대한신장학회

논문분류	춘계학술대회 초록집
제목	Failed Renal Allograft, Graft Nephrectomy, and Graft Intolerance Syndrome
저자	Jong Cheol Jeong2, Hyuk Yong Kwon2, Yoon Jung Kim2, Tai Yeon Koo, Hee Jung Jeon1, Miyeun Han1, Curie Ahn1, Jaeseok Yang2
출판정보	2013; 2013(1):
키워드	신장 이식, 이식 신 불내성 증후군, 이식 신 적출/ Failed Renal Allograft, Graft Nephrectomy, Graft Intoleran
초록	Background: As kidney transplantation (KT) cases have accumulated, optimal management of failed kidney, and preparation for re-transplantation become important issues. Allosensitization could be a major hurdle to successful re-transplantation. We investigated natural course, and management of failed renal allograft, and its impact on allosensitization. Methods: Among 1274 KT cases which were performed in Seoul National University Hospital during 1996-2012, cases of failed graft were reviewed. Clinical variables including panel reactive antibody (PRA), nephrectomy, and graft intolerance syndrome (GIS) were studied. Results: Over the 3.7 years of median follow-up period, 100 patients lost renal allografts. The mean age at KT was 30.0±17.5 years old. The mean graft survival was 4.7±4.2 years. Thirty nine patients received nephrectomy. The mean graft survival was shorter in patients with nephrectomy (2.2±2.8 vs. 6.2±4.3 years, p<0.001). There was no mortality related to nephrectomy. Desensitization, diabetes, or cardiovascular disease were not associated with the nephrectomy group; however, hypertension was associated with the group without nephrectomy (OR 20.9, p=0.029). GIS was cause of nephrectomy in 28.2% of cases, and more prevalent in late (>1 years after KT) nephrectomy group (43.5% vs 6.25% p=0.014). Acute rejection was the most common cause of nephrectomy in both early and late nephrectomy groups. Primary nonfunction (25%) and surgical problem (25%) were second most common causes in early nephrectomy group, whereas fever (17.4%) and graft malignancy (13.0%) was in late graft nephrectomy. PRA class I/II increased after graft failure (Class I; 5.2±15.2 vs. 34.0±40.7, p=0.002, Class II; 11.9±28.1 vs. 34.1±30.8, p=0.008, respectively). There were no significant difference in PRA class I/II after graft failure between patients with or without nephrectomy. Among the 23 cases of kidney re-transplantation, there was no difference in acute rejection incidence (60% vs. 69.3%, p=0.685), rejection free survival (10.5 days vs. 11 days, p=0.535), and PRA prior to 2nd transplant (Class I; 0±0 vs. 34.4±43.4, p=0.109, Class II; 27.2±42.1 vs. 16.6±22.1, p=0.553) between the nephrectomy group and the nephrectomy-free group.
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