term methotrexate. We divided patients into 2 groups: group 1 (n@?=@?25), which received HLA-matched (8/8) bone marrow (BM) without ATG, and group 2 (n@?=@?58), which received SCT from either an HLA-mismatched donor or peripheral blood (PB). Thereafter, group 2 was subdivided according to ATG use into group 2A (without ATG, n@?=@?26), which served as a historical cohort, and group 2B (with ATG, n@?=@?32). Rabbit ATG (Thymoglobulin; Genzyme-Sanofi, Lyon, France) was used in group 2B at a dose of 2.5@?mg/kg. The median age of all patients was 30 years (range, 17 to 59 years). The incidence of GVHD was significantly lower in group 2B than group 2A, as demonstrated by the rate of grade II to IV acute GVHD at day 100 (31.2% versus 61.5%, P@?=@?.003) and the rate of chronic GVHD at 3 years (21.9% versus 65.4%, P@?=@?.002). The overall survival rates of the 3 groups were similar. However, GVHD-free, failure-free survival (GFFS) was significantly higher in group 2B than group 2A (P@?=@?.034). A multivariable model identified use of ATG as an independent factor affecting grades II to IV acute GVHD (hazard ratio [HR], 2.902; 95% confidence interval [CI], 1.417 to 5.942; P@?=@?.004), chronic GVHD (HR@?,@?3.005; 95% CI, 1.279 to 7.059; P@?=@?.012), and GFFS (HR,@?2.363; 95% CI, 1.162 to 4.805; P@?=@?.014). Toxicities, including infectious complications, were not different among the 3 groups. In conclusion, low-dose ATG (2.5@?mg/kg) can reduce the incidence of acute and chronic GVHD and improve the quality of life in patients with SAA who receive stem cells from either an HLA-mismatched donor or PB; importantly, these benefits are achieved without increased toxicity. Furthermore, ATG can be considered in URD SCT from HLA-matched BM cells.

Changes in T Cells in Peripheral Blood after Adult Liver Transplantation

( Jong Man Kim ),( Jisoo Lee ),( Kyung-sik Kim ),( Nuri Lee ),( Chan-woo Cho ),( Gyu-seong Choi ),( Choonhyuck David Kwon ),( Jae-won Joh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Backgrounds: T lymphocytes are an essential component of allograft rejection and tolerance. The aims of the present study are to analyze the characteristics of T cell subsets between deceased donor liver transplantation (DDLT) patients and living donor liver transplantation (LDLT) patients and to investigate the potential role of T cell subsets in cytomegalovirus (CMV) infection, acute rejection, and graft failure. Methods: Between April 2013 and June 2014, 64 patients underwent adult LT. All patients received basiliximab as induction therapy and tacrolimus as maintenance therapy. The distribution of peripheral blood T lymphocyte subsets pretransplant and 4, 8, 12, and 24 weeks post-transplant were serially monitored. Results: Patient characteristics did not vary between DDLT and LDLT groups except for Child-Pugh class, model for end-stage liver disease score, and cold ischemic time. However, the Vδ1/Vδ2 ratio in the DDLT group was higher than in the LDLT group (P=0.045). Comparison between LDLT and DDLT groups revealed that CD4+ T cells, CD8+ T cells, CD4/CD8, Vδ1 cells, Vδ2 cells, and γδ T cells did not change significantly over time. The Vδ1/Vδ2 ratio in patients with CMV infection was higher than in patients without CMV infection. The absolute CD3+ and CD8 T cell counts in patients with biopsy-proven acute rejection (BPAR) were higher than in patients without BPAR. The absolute lymphocyte counts, CD4+ T cell, γδ T cell, and Vδ2 γδ T cell counts in patients with graft failure were lower than in patients without graft failure. Conclusion: CD3+ T cells are different between DDLT and LDLT groups. Patients with BPAR showed elevated CD3+ and CD8+ T cells. The present study suggests that LDLT patients receive high doses of immunosuppression compared with DDLT patients. Vδ2γδ T cells are closely associated with CMV infection and graft failure.

데스메막박리 각막내피층판이식술을 시행한 수포각막병증 8예의 단기 임상 결과 보고

정희옥,이현수,나경선,주천기 대한안과학회 2009 대한안과학회지 Vol.50 No.7

Purpose: To investigate the postoperative results of Descemet’s stripping automated endothelial keratoplasty in bullous keratoplasty and graft failure cases. Case summary: Eight eyes of eight patients who underwent DSAEK between September 2006 and August 2008 were followed-up for at least 3 months, and the charts of eight patients were reviewed retrospectively. Five eyes of the total eight had bullous keratopathy, and three eyes needed DSAEK due to graft failure. The best corrective visual acuity (logMAR) improved from 1.625±0.60 to 0.825±0.35 and corneal thickness decreased from 785.63±135.58 μm to 692.00±150.85 μm 3 months postoperatively. Grafted corneal dislocation occurred in two eyes, and we repositioned the cornea in those participants by air injection. We found graft rejection signs in two cases, and one case showed graft failure despite steroid therapy. Conclusions: We think that DSAEK will be a good surgical procedure in bullous keratopathy or graft failure patients because of its favorable postoperative prognosis. 목적: 데스메막박리 각막내피층판이식술을 시행한 수포각막병증 환자 또는 각막이식 실패 환자 8예의 단기 임상 결과에 대해 보고하 고자 한다. 증례요약: 데스메막박리 각막내피층판 이식술을 시행한 8안을 대상으로 술 후 임상 경과를 알아보기 위해 의무기록를 후향적으로 조사 하였다. 전체 8안 중 5안은 수포성 각막병증으로, 3안은 각막이식 실패로 데스메막박리 각막내피층판이식술을 시행받았다. 최대 교정 시력(logMAR)은 술 전 평균 1.625±0.60에서 술 후 3개월째 0.825±0.35로 호전되었고, 각막두께는 785.63±135.58 μm에서 692.00±150.85 μm로 호전되었다. 술 후 2안에서 수여각막내피이식편의 부분적인 탈락이 관찰되어 전방내 공기를 재주입하고 이식편의 위치를 조정하였고, 술 후 6개월까지 2안에서 거부반응을 보였으며, 그 중 1안에서 결국 이식 실패를 보였다. 결론: 데스메막박리 각막내피층판이식술은 각막내피세포 부전증 환자에서 빠른 시력교정 효과와 안정된 이식 각막편 유지가 기대되는 수 술법으로 알려져 있으며, 앞으로 더 나은 수술 결과를 위해 수술 숙련도 향상 및 수술 기법 개발에 노력해야 할 것으로 사료되는 바이다.

Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

Batsaikhan Bat-Erdene,Sergelen Orgoi,Erdene Sandag,Ulzii-Orshikh Namkhai,Bat-Ireedui Badarch,Batsaikhan Batsuuri 한국간담췌외과학회 2016 한국간담췌외과학회지 Vol.20 No.3

The sinusoidal obstructive syndrome (SOS) is a complication that usually follows hematopoietic stem cell transplantation. It is also known as veno-occlusive disease, which is a rare complication of living donor liver transplantation (LDLT). Herein, we reported a 34 year-old female patient presenting SOS after LDLT. Its underlying cause was presumed to be associated with liver abscess and subsequent inferior vena cava stenosis. SOS led to graft failure, thus requiring retransplantation with a deceased donor liver graft. The underlying causes of SOS are complex pathologic entity with multifactorial etiology. It is likely that its multifactorial etiology includes a decrease of hepatic venous outflow that is caused by graft liver infection and inferior vena cava stenosis.