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조동환,박범용,공진민,김정기,Cho, Dong-Hwan,Park, Bum-Yong,Kong, Jin-Min,Kim, Jeong-Gee 한국정신신체의학회 1998 정신신체의학 Vol.6 No.1
Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.
식이식 환자에서 mycophenolate mofetil 투여시의 스테로이드 중단의 안정성
정재성 ( Jae Sung Jung ),공진민 ( Jin Min Kong ),이동렬 ( Dong Ryeol Lee ) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Long term use of steroid induces multiple side effects and morbidity. However, SW has been reported to be associated with increased incidence of acute and chronic rejection, and subsequently reduced graft outcome. MMF inhibits the proliferation and functions of lymphocytes, decreases the incidence of acute rejection in organ transplants, and therefore may decrease the graft rejection associated with SW. We tried to withdraw steroid from 21 renal transplants treated with prednisolone and cyclosporine, who had clinically significant steroid induced side effects. Reasons for SW were diabetes in 15 patients (pre-transplant DM 4 and post-transplant 11), moon face 4 and avascular necrosis of femur 2. Prednisolone was tapered at a rate of 2.5mg every 2 weeks and was discontinued. MMF, 1.0-2.0g/day, was initiated at the beginning of SW. The time interval between transplantation and SW was 26±5 (1.5-67) months. Mean age was 48(28-61). Two patients developed MMF-induced GI side effects, and were returned to previous immuno- suppressants. In 1 patient, serum creatinine increased during SW, and steroid was re-administered with the restoration of renal function. In 18(86%) of 21 patients, therefore, steroid was successfully with-drawn. At the follow up of 171(13-24) months after SW, 1 patient with drug incompliance developed chronic rejection. The rest showed stable renal function. Steroid can be safely withdrawn from renal transplants by simultaneous administration of MMF. The long-term safety, however, needs to be evaluated by prolonged follow up studies.
신장이식 환자에서의 ABO 부(副)-부적합에 의한 용혈성 빈혈
이동렬 ( Dong Ryeol Lee ),강화미 ( Hwa Mi Kang ),김민웅 ( Min Woong Kim ),김치훈 ( Chi Heun Kim ),박종환 ( Jong Hwan Park ),윤지훈 ( Ji Hoon Yoon ),공진민 ( Jin Min Kong ) 대한내과학회 2005 대한내과학회지 Vol.69 No.2
저자들의 경우 ABO 부 부적합 이식 환자 중 ABO항체에 의한 용혈성 빈혈의 발생 빈도가 9%로 비교적 높은데 이는 공여자 특이 수혈(DST)을 시행한 것과 관련이 있을 수 있다. 또한 Azathiopurin, MMF와 같은 B임파구의 증식을 억제하는 약제의 사용이 적었던 것도 빈도의 증가에 기여했을 수 있다. ABO 부(副) 부적합에 의한 신 이식의 경우 초기 원인 불명의 빈혈이 관찰될 때 급성 용혈성 빈혈을 조기에 확인하고 감별 진단하는 것이 필요하며, 적절한 치료를 시행하면 대부분의 경우에서 이식 신 기능 장애 없이 회복이 가능하다. Background : Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. Methods : To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. Results : Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14±3 days after renal transplantation and lasted for about 10±3 days. The maximum reduction of hemoglobin was 3.3±1.0g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0±2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0±1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). Conclusion : Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.(Korean J Med 69:177-182, 2005)