The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Outcome of Cadaveric Kidney Transplantation from Expanded Criteria Donors

확장 범주 뇌사자의 신장이식 성적

  • Park, Ja-Yong (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Cho, Jang-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Yoon, Young-Deuk (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Song, Eun-Joo (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Jin, Mi-Kyung (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Yu, Chung-Hoon (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Jung, Hee-Yeon (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Lim, Jeong-Hoon (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Shin, Yong-Bong (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Choi, Ji-Young (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Yoon, Se-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Park, Sun-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Kim, Chan-Duck (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD) ;
  • Kim, Yong-Lim (Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for ESRD)
  • 박자용 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 조장희 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 윤영득 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 송은주 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 진미경 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 류정훈 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 정희연 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 임정훈 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 신용봉 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 최지영 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 윤세희 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 박선희 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 김찬덕 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터) ;
  • 김용림 (경북대학교 의학전문대학원 내과학교실, 말기신부전 임상연구센터)
  • Published : 2011.04.01
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Abstract

Background/Aims: The Korean Network for Organ Sharing (KONOS) was established in 2000, and the KONOS criteria for expanded-criteria donors (ECD) have since been applied to kidney allocation from deceased donors. The outcome of cadaveric kidney transplantation from ECD according to KONOS criteria has not been investigated. Methods: Seventy-seven cadaveric kidney transplants from January 2003 to December 2009 were recruited retrospectively. Factors that influence the glomerular filtration rate (GFR) of graft kidneys up to 36 months after transplantation were evaluated. Postoperative renal function and allograft and patient survival in the ECD group (n = 28) were compared with those in the standard-criteria donor (SCD) group (n = 49). Results: The GFR of graft kidneys was different according to donor GFR, age, hypertension history, and cause of brain death. In the ECD group, GFR was lower than that in the SCD group by KONOS criteria. No differences in allograft or patient survival were observed until 3 years after kidney transplantation. Conclusions: Cadaveric kidney transplantation using the ECD by KONOS criteria is acceptable in term of graft and 3-year patient survival, although the GFR was lower in the ECD than in the SCD group.

목적: 신장이식 대기자에 비해 장기 공여자의 수는 매우 부족하다. 확장 범주 뇌사자 신장이식이 그 대안으로 제시되고 있다. 본 연구에서는 단일기관에서 시행한 확장 범주 뇌사자 신장이식을 대상으로 이식신 기능 및 생존율을 후향적으로 분석하였다. 방법: 2003년 1월부터 2009년 12월까지 본원에서 시행한 77예의 뇌사자 신장이식을 대상으로 하였다. 뇌사자의 나이, 장기 적출 전 크레아티닌 청소율, 고혈압 병력, HLA 불일치 개수 및 뇌사자의 사망 원인에 따른 이식 수술 후 신장 기능의 차이를 알아보았다. KONOS의 확장 범주 공여자 정의에 따라 두 군(확장 범주, 표준 범주 공여자)으로 나누어 이식수술 후 36개월까지의 신장 기능과 이식신 및 환자 생존율을 비교분석 하였다. 결과: 뇌사자의 나이가 많거나 크레아티닌 청소율이 낮은 경우 및 고혈압 병력이 있거나 뇌혈관 질환이 사망 원인이었던 경우 이식 수술 후 신장 기능이 낮았다. 수술 후 36개월까지의 신장 기능을 비교하였으며, 확장 범주 공여자군에서 크레아티닌 청소율이 의미있게 낮았다(49.8 ${\pm}$ 22.7 vs. 75.0 ${\pm}$ 28.6, p < 0.05). 그러나 이식신 기능 부전과 이식신 생존율 및 환자 생존율에서는 두 군 간의 차이가 없었다. 결론: KONOS 기준의 확장 범주 뇌사자 신장이식에서 이식신 기능은 표준 범주 공여자에 비하여 낮게 유지되었다. 그러나 이식 후 3년까지의 이식신 및 환자 생존율은 표준 범주 공여자와 차이가 없었다. 공여자가 부족한 현실에서 확장 범주 뇌사자는 공여자군을 늘일 수 있는 받아들인 만한 대안으로 생각된다.

Keywords

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