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B형간염 표면항체 양성인 환자에서 간이식 후 B형간염 재발에 대한 예방법으로서 B형간염 면역글로블린과 라미부딘의 효과 비교
이광웅(Kwang-Woong Lee),박재범(Jae Berm Park),조재원(Jae Won Joh),김성주(Sung Joo Kim),송건도(Geon Do Song),최성호(Seong Ho Choi),허진석(Jin Seok Heo),김용일(Yong Il Kim),이병붕(Byung Boong Lee),김정한(Jeong Han Kim),이석구(Suk Koo L 대한외과학회 2001 Annals of Surgical Treatment and Research Vol.60 No.6
신장 ; 국내 단일기관에서 시행한 췌장이식의 임상적인 결과
한덕종 ( Duck Jong Han ),김송철 ( Song Cheol Kim ),박재범 ( Jae Berm Park ),김영훈 ( Young Hoon Kim ),박관태 ( Kwan Tae Park ),홍정자 ( Jung Ja Hong ),하희선 ( Hea Seon Ha ),정주희 ( Ju Hee Jung ),김인구 ( In Koo Kim ),박건춘 ( Ku 대한내과학회 2011 대한내과학회지 Vol.80 No.2
목적: 췌장이식은 인슐린 의존형 당뇨병에서 1966년 미네소타대학 병원에서 처음 시행된 수술로써 인슐린을 끊을 수 있는 유일한 치료법으로 이식수술 후 합병증의 감소, 면역억제제 및 수술 후 관리의 개선으로 널리 시행되고 있다. 국내에서는 1992년 첫 췌장이식이 시행된 이래 점차 늘어가고 있지만 아직 활발히 이루어지고 있지는 못하다. 이에 저자들은 1992년 7월부터 2009년 12월까지 국내 단일기관에서 시행한 췌장이식의 임상 결과를 분석하여 보고하고자 한다. 방법: 본원에서는 1992년 7월 이후 2009년 12월까지 18년간 119명의 당뇨병 환자에서 췌장이식을 시행한바 이를 후향적으로 분석하여 췌장 이식의 임상적인 결과를 분석하였다. 결과: 이식수혜자의 당뇨병 분류로 총 119명 중 인슐린 의존형이 93명(78.2%)이었고, 16명(13.4%)에서는 Type II형 이었다. 기증자는 뇌사자가 107명(89.9%), 그리고 12명(10.1%)에서는 가족간 생체기증이었다. 당뇨합병증으로 신·췌장 동시 이식이 67명(56.3%)이었고, 42명(35.3%)에서는 췌장단독이식, 10명(8.4%)에서는 이미 신장이식을 받은 환자에서 췌장이식이 시행되었다. 수술 후 췌장 이식편생존율은 81.6%(1년), 63.4%(5년), 그리고 57.1%(10년)이었다. 면역억제제로 tacrolimus와 MMF를 사용한 1999년 이후(n=96) 췌장 이식편 생존율은 89.1%(1년), 72.9%(5년), 그리고 66.2%(10년)이었고, 환자의 생존율은 93.0%(1년), 86.0%(5년), 그리고 86%(10년)이었다. 결론: 최근 췌장이식 수술의 향상된 성적으로 삶의 질과 장기 환자 생존을 고려할 때, 췌장 이식은 당뇨병의 유형에 상관 없이 인슐린 투여가 필요한, 심각한 당뇨 합병증 또는 인슐린 투여 관련 합병증의 위험에 놓여 있는, 비비만형 당뇨병 환자들에게 효과적인 치료로 제시 될 수 있다. Background/Aims: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. Methods: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. Results: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. Conclusions: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes. (Korean J Med 2011;80:167-178)
Chan Woo Cho(조찬우),Kyo Won Lee(이교원),Hyojun Park(박효준),Jae Berm Park(박재범),Sungjoo Kim(김성주) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2
Surgical approaches for leiomyosarcoma of the inferior vena cava (IVC) are based on tumor location. Radical resection for the IVC leiomyosarcoma involving the renal vein has traditionally included nephrectomy with renal vein ligation or kidney autotransplantation. A 51-year-old woman was admitted for elective surgery for the tumor of IVC. At surgery, the tumor was located in front of IVC, abutted with right renal vein. After the tumor resection, IVC reconstruction involved the patch cavoplasty with cryopreserved cadaveric vein graft and the implantation of the right renal vein into the inferior IVC. The patient recovered fully without any postoperative complications including kidney function change. This technique could be adopted for tumors located in front of IVC involving renal veins, provided complete resection of the tumor with a comfortable resection margin is possible.
