KCI등재후보
신장 이식 96 예에 대한 임상적 고찰 = A Clinical Analysis of 96 Renal Transplantation신장 이식 96 예에 대한 임상적 고찰
저자
노임환(Im Hwan Roe) ; 고윤석(Youn Suck Koh) ; 안정경(Jung Kyung Ahn) ; 박찬현(Chan Hyun Park) ; 강종명(Chong Myung Kang) ; 박한철(Han Chul Park) ; 곽진영(Jin Young Kwag) ; 원치규(Chi Kyu Won)
발행기관
학술지명
권호사항
발행연도
1988
작성언어
-주제어
KDC
500
등재정보
KCI등재후보
자료형태
학술저널
발행기관 URL
수록면
147-157(11쪽)
제공처
소장기관
We have performed 96 renal transplantations in Hanyang University Hospital since Apri11978. We have analyzed the complications and outcome of these patients in connection with the tissue types and other factors. The results are as follows; 1) The mean age of recipients was 34.4 years. They were most commonly in the 3rd and 4th decades. The male to female ratio was 4.3:l. 2) Among 96 patients, 74 patients received kidneys from living related donors, while 11 patients received donations from living unrelated donors. Eleven cases were cadaver transplantations. Of living related donors, mothers donated in 35 cases (36.5%) and siblings donated in 21 cases (21.9%). All of the cadaver donors were men. 3) HLA typing and cross matching were performed in 56 cases. The grade of the match was defined by the number of shared antigens between donor and recipient. Twenty-seven patients were matched for two antigens. Twelve patients were matched for one antigen, while 12 patients were matched for 3 antigens. Six patients were HLA identical. A mixed lymphoeyte culture was done in 55 patients of there. 33 patients were low responders, who showed less than 55% relative response, 6 patients were high responders (over 100% response), and 16 patients belonged to intermediate group. 4) The recovery rate from acute rejection was 56.5% in living related transplantation patients (sibling; 57.8%, parent and child; 55.1%). In living unrelated transplantation patients, the recovery rate was 50.0%, and it was 42.8% in cadaver transplantation patients. The recovery rate of acute rejection was varied among the different HLA match grades; 62.5% for the group with one antigen matched, 67.0% for two antigens matched, and 100% for four antigens matched. Of low MLC responders, 72% recovered from acute rejection; the higher the relative response, the lower the recovery rates. 5) The Seventy-two of 96 cases were complicated by infertion, mainly pneumonia, fungal infection. The sixty nine of 96 cases were complicated by nonifectious causes, suchas acute tubular necrosis, avascular necrosis of bone, cataract, glaucoma, peptic ulcer and diabetes. 6) The overall mortality rate was 26.0%. During the period of 1978 through 1982, mortality was higher (80%) than that of the period of 1983 through 1987 (20%). The major cause of death before 1982 was infection, The major cause of death after 1983 were hepatic failure and pneumonia. 7) Patients with hepatitis B antigenmia did poorly. Four patients died of hepatic failure, and two patients lost graft. One patient became cirrhotic, 8) The overall patient survival rate was 84.8% at one year and 72.4% at 5 years. The graft survival rate was 81.3% at 1 year and 48.8% at 5 years resply. 8-1) The patient and graft survival rate for living related transplantation patients was 87.0%/82.6% at 1 year and 76.0%/46.7% at 5 years respoectively. The outcome was much better for transplantation between siblings than for parent-child combinations. 8-2) The patient and graft survival rate at 2 years according to HLA match was as follows; 88.9%/81.5% for the group with 2 antigens matched, 88.3%/75.0% for 3 antigens matched, and 100%/83.3% for 4 antigens matched. 8-3) The patient and graft survival rate at 2 years according to MLC was as follows; 96.7%/84.9% in low responders, 93.7%/74.0% in intermediate responders and 31.8%/31.8% in high responders, 8-4) The patient and graft survival rate was compared in patients using different immunosuppressives. Patients with imuran showed 87.0%/85.6% at 6 months and 85.5%/79.8% at 1 year respectively. Patients with cyclosporine showed 91.7%/91.7% at 6 months and 91.7% /86.6% at 1 year. 8-5) Regarding the effect of DST, patients who had not received a transfusion showed a patient and graft survival rate of 77.9%/68.0% at 2 years. Transfused patients did much better, showing survival rate of 96.5 %/84.0% at 2 years. Thus we conclude that MLC and DST greatly influence the survival rate after renal transplantat
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