Biomedical subjects

K W Lee

Publications and source records attributed to K W Lee.

At least 37 records · Page 2Linked to original sources

PubMed2005

Genotypic resistance of hepatitis B virus to lamivudine in renal transplant recipients.

Renal recipients with hepatitis B virus (HBV) should be treated with prolonged lamivudine. However, lamivudine resistance usually results after YMDD mutation within the HBV polymerase gene. Thereupon, the aim of this study was to investigate the genotypic resistance to lamivudine among renal transplant recipients to identify its effect on the clinical course of HBV in these patients. Between March 1997 and September 2003, eight of 17 renal transplant patients with hepatitis B virus were enrolled into this study and treated with 100 mg of lamivudine once each day. We amplified a selected region of the polymerase gene of HBV in order to confirm mutations in the YMDD motif. Mutations of YMDD region were observed in five of eight patients (62.5%). Out of five patients positive for HBV DNA, three (60%) showed genotypic resistance (YMDD mutation) with a normal ALT level. Two patients converted to HBV DNA negative. But, they were not associated with HBeAg seroconversion. Out of three patients who were pretransplant HBV DNA negative, genotypic resistance was observed in two patients (67%) revealing both positivity of HBe antibody and negativity of HBV DNA. In conclusion, although a normal ALT level and HBV DNA negative are maintained, the mutation of the YMDD locus may develop. Accordingly, we suggest that if the YMDD mutation is not involved in the progression of hepatitis B, lamivudine therapy should be continued despite genotypic resistance.

Adult↗

PubMed2005

Microvascular tumor embolism: independent prognostic factor after liver transplantation in hepatocellular carcinoma.

Microscopic tumor cell dissemination may be a more important factor in the recurrence of hepatocellular carcinoma (HCC) after liver transplantation, probably because of posttransplant immunosuppression. The presence of microvascular tumor embolism was undetermined as a factor for HCC recurrence after orthotopic liver transplantation (OLT). This study evaluated whether microvascular tumor embolism affects recurrence-free survival and correlates with other clinicopathologic factors after OLT among patients with HCC. From September 1996 to June 2003, 72 OLTs for HCC were enrolled in this study. Median follow-up was 22.8 months. Among 41 patients without microvascular tumor embolism, 1-year, 2-year, and 5-year recurrence-free survival rates were all 97.6%, while these rates were 77.3%, 68.2%, and 59.7%, respectively, for 31 patients (43.1%) with microvascular tumor embolism (P = .0006). The 5-year recurrence-free survival rate showed significant differences for a pT2 tumor (P = .0073), for maximal tumor size <3 cm (P = .0328), for > or =5 cm solitary tumor (P = .0095), and for the presence of a tumor capsule (P = .0012), within the Milan criteria (P = .0376). At multivariate analysis, significant independent predictors for HCC recurrence were microvascular tumor embolism and histopathologic grade. In conclusion, microvascular tumor embolism is an independent predictor of HCC recurrence after liver transplantation. Although OLT is a safe and effective treatment for HCC within the Milan criteria, the presence of microvascular tumor embolism at pathologic examination can predict its recurrence. In these cases, the feasibility of immunosuppressive therapy or adjuvant chemotherapy must be considered to prevent tumor recurrence.

Adult↗

PubMed2005

Diffusion-weighted and conventional magnetic resonance imaging in cerebral cryptococcoma.

A case of cryptococcoma involving the right cerebral hemisphere is reported. The diffusion-weighted image shows hypointensity in the central cavity of the cryptococcoma, while apparent diffusion coefficient maps show hyperintensity. The imaging features of an intracerebral cryptococcoma mimic that of a central necrotic brain tumor, rather than a pyogenic brain abscess.

Amphotericin B↗

PubMed2005

Effects of yeast (Saccharomyces cerevisiae) cell components on growth performance, meat quality, and ileal mucosa development of broiler chicks.

