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        생체 신장이식에서 이식신 생존율에 미치는 HLA 적합성의 영향

        윤영석(Young Suk Yoon),방병기(Byung Kee Bang),김원일(Won Il Kim),고용복(Yong Bock Koh) 대한내과학회 1992 대한내과학회지 Vol.43 No.4

        N/A Background & Methods: HLA matching continues to stand out as an important factor in renal transplantation despite improvement in immunosuppression. Therefore, we have analyzed 478 first living renal transplants who had been treated with Aza (n=68) or CsA (n=410) between April 1979 and March 1991 to determine the beneficial effect on graft survival of HLA antigens matching. Results: CsA signiftcantly improved kidney graft survival by 17% at 5years as compared with Aza group (77% vs. 65%; p=0.0252), Matching for the HLA-A+B significantly improved kidney graft survival, which the difference between 1 mismatched group and 2mismatehed group was 27% at 5years (67% vs. 40% p=0.0436) in the Aza group, but not in the CsA group, An impressive 34% difference in kidney graft survival was observed at 5years between the CsA-treated patients who received 0 and 2HLA-DR mismatches (83% vs. 49%; p=0,00001), but not between Aza-treated patients. The 5-year kidney graft survival in the 1 B+ DR mismatched CsA group was 86d, which was significantly different from 64Fp survival in the 4 B+DR mismatched group (p=0.0105), but not in the Aza group. The effect of HLA -A+DR and HLA-A+B+DR matching showed a little difference between the groups with different mismatches number in the Aza and CsA groups. Conclusion: Matching for the HLA-A+B significantly improved kidney graft survival in the Aza group. Matching for the HLA-DR and B+DR significantly improved kidney graft survival in the CsA group. The best kidney graft survival was observed in the HLA -A+B+DR identical combination group treated with Aza (80Fp at 5years); while in 0 HLA-A+B mismatched recipients treated with CsA (95% at 5years).

      • KCI등재후보

        Catholic Medical Center 에서의 신이식 22 년 - 생체 신이식 600 예의 결과 -

        윤영석(Young Suk Yoon),김용수(Yong Soo Kim),방병기(Byung Kee Bang),윤재영(Jae Young Yoon),박용현(Yong Hyun Park),박철주(Chul Joo Park),고용복(Yong Bock Koh) 대한내과학회 1992 대한내과학회지 Vol.43 No.4

        N/A Background: The results of twenty-two years of renal transplantation at the Catholic Medical Center have been reviewed to analyze data of transplants performed between March 1969 and March 1991, During these time our center has transplanted 578patients with 600allografts. We reviewed the factors which effect on the graft survival. Methods: The data have stratified to reflect differences in 1) immunosuppressants; 2) HLA matching; 3) donor sources; 4) graft number; 5) diabetics; 6) HBV status; 7) donor specific transfusion (DST); 8) number of pretransplant blood transfusion. Results: Overall actuarial 5-year patient and graft survivals were 77% and 66%, respectively. The actuarial 5-year graft survivals for the Aza-(n=141) and the CsA-(n=431) treated recipients were 51% and 76% respectively (p=0,00001), The actuarial 5-year graft survivals for the HLA-identical (n=4), haploidentical (n=85) and mismatched (n=26) groups were 75%, 54g and 3196 in the Aza group (p-0.0159); and HLA-identical (n=14) 77% haploidentical, (n=197) 77% 4mismatched groups (n=220) 81% in the CsA group (p= 0. 7432). The actuarial 5-year graft survivals according to related (n=294), non-related living donors (n=275) and cadavers (n =9) were 66%, 70% and 44%, respective- 1v (p=0.1182). The actuarial 5-year graft survivals for the first graft (n=578) and regraft (n=22) were 66% and 35% respectively (p=0.1751). The actuarial 5-year graft survivals for the diabetics (n=18) and non-diabetics (n=560) were 62% and 66%, respectively (p=0.5457). The actuarial 5-year graft survival for the HBV positive (n=47) and the negative (n =381) groups were 61% and 78%, respectively (p=0.1195). The actuarial 5-year graft survivals according to DST (n=123) and non-DST (n=314) in the CsA-treated recipients were 75% and 76%, respectively (p=0.6538); and the number of pretransplant blood transfusion, 0 (n=54), 1-4 (n=180) and over 5 (n=206) units groups were 77%, 71 and 73% respectively (p= 0.7929). Conclusion: The best graft survivals were obtained in recipients who received CsA for immunosuppression, and HLA-identical for the Aza group; but not in the HLA matching for the CsA group, donor sources, diabetics or not, HBV status, graft number, DST and number of pretransplant transfusion.

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      • KCI등재후보

        신이식환자에서 Cyclosporine 의 치험;제 1 보

        윤영석,이용각,방병기,김호연,고용복 대한내과학회 1986 대한내과학회지 Vol.30 No.2

        Between May, 1984 and May, 1985, twenty-one patients received kidney transplants from living related donor in 18 and from non-related donor in 3 were treated with cyclosporin A(CsA). On May, 1985, actuarial patient survival rates at one year were 94% in the CsA group and 80g in the Aza group(p$lt;0.05), and the corresponding graft survival rates were 94%$lt; in the CsA group and 76% in the Aza group(p< 0.01). The hirsutium, hypertension, tremor, nephrotoxicity k infection were common side effect in CsA group. The nephrotoxicity, however, was easily manageable through management strategy. Episodes of acute rejection were not frequent & occurred 2 times in 2 patients. All the patients except one had good renal funcuion immediately after transplantation, In one case treated with CsA-steroid, a fatal complication occurred due to status epilepticus with acute brain dysfunction. Results of these experience have shown that CsA was superior immunosuppresive regimen used. With small dose of steroid.

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