중국에서 사체 신장이식을 받은 환자들의 임상적 특징 = Short-term Outcome for Korean Recipients Undergoing Cadaveric Kidney Transplantation in China

다국어 초록 (Multilingual Abstract)

Purpose: Number of patients expecting for kidney transplantation and transplantations in foreign countries are rapidly increasing. However, there was a lack of information about clinical progresses and outcomes of kidney recipients, underwent cadaveric kidney transplantation in China.
Methods: We included 44 patients (China group), received cadaveric kidney transplantation in China and have been managed at our institute from Jan 2002 to Jan 2006 and 33 patients (domestic group), received cadaveric kidney transplantation at our institute from Feb 2000 to Jan 2006. We performed retrospective study based on medical records.
Results: Duration of pre-transplantation renal replacement therapy and of post-transplantation follow up was longer in domestic group (China group vs. domestic group; 89.9 months vs. 24.6 months, 31.9 months vs. 13.9 months) (p<0.05, p<0.05). Final GFR of China group was lower than domestic group (China group vs. domestic group; 54.97±18.92 mL/min vs. 64.26±18.23 mL/min) (p<0.05). Infection and rejection rates of China group were higher than domestic group (Incidences/ Pantients *Yr./1000; China group vs. domestic group; infection; 2.05 vs. 0.76, rejection; 1.34 vs. 0.51) (p<0.05). There was no difference of patient and graft survival between two groups.
Conclusion: Korean recipients of Chinese cadaveric kidneys showed lower final GFR and higher rates of infection and rejection. We should be aware of the possible rejections and complications of kidney recipients undergoing cadaveric kidney transplantation in China. Mutual exchange of information about current status of patients, transplantation indications, donor status and treatment protocols is needed between foreign transplantation centers and our medical centers.

국문 초록 (Abstract)

목 적: 신장이식은 말기 신부전의 중요한 신대체 요법이나 공여 신장의 부족으로 이식 대기 환자는 급격히 늘어나고 있다. 이에, 중국을 포함한 해외에서의 신장이식이 최근 급증하고 있으나 우리나라에서 이들의 치료 경과 및 성적에 대한 보고는 제한적이다. 연구자들은 중국에서 사체 신장이식을 받은 환자들의 임상상을 살펴보고, 이들의 단기 성적을 국내에서 사체 신장이식을 받은 환자들과 비교해 보고자 하였다.
방 법: 2002년 1월부터 2006년 1월까지 중국에서 사체 신장이식을 받고 서울대학교병원에서 유지 면역억제 치료를 받고 있는 44명의 환자들과 2000년 2월부터 2006년 1월까지 서울대학교병원에서 사체 신장이식을 받은 33명의 환자들을 대상으로 후향적 연구를 진행하였다.
결 과: 양 군 간에 인구학적인 차이는 없었고, 원인 신장 질환과 기존의 신대체 요법, 이식 전 혈청 크레아티닌 값도 차이가 없었다. 기존의 신대체 요법 기간은 국내이식군에서 길었으며 (중국이식군 vs. 국내이식군; 24.6 months vs. 89.9 months; p<0.05), 이식 후 관찰 기간도 국내이식군에서 길었다 (중국이식군 vs. 국내이식군; 13.9 months vs. 31.9 months; p<0.05). 이식 후 6개월 째와 1년 째 사구체 여과율은 양 군 간에 차이가 없었으나 마지막 사구체 여과율은 중국이식군에서 낮았다 (중국이식군 vs. 국내이식군; 54.97 mL/min. vs. 62.46 mL/min.; p<0.05). 이식 후 감염증과 거부 반응의 빈도는 중국이식군에서 많았다 (p<0.05). 국내이식군에서는 사망자가 없었으나 중국이식군에서는 3명이 있었고, 신기능의 소실은 국내이식군에서 1명, 중국이식군에서 4명이 있었다.
결 론: 중국이식군에서 국내이식군에 비해 신기능의 저하와 합병증 발생의 증가 등이 관찰되었으며, 이를 해결하기 위해서는 이식 적응증 및 이식 전 평가, 초기 면역억제를 포함한 중국에서의 치료, 공여자 정보의 제공 등에 대해 해외 이식 기관과의 의견 교환이 있어야 할 것이다.

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