An experiment was conducted with 240, 1-d-old, male broilers to investigate the effects of Saccharomyces cerevisiae (SC) cell components on the growth performance, meat quality, and ileal mucosa development. There were 4 dietary treatments, each consisting of 6 replicates. Whole yeast (WY), SC extract (YE), and SC cell wall (CW) were added at 0.5, 0.3, and 0.3%, respectively, to the control starter and finisher diets. From 0 to 3 wk of age, a lower feed/gain ratio (P < or = 0.05) was observed with CW, whereas the WY-fed birds at 4 to 5 wk of age showed a lower feed/gain ratio compared with the control. From 0 to 5 wk of age, WY and CW gave higher BW gains than did the control. The shear force of raw drumstick decreased in the WY treatment relative to the control, and YE and CW treatments were intermediate. The shear forces in cooked breast and drumstick in treatments WY and YE decreased when compared with the control. The amount of 2-thiobarbituric acid-reactive substances (TBARS) in the breast meats of WY, YE, and CW were lower than the control at 10 d of incubation. In raw drumstick meats, TBARS values were lower in treatments WY and YE than that of the control at 6 and 10 d of incubation. At 10 d of incubation, skins from YE and CW treatments had lower TBARS values than did the control. Villus height was greater in WY and CW compared with those in control and YE. No differences were found in crypt depth among the 4 treatments. The villus height/ crypt depth ratios in WY and CW were greater than those of the control and YE. It could be concluded that dietary yeast components, such as WY or CW supplementation improved growth performance. Meat tenderness could be improved by the WY or YE. Both YE and CW had oxidation-reducing effects. Yeast cell wall may improve ileal villus development.

Animals↗

PubMed2005

Serum osteoprotegerin levels are associated with inflammation and pulse wave velocity.

OBJECTIVE: We examined the association between serum osteoprotegerin (OPG) levels, systemic inflammation and arterial stiffness in normal and diabetic patients. PATIENTS AND MEASUREMENTS: The study subjects comprised 49 newly diagnosed diabetic patients and 72 age- and sex-matched normal glucose controls. Anthropometric parameters, blood pressure, fasting blood glucose (FBG), lipid profiles, serum OPG, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6) and brachial-ankle pulse wave velocity (baPWV) were measured. RESULTS: Serum OPG levels (6.1 +/- 1.4 vs. 5.4 +/- 1.3 pmol/l, P = 0.011) and baPWV (1562 +/- 354 vs. 1399 +/- 257 cm/s, P = 0.004) were significantly higher in the diabetic group than in the normal glucose group. Serum OPG levels in normal and diabetic patients correlated significantly with systolic blood pressure (r = 0.20, P = 0.035), FBG (r = 0.30, P = 0.002), right baPWV (r = 0.22, P = 0.021), left baPWV (r = 0.26, P = 0.006), homeostasis model assessment insulin resistance (HOMA-IR) (r = 0.19, P = 0.045), IL-6 (r = 0.32, P = 0.001) and hsCRP (r = 0.21, P = 0.027) after adjusting for age and sex. Multiple regression analysis showed that serum OPG level was significantly associated with age, FBG, IL-6, systolic blood pressure, triglyceride and hsCRP (R(2) = 0.299). CONCLUSIONS: In summary, serum OPG and baPWV levels are elevated in diabetic patients and serum OPG levels are significantly associated with inflammation and arterial stiffness.

Biomarkers↗

PubMed2005

The simultaneous detection of both enteroviruses and adenoviruses in environmental water samples including tap water with an integrated cell culture-multiplex-nested PCR procedure.

