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신장 ; 국내 단일기관에서 시행한 췌장이식의 임상적인 결과
한덕종 ( Duck Jong Han ),김송철 ( Song Cheol Kim ),박재범 ( Jae Berm Park ),김영훈 ( Young Hoon Kim ),박관태 ( Kwan Tae Park ),홍정자 ( Jung Ja Hong ),하희선 ( Hea Seon Ha ),정주희 ( Ju Hee Jung ),김인구 ( In Koo Kim ),박건춘 ( Ku 대한내과학회 2011 대한내과학회지 Vol.80 No.2
목적: 췌장이식은 인슐린 의존형 당뇨병에서 1966년 미네소타대학 병원에서 처음 시행된 수술로써 인슐린을 끊을 수 있는 유일한 치료법으로 이식수술 후 합병증의 감소, 면역억제제 및 수술 후 관리의 개선으로 널리 시행되고 있다. 국내에서는 1992년 첫 췌장이식이 시행된 이래 점차 늘어가고 있지만 아직 활발히 이루어지고 있지는 못하다. 이에 저자들은 1992년 7월부터 2009년 12월까지 국내 단일기관에서 시행한 췌장이식의 임상 결과를 분석하여 보고하고자 한다. 방법: 본원에서는 1992년 7월 이후 2009년 12월까지 18년간 119명의 당뇨병 환자에서 췌장이식을 시행한바 이를 후향적으로 분석하여 췌장 이식의 임상적인 결과를 분석하였다. 결과: 이식수혜자의 당뇨병 분류로 총 119명 중 인슐린 의존형이 93명(78.2%)이었고, 16명(13.4%)에서는 Type II형 이었다. 기증자는 뇌사자가 107명(89.9%), 그리고 12명(10.1%)에서는 가족간 생체기증이었다. 당뇨합병증으로 신·췌장 동시 이식이 67명(56.3%)이었고, 42명(35.3%)에서는 췌장단독이식, 10명(8.4%)에서는 이미 신장이식을 받은 환자에서 췌장이식이 시행되었다. 수술 후 췌장 이식편생존율은 81.6%(1년), 63.4%(5년), 그리고 57.1%(10년)이었다. 면역억제제로 tacrolimus와 MMF를 사용한 1999년 이후(n=96) 췌장 이식편 생존율은 89.1%(1년), 72.9%(5년), 그리고 66.2%(10년)이었고, 환자의 생존율은 93.0%(1년), 86.0%(5년), 그리고 86%(10년)이었다. 결론: 최근 췌장이식 수술의 향상된 성적으로 삶의 질과 장기 환자 생존을 고려할 때, 췌장 이식은 당뇨병의 유형에 상관 없이 인슐린 투여가 필요한, 심각한 당뇨 합병증 또는 인슐린 투여 관련 합병증의 위험에 놓여 있는, 비비만형 당뇨병 환자들에게 효과적인 치료로 제시 될 수 있다. Background/Aims: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. Methods: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. Results: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. Conclusions: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes. (Korean J Med 2011;80:167-178)
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신장이식 환자의 근력, 근지구력, 유연성 및 일상생활활동의 변화
안재현,하희선,홍정자 성인간호학회 2001 성인간호학회지 Vol.13 No.1
The purpose of this study was to explore the change of muscle strength, muscle endurance, flexibility and activities of daily living to develop a rehabilitational program. The subjects were selected randomly among the patients who underwent kidney trans- plantations at one major transplantation hospital in Seoul, Korea. This study was carried out between November 23, 1999 and February 15, 2000. The subjects in this study consisted of 16 patients who had kidney transplantations between 1 month and 12 months ago prior to this study. They were all on steroids and did not take any physical exercise regularly. The muscle strength, muscle endurance, flexibility and activities of daily living were evaluated at 1st week and after 12 weeks. The data were analyzed with numbers, percentiles, mean, standard deviation and t-test. The results were as follows : 1.After 12 weeks, the grip strength was significantly decreased than 1st week(p =.0002). 2.After 12 weeks, the back lift strength was significantly decreased than 1st week(p =.0002). 3.After 12 weeks, the muscle endurance was increased than 1st week, but it was not significant(p=.5487) 4.After 12 weeks, the flexibility was significantly decreased than 1st week(p=.0002). 5.After 12 weeks, the activities of daily living was significantly decreased than 1st week(p=.0006). Like the above result, the kidney transplant receipients' muscle strength, flexibility and activities of daily living were reduced In order to solve this problem, the writer has found that program development to prevent the defects should be extremely required. Since now on the number of patients should expand. After the kidney transplantation, the periods of 4, 8, 12 and 16 weeks are extended. The writer proposes to examine the different phase of change in each periods.
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이유미,이승규,최규택,이동명,이청,서병태,성규완,하희선 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1
Background : Since the first successful kidney transplantation from a brain death donor(BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. Methods : We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. Results: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell(PRBC) to maintain the hematocrit between 25∼35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. Conclusions : We wish that these results were made use of bases of status of organ donation from BDDs. (Korean J Anesthesiol 1998; 34: 160∼166)
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