배우자간 신장이식의 성적 : 혈연간 생체 신장이식과 비교 = Outcomes of Kidney Transplantation from Spousal Donors : Comparison with Kidney Transplantation from Living-related Donors

국문 초록 (Abstract)

목 적:신장이식의 수요 증가에도 불구하고 공여신의 공급이 제한된 현실에서 배우자간 신장이식을 선택하는 경우가 증가하고 있다. 저자들은 혈연간 생체신장이식에 비해 조직적합성이 열등함에도 불구하고 이루어지는 배우자간 신장이식에서 이식신의 생존율을 혈연간 생체신장이식의 경우와 비교하고, 배우자간 신장이식의 임상적 특성을 평가하고자 하였다.
방 법:1990년부터 2002년까지 한양대학교병원에서 신장이식을 받은 환자를 후향적으로 분석하였다. 혈연간 생체신장이식 205명, 배우자간 신장이식 21명, 배우자간 신장이식을 제외한 비혈연간 생체신장이식 256명, 사체신장이식 17명이었다. Kaplan-Meier 분석법을 이용하여 누적 이식신 생존을 구하였고, 배우자간 신장이식과 혈연간 생체신장이식 사이 및 배우자간 신장이식의 아군 (subgroup) 사이에서 누적 이식신 생존을 비교하였다.
결 과:환자의 연령은 배우자간 신장이식 43.7±7.8세, 혈연간 생체신장이식 36.2±10.8세로 배우자간 신장이식에서 유의하게 높았다 (p<0.005). HLA 불일치수는 배우자간 신장이식, 혈연간 생체신장이식에서 각각 3.79±1.03, 2.60±1.21로 배우자간 신장이식에서 유의하게 많았다 (p<0.0001). 추적 기간 동안 이식신 기능소실은 배우자간 신장이식의 경우 7명, 혈연간 생체신장이식의 경우 60명으로 유의한 차이가 없었다. Kaplan-Meier 누적 이식신 생존곡선 결과 배우자간 신장이식과 혈연간 생체신장이식 사이에 누적 이식신 생존에는 유의한 차이가 없었다. 배우자간 신장이식 중에서 공여자가 남편인 경우 (p<0.05), HLA 불일치수가 5개 미만인 경우 (p<0.0001), 급성 거부반응이 없었던 경우 (p<0.005)에서 각각 그렇지 않은 경우에 비해 누적 이식신 생존이 양호하였다.

다국어 초록 (Multilingual Abstract)

Background:Although transplantation is the best treatment for many people with end-stage renal disease, the gap between the number of organs and the number of potential recipients continues to widen. In addition to living-related individuals, the primary source of donor kidney, the severe organ shortage has led to consideration of genetically unrelated but emotionally related persons as donor candidates. The aim of this study was to compare the results of spousal kidney transplantation with those of living-related kidney transplantation and to analyze the characteristics of spousal kidney transplantation.
Methods:Clinical data were retrospectively analyzed from 21 patients with spousal kidney transplantation and 205 patients with living-related kidney transplantation. Cumulative renal allograft survival was compared between the two groups using Kaplan-Meier curve and log-rank test. Subgroup analysis was done within the patients with spousal kidney transplantation.
Results:The patients were significantly older in spousal group (43.7±7.8 years) than in living-related group (36.2±10.8 years). Donor age was also significantly higher in spousal group (43.0±8.4 years) than in living-related group (39.8±13.9 years). The number of HLA mismatch was significantly larger in spousal group (3.79±1.03) than in living-related group (2.60±1.21). The episodes of acute rejection occurring within a year after the transplantation were more frequent in spousal group (5/21) than in living-related group (13/205). Kaplan-Meier curves for cumulative survival of renal allograft revealed no difference between spousal group and living-related group. Renal allograft survival rates in spousal group were 85.2% at 1 year, 75.2% at 5 years, and 67.7% at 10 years after the transplantation. In living-related group, renal allograft survival rates were 96.6% at 1 year, 85.9% at 5 years, and 69.9% at 10 years after the transplantation. Within the patients with spousal kidney transplantation, cumulative renal allograft survival was superior in cases with absent acute rejection, husband-to-wife transplantation, and the number of HLA mismatch less than 5.
Conclusion:Spousal kidney transplantation shares comparable results with living-related kidney transplantation despite older age, poorer HLA matching and a higher rate of acute rejection. Spousal donor transplants could be a real alternative especially when the donors are husband and the number of HLA mismatch is less than 5.

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