AIMS: To evaluate an integrated cell culture (ICC)-multiplex-nested PCR using the buffalo green monkey kidney (BGMK) cells for the simultaneous detection of both enteroviruses and adenoviruses in surface water and tap water samples and optimize the procedure for more sensitive detection of virus showing no apparent cytopathic effect (CPE). METHODS AND RESULTS: A total of 69 surface water and 50 tap water samples were analysed by the ICC-multiplex-nested PCR. All the PCRs were performed five times with a cell lysate from each flask after at least 2 weeks incubation. Forty-six surface water samples (66.7%) and 23 tap water samples (46.0%) exhibited CPE by the cell culture method. By using an ICC-multiplex-nested PCR, 53 surface water samples (76.8%) and 29 tap water samples (58.0%) were determined as containing infectious enteric viral particles. CONCLUSIONS: An ICC-PCR method with a long incubation time using BGMK cells enables the simultaneous detection of enteroviruses and adenoviruses from environmental water samples, including tap water, even with low numbers of viruses. SIGNIFICANCE AND IMPACT OF THE STUDY: A method capable of detecting small numbers of viral particles is necessary.

Adenoviridae↗

PubMed2005

Allelic and haplotypic diversity of HLA-A, -B, -C, -DRB1, and -DQB1 genes in the Korean population.

High-resolution human leukocyte antigen (HLA) typing exposes the unique patterns of HLA allele and haplotype frequencies in each population. In this study, HLA-A, -B, -C, -DRB1, and -DQB1 genotypes were analyzed in 485 apparently unrelated healthy Korean individuals. A total of 20 HLA-A, 43 HLA-B, 21 HLA-C, 31 HLA-DRB1, and 14 HLA-DQB1 alleles were identified. Eleven alleles (A*0201, A*1101, A*2402, A*3303, B*1501, Cw*0102, Cw*0302, Cw*0303, DQB1*0301, DQB1*0302, and DQB1*0303) were found in more than 10% of the population. In each serologic group, a maximum of three alleles were found with several exceptions (A2, B62, DR4, DR14, and DQ6). In each serologic group exhibiting multiple alleles, two major alleles were present at 62-96% (i.e. A*0201 and A*0206 comprise 85% of A2-positive alleles). Multiple-locus haplotypes estimated by the maximum likelihood method revealed 51 A-C, 43 C-B, 52 B-DRB1, 34 DRB1-DQB1, 48 A-C-B, 42 C-B-DRB1, 46 B-DRB1-DQB1, and 30 A-C-B-DRB1-DQB1 haplotypes with frequencies of more than 0.5%. In spite of their high polymorphism in B and DRB1, identification of relatively small numbers of two-locus (B-C and DRB1-DQB1) haplotypes suggested strong associations of those two loci, respectively. Five-locus haplotypes defined by high-resolution DNA typing correlated well with previously identified serology-based haplotypes in the population. The five most frequent haplotypes were: A*3303-Cw*1403-B*4403-DRB1*1302-DQB1*0604 (4.2%), A*3303-Cw*0701/6-B*4403-DRB1*0701-DQB1*0201/2 (3.0%), A*3303-Cw*0302-B*5801-DRB1*1302-DQB1*0609 (3.0%), A*2402-Cw*0702-B*0702-DRB1*0101-DQB1*0501 (2.9%), and A*3001-Cw*0602-B*1302-DRB1*0701-DQB1*0201/2 (2.7%). Several sets of allele level haplotypes that could not be discriminated by routine HLA-A, -B, and -DRB1 low-resolution typing originated from allelic diversity of A2, B61, DR4, and DR8 serologic groups. Information obtained in this study will be useful for medical and forensic applications as well as in anthropology.

Alleles↗

PubMed2005

Identification of three novel HLA class I alleles: HLA-A0261, HLA-B1585 and HLA-B*1587.

