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김명규 ( Myung-gyu Kim ) 대한내과학회 2020 대한내과학회지 Vol.95 No.1
Kidney transplantation (KT) is the best way to improve the quality of life and survival of patients with end-stage renal disease. However, after KT the adaptive immune system plays important roles in the development of rejection via multiple pathways. Accordingly, the suppression or modulation of these pathways is key to allograft survival. Advances in our understanding of the immunology related to KT with the development of immunosuppressants have reduced the rate of acute rejection and improved short-term transplant outcomes. Nonetheless, de novo donor-specific antibodies and subsequent chronic rejection continue to be responsible for the poor long-term survival of transplanted patients. In addition, the morbidity and mortality rates in patients returning to dialysis after graft failure are high. Better long-term outcomes following KT require innovative treatment strategies that include a focus on de novo antibodies. Here, we review basic transplant immunology as well as the diagnostic tools and medications that contribute to successful KT. We also provide an update on newly developed immunosuppressants. (Korean J Med 2020;95:18-26)
신장 이식 환자에서 CMV duodenitis 치료 후 병발한 Pneumocystis jirovecii 폐렴 1예
김혜원 ( Hye Won Kim ),김명규 ( Myung Gyu Kim ),우영석 ( Young Seok Woo ),부창수 ( Cang Soo Boo ),조상경 ( Sang Kyung Jo ),김형규 ( Hyoung Kyu Kim ),조원용 ( Won Yong Jo ),이광균 ( Kwang Gyun Lee ),김혜옥 ( Hye Ok Kim ),오초롱 ( C 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5
Solid organ transplant recipients are at increased risk for various opportunistic infections because of their immunocompromised state. Pneumocystis jirovecii (carinii) infection has posed serious problems in these patients which can be life threatening. It has been reported that incidences of Pneumocystis infection have dramatically decreased with the use of prophylactic antibiotics. However, there have been reports that say the risks of Pneumocystis infection are increasing with the use of new immunosuppressive drugs and in presence of preceding immunomodulating infections such as CMV infection which is another common opportunistic infection in transplant patients. There were only a few case reports abroad on Pneumocystis infection following CMV infection in patients who underwent kidney transplantation. In Korea, however, there hasnt been any report of such cases. Herein we report a case of a kidney transplant patient who experienced a serious episode of Pneumocystis jirovecii pneumonia following CMV duodenitis. After adequate mechanical ventilation and use of antibiotics the patient completely recovered without any complications.