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한국식을 먹는 신장이식 수혜자들의 식이분석(단일기관 연구)
김한새,오준석,이동열,이진호,김성민,신용훈,박용순,안원석,김중경 대한이식학회 2015 Korean Journal of Transplantation Vol.29 No.2
신장이식은 전 세계적으로 가장 흔히 시행되는 고형장기이식술이다. 면역억제제의 발달로 신장이식 환자의 생존율은 점차 향상되어 왔으며, 이로 인해 비면역학적인 요소 특히 영양과 관련된 문제가 신장이식 후의 유병률과 사망률에 큰 영향을 미치는 요소가 되었다. 만성신부전 환자는 신장이식을 통해 요독증과 관련된 대사장애와 투석의 부작용을 교정할 수 있다. 하지만 신장이식 후에도 기존의 만성신부전으로 인한 일부 대사장애가 지속될 수 있으며, 또한 신장이식 그 자체와 면역억제제의 복용은 장단기적인 건강문제와 이식신의 생존율에 지대한 영향을 미칠 수 있는 새로운 대사장애들을 유발할 수 있다. 따라서 영양조정은 비만, 고혈압, 당뇨병, 심혈관계 질환과 같은 신장이식과 관련된 흔한 건강 문제들을 예방하고 치료하는데 있어 중요한 역할을 한다. 투석 관련 영양문제에 대해서는 이전의 많은 연구가 있어왔다. 하지만 신장이식 후의 영양문제에 대해서는 상대적으로 적은 관심을 받아왔으며, 더욱이 한국식을 섭취하는 신장이식환자들의 영양상태에 대한 연구는 매우 부족한 실정이다. 이 연구는 한국식을 섭취하는 신장이식 환자들의 영양상태를 파악함으로써 적극적인 영양조정을 통해 신장이식 후 발생할 수 있는 대사관련 합병증 예방 및 치료, 나아가 이식신장 생존율 향상에 기여하고자 한다. Background: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. Methods: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. Results: The mean energy and protein of daily intake were 2,088±1,016 kcal and 75.5±38.2 g. Patients’ diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. Conclusions: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.
B형 간염 보균자에서 공여받아 B형 간염 감염 없이 성공적으로 시행한 1:512의 고역가 혈액형 부적합 신장이식 1예
이진호,김한새,이동열,오준석,신용훈,김중경,박종현,허길,박종인 대한이식학회 2016 Korean Journal of Transplantation Vol.30 No.4
Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
신장이식 수술 후 7일 차에 발생한 이식신 동맥협착을 저압력 풍선 혈관성형술로 성공적으로 치료한 1예
김두엽,정현도,이진호,김한새,이동열,오준석,김성민,신용훈,김중경,허길,박종현,정규식 대한이식학회 2016 Korean Journal of Transplantation Vol.30 No.2
Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft’s renal artery and the patient’s common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90∼180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient’s common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient’s common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.
지속성 외래 복막투석 환자에서 발생한 흉강 내 그물막 탈장 1예
최승호 ( Seung Ho Choi ),오준석 ( Joon Seok Oh ),정필 ( Peel Jung ),김한새 ( Han Sae Kim ),이강훈 ( Kang Hun Lee ),김중경 ( Joong Kyung Kim ),박종현 ( Jong Hyun Park ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6
복막투석 환자에서 대부분의 탈장은 복강으로 발생하며 위장관의 탈장이 없는 흉강 내 그물막 탈장은 매우 드문 질환이다. 저자들은 복막투석 환자에서 생긴 흉강 내 그물막 탈장을 전산화 단층촬영으로 진단 후 복강경 수술로 치료하여 복막투석을 재개한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Intrathoracic omental herniation through the esophageal hiatus is extremely rare. Here, we report a case of a 57-year-old male with continuous ambulatory peritoneal dialysis (CAPD) who was admitted to our hospital after experiencing nausea and abdominal discomfort for 3 days. Computed tomography (CT) revealed a fatty mass, extended continuously through the esophageal hiatus into the thoracic cavity. Laparoscopic surgery revealed an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines. Peritoneal dialysis was resumed six weeks later. This is a report of omental herniation through the esophageal hiatus in a patient with CAPD. (Korean J Med 2014;86:766-769)