Three novel human leucocyte antigen (HLA) class I alleles have been characterized by means of direct DNA sequencing analysis. HLA-A* 0261 showed sequence variation at conserved codon. It differs from HLA-A* 020601 by a single-nucleotide substitution at codon 57 (CCG-->GCG) resulting in an amino acid change from Pro to Ala. The sequences of HLA-B*1585 are similar to those of HLA-B*15010101, but differed five nucleotides on exon 3 resulting in three amino acid changes at residues 94 (Thr-->Ile), 95 (Leu-->Ile) and 103 (Val-->Leu). Likewise, HLA-B*1587 is identical to HLA-B*15010101 except at codons 80-83 (Asn-Leu-Arg-Gly-->Ile-Ala-Leu-Arg) which has been replaced by HLA-Bw4 motif. These alleles seemed to be generated by either a point mutation or a gene conversion-like event from alleles existing in the population with high frequencies.

Adult↗

PubMed2005

Relationship between serum adiponectin concentration, pulse wave velocity and nonalcoholic fatty liver disease.

OBJECTIVES: We aimed to investigate the relationship between nonalcoholic fatty liver disease (NAFLD), serum adiponectin concentration and brachial-ankle pulse wave velocity (baPWV) as a risk marker for atherosclerosis. METHODS: A total of 213 nonalcoholic subjects (67 males, 146 females) participated in this study. Division of subjects into the NAFLD group or the normal group was based on the existence of fatty liver detected by sonography. RESULTS: Serum adiponectin levels in the NAFLD group were significantly lower than those in the normal group. After adjusting for age, body-mass index (BMI) and the homeostasis model of assessment (HOMA), there was a significant negative correlation between NAFLD and serum adiponectin level only in females (r = -0.22, P = 0.008). Multiple logistic regression analysis showed a tendency of inverse correlation between NAFLD and serum adiponectin level in females (P = 0.055). After adjustment for age, BMI and HOMA value, serum adiponectin levels were inversely correlated with serum alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels (r = -0.199 (P = 0.004) and r = -0.282 (P < 0.001)). On the other hand, baPWV in the NAFLD group was also significantly higher than that in the normal group in females (P = 0.005). Individual levels of serum ALT, aspatate aminotransferase (AST), alkaline phosphatase (ALP) and GGT were positively correlated with baPWV after adjusting for age, sex, BMI, HOMA and systolic blood pressure (P < 0.05). CONCLUSION: Serum adiponectin level and baPWV were significantly associated with NAFLD and various liver enzymes, especially in females.

Adiponectin↗

PubMed2005

Two-port needlescopic cholecystectomy: prospective study of 100 cases.

OBJECTIVE: To test the feasibility of needlescopic cholecystectomy using a two-port technique with 3-mm miniaturised instruments. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: One hundred consecutive patients undergoing elective cholecystectomy from September 2001 to August 2002. INTERVENTION: Two-port needlescopic cholecystectomy all performed or supervised by a single laparoscopic surgeon. MAIN OUTCOME MEASURES: Conversion of the procedure, the operating time, postoperative analgesic requirement, pain score using the 10-cm visual analog scale, complications, and the postoperative stay. To determine the technical difficulty of this new technique, the data from the first 50 patients were compared with those of the latter 50. Outcome variables were also compared with a group of 58 patients operated on with the standard two-port laparoscopic cholecystectomy in a previous randomised trial. RESULTS: One conversion to open cholecystectomy was reported. Three patients required the enlargement of epigastric port to a size of 5 mm and six patients required an additional port to complete the operation. The median operating time was 62 minutes (range, 33-168 minutes). The median pain score was 3.5 (range, 0-9) and the median postoperative stay was 2 days (range, 1-14 days). Six patients had postoperative complications. When the first 50 patients were compared with the latter 50, there were no differences in the conversion rate, operating time, complication rate, and duration of hospital stay. However, the latter 50 patients had significantly lower pain scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet (median, 5 vs 9 hours; P<0.001). The median operating time of needlescopic cholecystectomy was notably longer (62 vs 46 minutes; P<0.001) compared with that of the two-port laparoscopic cholecystectomy. Patients undergoing needlescopic cholecystectomy had a better resumption of diet (median, 5 vs 7 hours; P<0.001) and less postoperative pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the two-port laparoscopic cholecystectomy group. Pain scores at individual port sites were also lower in needlescopic cholecystectomy group (umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median, 2.0 vs 3.6, P=0.036). CONCLUSION: Two-port needlescopic cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic cholecystectomy technique.

