사체신이식에서 이식신생존율에 영향을 미치는 사체공여자의 위험인자 분석
The Analysis of Risk Factors of Donor Affecting the Graft Survival in Cadaveric Kidney Transplantation
공필성, 최인성, 이광웅, 김성주, 송건도, 이석구, 김용일, 이병붕, 조재원,
소속 상세정보
공필성 ( Kong Pil-Sung )
성균관대학교 의과대학 삼성서울병원 일반외과
최인성 ( Choi In-Seok )
건양대학교 의과대학 외과학교실
이광웅 ( Lee Kwang-Woong )
성균관대학교 의과대학 삼성서울병원 일반외과
김성주 ( Kim Sung-Ju )
성균관대학교 의과대학 삼성서울병원 일반외과
송건도 ( Song Geon-Do )
성균관대학교 의과대학 삼성서울병원 일반외과
이석구 ( Lee Suk-Koo )
성균관대학교 의과대학 삼성서울병원 일반외과
김용일 ( Kim Yong-Il )
성균관대학교 의과대학 삼성서울병원 일반외과
이병붕 ( Lee Byung-Boong )
성균관대학교 의과대학 삼성서울병원 일반외과
조재원 ( Cho Jae-Won )
성균관대학교 의과대학 삼성서울병원 일반외과
KMID : 0371320010600030281
Abstract
Purpose: The supply of donor organs does not meet the demand of transplantation. To find a possible way of expanding the donor pool, we have evaluated the risk factors of cadaveric donors that influence the graft survival.
Methods: Between Feb. 1995 and Dec. 1999, we performed 200 cases of cadaveric kidney transplantation. The graft survival rates in 1 yr, 2 yr, & 3 yr are 93.0%, 91.1%, & 89.9%, respectively. We defined the marginal donor as a donor who possesses one of the risk factors of donor age ≥50, or ≤5 year old (n=18), ICU stay ≥10 days (n=46), history of hypertension (n=30), CPR ≥20 min (n=7), prolonged hypotension (SBP ≤80 mmHg, over 6 hr) (n=40), high dose inotropic support (dopamine ≥20μg/kg/min, or dobutamine ≥15μg/kg/min) (n=78), serum creatinine level ≥2.5 mg/dl (n=16), or cold ischemic time ≥12 hr (n=34). We compared graft survival rates between the marginal donor group and the non-marginal donor group, and analyzed risk factors affecting graft survival by univariate and multivariate methods.
Results: CPR ≥20 min (71.5%, 71.5%, - vs 93.8%, 91.8%, 90.6%, p=0.027), prolonged hypotension (85.0%, 85.0%, 80.3% vs 95.0%, 92.6%, 92.6%, p=0.028) and serum creatinine ≥2.5 mg/dl (75.0%, 75.0%, 75.0% vs 94.6%, 92.4%, 91.0%, p=0.001) affect graft survival in univariate analysis. There is, However, no risk factor that affects graft survival in multivariate analysis.
Conclusion: We can increase the supply of donor organs for kidney transplantation by the selective use of high-risk cadaver donor. However, a prospective randomized study including recipient factors is needed to define the acceptable conditions better.
키워드
사체 신이식;위험인자;이식편 생존율
Cadaveric kidney transplantation;Risk factors;Graft survival
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