B형간염과 연관된 간세포암종의 근치적 절제술 후 혈관내피성장인자 아형의 발현양성 및 예후와의 관계
문주익 ( Ju Ik Moon ),김종만 ( Jong Man Kim ),정금오 ( Gum Oh Jung ),천재민 ( Jae Min Chun ),최규성 ( Gyu Seong Choi ),박재범 ( Jae Berm Park ),권준혁 ( Choon Hyuck David Kwon ),김성주 ( Sung Joo Kim ),조재원 ( Jae Won Jo ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2
태아의 간과 흉선 조직 그리고 조혈모 세포를 이식한 Rag2<SUP>-/-</SUP>γc<SUP>-/-</SUP> Mice에 사람의 면역 세포 형성
강미진(Mijin Kang),주성연(Sung-Yeon Joo),최봉금(Bong-Kum Choi),정다연(Da-Yeon Jung),최호인(Ho-In Choi),박재범(Jae Berm Park),최규성(Gyuseong Choi),권준혁(Choon Hyuck Kwon),김성주(Sung-Joo Kim),조재원(Jae-Won Joh) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1
Purpose: Many researchers have tried to develop animal models that mimic the human immune system, e.g. a humanized mouse model, to improve the engraftment of hematopoietic stem cells and develop human immune cells in an animal model. This study evaluated the feasibility of the cultured human umbilical cord blood (hUCB)-derived CD34? cells for cell expansion, in Rag2<SUP>-/-</SUP>γc<SUP>-/-</SUP> mice, and establish co-transplantation with human fetal thymus/liver tissue (Thy/Liv) under the kidney capsule. Methods: Co-transplantation of hUCB-derived CD34? cells with Thy/Liv was performed. The hUCB-derived CD34? cells were prepared by freshly thawing (G1) and culturing for 7 days with two types of cytokine combinations (G2, G3). The CD45? cell populations were measured at 6, 8, 10 and 16 weeks in the peripheral blood. The splenocytes were cultured with mitogenic stimuli (PHA -L or IL-2) at 20 weeks posttransplantation, and the proliferation of human immune cells was evaluated. Results: There were no significant differences in the human CD45? cell populations at 6, 8, 10 and 16 weeks post-transplantation between the groups. In the cultured splenocytes at 20 weeks post-transplant with PHA-L or IL-2, there was remarkable expansion of CD3? cells in the three groups. Although no CD19? cells were detected in the spleen, human Ig G was detected in the sera of these mice. Conclusion: The cultured and expanded hUCB-derived cells with cytokine combinations might be a feasible cell source in humanized mouse modeling. In addition, human immune cells can be reconstituted from the co-transplantation of Thy/Liv and cultured hUCB-derived CD34? cells.
Rituximab와 혈장교환을 사용한 ABO 혈액형 부적합 생체 신장이식: 단일 기관의 경험
유훈 ( Hoon Yu ),김윤지 ( Yoon Ji Kim ),권석운 ( Seog Woon Kwon ),한덕종 ( Duck Jong Han ),박재범 ( Jae Berm Park ),박정식 ( Jung Sik Park ),정주희 ( Joo Hee Jung ),박수길 ( Su Kil Park ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
Purpose: ABO incompatibility had long been an obstacle in kidney transplantation. However, recent reports showed excellent outcomes. In this study, we evaluated the outcomes of ABO incompatible kidney transplantation with preconditioning protocol using rituximab and plasmapheresis. Methods: The recipients who had an ABO-incompatible donor and underwent living donor kidney transplantation were enrolled. Preconditioning protocol was pretransplant single dose rituximab with plasmapheresis at pretransplantation 7-10 days. Immune suppression regimen consisted of tacrolimus, mycophenolate mofetil and steroid. Anti-A or anti-B antibody titer was monitored during preconditioning and post transplantation period. Results: 37 patients underwent living donor ABO incompatible kidney transplantation. Median pre-treatment antibody titer was 1:64 and pre transplant antibody titer after 1-6 times of plasmapheresis was 1:2. Median follow-up duration was 332 days (range 156-681). One episode of acute T cell mediated rejection was observed. Mean serum creatinine at 2 weeks was 1.00±0.27 mg/dL and at 24 weeks was 1.21±0.37 mg/dL. Conclusion: ABO incompatible kidney transplantation with rituximab and plasmapheresis can be safely performed. It is therefore a valuable option for expanding donor pool and should be actively performed in Korea.