Aged↗

PubMed2004

Inflammation, insulin resistance, and glucose intolerance in acute myocardial infarction patients without a previous diagnosis of diabetes mellitus.

We examined the prevalence of impaired glucose metabolism and its association with inflammation and insulin resistance (IR) in acute myocardial infarction (AMI) patients without a previous diagnosis of diabetes. This prospective study enrolled 52 AMI patients, and 75-g oral glucose tolerance testing was performed on 30 patients at discharge and again 3 months later. We also measured serum adiponectin, high sensitive C-reactive protein, and IL-6 on both occasions. Data were compared with those of 30 type 2 diabetic patients without a history of AMI. Forty percent and 36.7% of AMI patients had impaired glucose tolerance (IGT) at discharge and at 3 months, respectively. The corresponding proportions for newly diagnosed diabetes are 33.0% and 30.0%. At discharge, AMI patients with IGT or diabetes showed higher high sensitive C-reactive protein and IL-6 levels compared with AMI patients with normal glucose tolerance or control type 2 diabetic patients. Furthermore, AMI patients with IGT or diabetes exhibited higher IR and lower serum adiponectin levels than AMI patients with normal glucose tolerance at 3 months after discharge. Previously undiagnosed diabetes and IGT are common in Korean patients with AMI. These glycometabolic abnormalities are associated with inflammation, IR, and serum adiponectin levels.

Adiponectin↗

PubMed2004

Comparison of serum concentrations of C-reactive protein, TNF-alpha, and interleukin 6 between elderly Korean women with normal and impaired glucose tolerance.

This study was performed to compare concentrations of pro-inflammatory cytokines, such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) as well as acute-phase protein, such as C-reactive protein (CRP) between subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT). The purpose of this study was to verify whether the pro-inflammatory cytokine-induced acute-phase response is a pathogenic mechanism in type 2 diabetes in elderly Korean women. A total of 1737 elderly subjects aged over 60 years participated in a population based study in Seoul, Korea (SWS Study 1999). Amongst them, a total of 232 non-smoking and non-diabetic female subjects aged 60-89 years was randomly selected and compared with each other. Higher serum high-sensitivity CRP (hs-CRP) concentrations were shown in subjects with IGT than those with normal glucose tolerance (median 1.2 versus 0.9, P < 0.05). Moreover, a relationship between serum hs-CRP concentrations and many components of the metabolic syndrome were detected. Serum pro-inflammatory cytokine IL-6 or TNF-alpha concentrations, however, were neither increased in subjects with IGT nor closely correlated with the components of the metabolic syndrome. In multiple regression analysis with stepwise selection method using hs-CRP as a dependent variable, it was found that white blood cell (WBC) counts, body mass index (BMI), fasting insulin, post-load 2h glucose, hematocrit and LDL cholesterol were significant independent variables. Our study confirms that increased acute-phase reaction is associated with impaired glucose tolerance and the metabolic syndrome in elderly Korean women. However, the hypothesis that pro-inflammatory cytokine-induced systemic inflammation is an early metabolic defect prior to onset of type 2 diabetes, is not supported in our study of elderly Korean women.

Acute-Phase Reaction↗

PubMed2004

Relationship between brachial-ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome.

