HLA Crossmatching 양성에서 음성으로 전환된 환자의 신이식 = The Cutcome of Living-related Renal Transplantation with Previously Positive but Currently Negative HLA Crossmatching

다국어 초록 (Multilingual Abstract)

Purpose:Previously positive but currently negative HLA crossmatching is considered to be a risk factor not in the first renal transplantation but in the second renal transplantation. The aim of this study is to analyse the outcome of living-related renal transplantation with previously positive but currently negative HLA crossmatching.
Methods:The results of first HLA crossmatching, demographic characteristics, the outcome of renal trasplantation were examined in four patients undergoing renal transplantation with previously positive but currently negative HLA crossmatching.
Results:The acute rejection was occurred in 3 patients. Azotemia was improved with the immunosuppressive therapy containing tacrolimus. There were no graft failures in four patients for 1 year. In the first HLA crossmatching, anti-human globulin T cell HLA crossmatching was positive in all patients with acute rejection. The period that positive HLA crossmatchings were converted to negative was longer in patients with acute rejections than without acute rejections (177 days vs 22 days).
Conclusion:There were 3 acute rejections in 6 patients undergoing living related renal transplantations with previously positive and current negative HLA crossmatching. There were no graft failure for 1 year. (Korean J Nephrol 2005;24(3):448-454)

국문 초록 (Abstract)

목 적:HLA 교차시험이 처음에는 양성이었다가 음성으로 전환된 환자들이 생체 신이식을 받은 경우의 신이식 성적에 대해 고찰하고자 하였다.
방 법:1998년 1월부터 2003년 12월까지 서울아산병원에서 HLA 교차시험을 받은 환자들을 대상으로 처음에는 HLA 교차시험이 양성이었다가 음성으로 전환된 환자 10명 중에서 생체 신이식을 받은 환자 4명에 대해 첫 번째 HLA 교차시험에서 양성으로 나온 항체의 종류와 신이식 성적에 대해 기술하였다.
결 과:대상 환자의 연령은 33세에서 46세였으며 중간 연령은 41세이었고 모두 혈액투석을 받았으며 투석의 기간은 18개월에서 60개월로 중간값은 48개월이었다. 환자들은 이식 후 5개월에서 17개월까지 지난 상태로 환자의 혈청 크레아티닌은 0.9 mg/dL에서 1.2 mg/dL이었다. 3명에서 급성 거부반응이 있었고 급성 거부반응 시에 methyl prednisolone, tacrolimus와 mycophenolate mofetil이나 azathioprine 중 하나를 사용하였고 혈청 크레아티닌은 정상으로 회복되었다. 교차반응의 결과는 항인체글로블린 T cell 교차시험 (anti-human globulin, AHG)은 4명에서 양성이었고 그 중 3명은 항인체글로블린 T cell 교차시험에만 양성이고 T cell이나 B cell에 대한 항체는 나타내지 못하였다. 거부반응이 있었던 3명에서는 첫 교차시험에서 AHG가 모두 양성이었다. HLA 교차시험이 음전되는데 걸리는 시간은 급성 거부반응이 있는 환자에서 70일에서 698일로 평균 315일이고 급성 거부반응이 없었던 환자에서 22일로 나타나 거부반응이 있는 환자에서 HLA 교차시험이 음전되는데 걸리는 시간이 더 길게 나타났다.
결 론:HLA 교차시험이 양성에서 음성으로 전환된 환자에서 생체 신이식은 4명 중 3명에서 거부반응이 나타났지만 초급성 거부반응이 나타나지 않았고 급성 거부 반응시에 면역억제제의 사용으로 호전되었다.

참고문헌 (Reference)

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