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김진영 ( Jin Young Kim ),이주하 ( Jennifer Lee ),이성은 ( Sung Eun Lee ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),문인성 ( In Sung Moon ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),고용복 ( Yong Bok Koh ),방병기 ( Byu 대한내과학회 2007 대한내과학회지 Vol.73 No.1
목적: 새로운 면역억제제의 도움으로 급성 거부반응의 발생률이 꾸준히 감소되고 신이식 환자의 수명을 증진되면서 이식 후 발생하는 악성종양이 사망의 중요한 원인이 되었다. 저자들은 신이식환자의 추적기간별 악성종양 발생률의 변화를 알아보고자 하였다. 방법: 1969년부터 2005년까지 가톨릭대학교 강남성모병원에서 신장이식을 시행 받은 1500예를 대상으로 하였다. 평균 추적관찰기간은 108±77개월이었다. 신이식환자의 악성종양 발생률, 임상경과, 치료 및 예후를 후향적으로 조사하여 일반인과 비교하였다. 결과: 7% (103명에서 105예)의 환자에서 악성종양이 발생하였다. 남자보다 여자의 암발생률이 높았고, 가장 흔한 암은 남자의 경우 위암, 여자의 경우 자궁경부암이었다. 1990년, 1995년, 2000년, 2005년 누적발생률은 0.72%, 2.91%, 4.62%, 7.0%로 점진적으로 증가하였다. 신이식환자의 암발생률은 일반인보다 높았고, 특히 악성 임파종, 피부암, 갑상선암, 카포시 육종, 비뇨 생식계암이 높은 발생률을 보였다. 초기 면역억제제에 따른 악성종양의 발생은 AZA 8.3%, CsA 7.6%, FK 506 3.4%이었으나 이식 후 발생시기는 AZA 172±61개월, CsA 91±49개월, FK 506 57±28개월로 AZA, CsA에 비해 FK506을 투여 받은 환자에서 악성종양이 보다 일찍 발생하였다. 임상적 경과는 37명이 사망하고(21명은 종양으로 인한 사망), 51명은 현재까지 생존하고 있다(7명은 이식신기능상실). 결론: 추적기간이 길어지면서 악성 종양의 발생률이 점진적으로 증가하고 있다. 암발생률을 감소시키기 위한 적극적인 암검진 프로그램이 필요할 것으로 생각된다. Background: Strong immunosuppressive regimens have steadily improved both graft and patient survival, but posttransplant malignancy is still a clinical issue that needs to be resolved. Methods: There were 1,500 transplant recipients between 1969 and 2005 at Kangnam St. Mary`s hospital. The mean follow-up period was 108 77 months. We retrospectively analyzed the incidence, clinical course, treatment and prognosis of malignancy in the kidney transplant recipients. Results: The incidence of malignancy after transplantation was 7.0% (10.5 cases out of 103 patients). The incidence of malignant lymphoma, thyroid cancer, renal cell carcinoma and Kaposi`s sarcoma were higher in the renal transplanted patients than in the general population. The cancer incidence for women was higher than that for men, with stomach cancer being the most common in males and uterine cervix cancer the most common in females. The cumulative incidence of posttransplant malignancy at 1990, 1995, 2000 and 2005 were 0.72%, 2.91%, 4.62% and 7.0%, respectively. The cancer incidence with the use of initial immunosuppressive agents was 8.3% for azathioprine, 7.6% for cyclosporine, and 3.4% for tacrolimus. The mean times for making the diagnosis of malignancy after transplantation were 172±61 months for azathioprine, 91±49 months for cyclosporine, and 57±28 months for tacrolimus, respectively. During the observational period, 37 patients died (21 patients died of cancer) and 51 patients were still alive (7 grafts failed). Conclusions: The incidence of malignancy after renal transplantation increases according to the longer follow-up period. An active screening program is needed to lower the incidence of malignancy in renal transplant recipients.(Korean J Med 73:67-75, 2007)
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한상우 ( Sang Woo Han ),김진영 ( Jin Young Kim ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),문인성 ( In Sung Moon ),김동구 ( Dong Goo Kim ),고용복 ( Yong Bok Koh ),방병기 ( Byu 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.1
Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.
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