In this study, we investigated the association between brachial-ankle pulse wave velocity (baPWV), a novel non-invasive means of measuring atherosclerosis, and the cardiovascular risk factors of the metabolic syndrome. The study group comprised of 368 Koreans without history of diabetes or hypertension. Anthropometric parameters, blood pressure, fasting blood glucose (FBG), lipid profiles, ankle-brachial pressure index (ABI), and baPWV were measured in each subject. ABI and baPWV levels were higher in men than in women. ABI and baPWV levels were not correlated with each other. In women, baPWV was closely associated with the cardiovascular risk factors of the metabolic syndrome. Women with the metabolic syndrome showed higher baPWV levels compared to those without the metabolic syndrome (1540 +/- 281 versus 1312 +/- 223, P < 0.001). Multiple regression analysis showed that baPWV was significantly associated with systolic blood pressure, age, sex, waist circumference, and FBG (adjusted R2 = 0.548). The present study shows that baPWV is significantly associated with the features of the metabolic syndrome in Korean women.

Ankle Joint↗

PubMed2004

Ultrasound image-based computer model of a common carotid artery with a plaque.

Ultrasound scans were acquired from a common carotid artery in a patient with an early atherosclerotic plaque forming a mild asymmetrical stenosis. The 3D vascular geometry of the diseased arterial segment was reconstructed from a series of 2D cross-sectional images, and computational meshes for the flow and wall domains were developed. Numerical flow simulations incorporating coupled fluid-solid interaction were implemented using flow and pressure waveforms measured in vivo. The effects of wall distensibility were investigated by comparing the predictions obtained with different wall compliance, one with 'natural' compliance and another with a stiffer wall. Limited flow separation was predicted in the post-stenotic zone. The non-uniform thickness of the diseased wall restricted the wall motion locally and re-distributed the stress, giving raised concentrations at the plaque shoulders.

Blood Flow Velocity↗

PubMed2004

Cadaveric renal transplantation in hepatitis B antigen-positive recipients using hepatitis B antigen-positive donor organs with lamivudine treatment.

Although renal transplantation has been regarded as the best renal replacement therapy in end-stage renal disease patients, there have never been enough organ donors. Therefore, hepatitis B surface antigen (HBsAg)-negative patients are often given priority over HBsAg-positive patients. We performed cadaveric renal transplantation in six HBsAg-positive recipients given HBsAg-positive donor organs who were on lamivudine treatment. Donors were found to have normal renal function by serum and urine laboratory tests. All recipients underwent liver biopsies before transplantation; those with liver cirrhosis were excluded. All recipients were treated with 100 mg lamivudine once daily because of positive titers of hepatitis B viral (HBV) DNA (three patients), and increased levels of alanine aminotransferase (ALT) (three patients). During the follow-up period, one patient died from hepatic failure at 50 months after transplantation without deterioration of graft function. The remaining five patients showed sustained normal ALT levels. Decreases in HBV DNA titer were observed among patients who were positive before transplantation, but did not reverse to negative. Acute rejection developed in two patients: one was treated successfully with steroid pulse therapy, and the other had two bouts of acute rejection within a 33-month interval. The first was successfully treated with steroid pulse therapy, but the second failed. The four remaining patients have maintained normal renal function for a considerable time. HBsAg-positive donor organs must be used carefully in renal transplantation of HBsAg-positive recipients.

Adult↗

PubMed2004

The viability and function of cryopreserved hepatocyte spheroids with different cryopreservation solutions.

We sought to evaluate the viability and function of cryopreserved hepatocyte spheroids using different cryopreservation solutions in order to elucidate the efficiency of cryopreservation. Hepatocytes isolated from a Sprague-Dawley rat were formed into spheroids by 24 hours of rotational culture. The spheroids were cryopreserved using a programmed linear freezer in a liquid nitrogen tank for 24 hours in four different cryopreservation solutions: UW solution (UW), William E media (WE), fetal bovine serum (FBS), and a mixture (MIX). After thawing, they were cultured for 4 days. With each hepatocyte spheroid, the viability using the MTT assay and hepatocyte-specific functions, such as ammonia clearance, urea nitrogen synthesis, and albumin secretion, were analyzed. The viabilities of cryopreserved hepatocyte spheroids were 64.8% +/- 10.2% (UW), 33.2% +/- 9.7% (WE), 69.3% +/- 8.7% (FBS), and 48.4% +/- 15.5% (MIX). Ammonia clearance of spheroids cyropreserved in UW solution was 0.93 +/- 0.13 mmol/L per well per day, which was not significantly different from freshly cultured spheroids. From the aspect of urea nitrogen synthesis, spheroids cryopreserved with UW, FBS, and MIX solution were not significantly different from freshly cultured spheroids. The amount of albumin secretion by the UW cryopreserved spheroids was significantly greater than that of other cryopreserved spheroids. Cryopreserved hepatocyte spheroids in UW solution were not significantly different from freshly cultured spheroids with respect to viability and function. UW solution was superior to other cryopreservation solutions for viability and functions.

Animals↗

PubMed2004

Randomized trial of tacrolimus versus cyclosporine in steroid withdrawal in living donor renal transplant recipients.

The introduction of new immunosuppressants has prompted trials of steroid withdrawal. However, several groups have reported a higher incidence of rejection. We conducted a randomized two-arm, parallel-group, open-label, prospective study to compare steroid withdrawal (at 6 months posttransplant) from the regimens of tacrolimus + mycophenolate mofetil (MMF) (FK group) versus cyclosporine + MMF (CSA group). The entry criteria were recipients of first living donor transplants with no diabetes mellitus (DM), congestive heart failure, chronic liver disease, or acute rejection within 6 months posttransplant. The primary endpoint was a biopsy-proven acute rejection episode or treatment failure within 1 year posttransplant. While 87 recipients were assigned to FK (n = 43) and CSA groups (n = 44) before transplantation, 76 recipients (FK 39, CSA 37) could be tapered off steroids at 6 months posttransplant, since 11 were excluded due to acute rejection within 6 months posttransplant (FK two, CSA three) or protocol violations (FK two, CSA four). After steroid withdrawal, the incidence of acute rejection episodes was 0% in the FK group and 13.5% in the CSA group (P < .05). Other results at 12 months posttransplantation were comparable: the incidences of DM 7.8% versus 0% (FK group vs CSA group), hypercholesterolemia 41.0% versus 59.5%, hypertensives 48.7% versus 59.6% as well as the levels of plasma creatinine 1.21 +/- 0.24 versus 1.31 +/- 0.50 mg/dL (P > .05 in every variable). These data suggest that steroid withdrawal is successful in first living donor renal transplant recipients. Tacrolimus may be significantly more effective than cyclosporine to prevent acute rejection after steroid withdrawal.

Adrenal Cortex Hormones↗

PubMed2004

Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation.

Numerous studies have reported various prognostic factors that affect graft and patient survival in living and cadaveric donor kidney transplantation (KT). The purpose of this study was to evaluate the clinical outcomes and prognostic factors affecting graft and patient survivals in living and cadaveric donor KT. Between February 1995 and December 2001, 421 patients who had undergone cadaveric donor KT (group I: 216 cases, 51.3%) or living donor KT (group II: 205 cases, 48.7%), were retrospectively analyzed. Five-year overall graft survival rates in living was significantly better than that in cadaveric donor KT, respectively (P = .0234). There was no difference in patient survival rates between the two groups. Such factors as absence of rejection, female donor, female recipient, adult KT according to recipient age (>14 years), and donor serum creatinine level just before transplantation (< 2.5 mg/dL) were significantly associated with good graft survival among cadaveric donor KT, whereas two factors-absence of rejection and adult KT according to recipient age (>14 years)-influenced graft survival in living donor KT. In multivariate analysis, the only significant prognostic factor related to graft survival was the presence of rejection. In conclusion, we suggest that the presence of rejection is the only factor that impairs graft survival in both cadaveric and living donor KT, while other factors affected graft survival differently in the two groups.

Adult↗