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논문분류	춘계학술대회 초록집
제목	Incidence and Risk Factors for Adrenal Insufficiency after Kidney Transplantation
저자	Jung Nam An1, Jin Ho Hwang3, Sunhwa Lee2, Sejoong Kim4, Young Hoon Kim5, Yun Kyu Oh1, Duck-Jong Han5, Su-Kil Park6, Chun Soo Lim1, Curie Ahn7, Yon Su Kim2, Jung Pyo Lee1
출판정보	2015; 2015(1):
키워드	신장이식,부신피질기능저하증,위험인자
초록	Corticosteroid, which has been the mainstay of immunosuppressive treatment after kidney transplantation, is associated with several clinical problems including adrenal insufficiency (AI), therefore remains controversial as to its duration of administration, optimal dose and the tapering strategy. We analyzed the incidence, clinical features, and risk factors, and then investigated the clinical outcomes of AI. Among the 1189 Korean patients who underwent kidney transplantation in a single center cohort from 1997 to 2012, a total of 922 patients were enrolled in this study. The patients with symptoms implying AI had standard adrenocorticotropin stimulation test, and were diagnosed according to peak cortisol level measured at 30-60 minutes after corticotropin administration. Symptomatic AI was diagnosed in 16 (1.7%) recipients during a mean follow-up period of 70 months. The incidence was higher in patients with larger cumulative dose of steroid (7798.7±2013.6 mg vs. 6477.2±1619.3 mg) as well as in patients who treated for longer duration more than 1 year (93.8% vs. 68.8%). AI was significantly associated with the patients with older-age, the higher level of HLA mismatch, and lower pretransplant albumin level. Biopsy proven acute rejection was also risk factor for the development of AI. However, there were no associations between AI and gender, comorbidities, donor type, and immunosuppressant. Furthermore, adrenal insufficiency was independently associated with post-transplant cardiovascular events, graft failure, and mortality. In particular, the risk of infection requiring hospitalization and the number of infection episodes were significantly higher in patients with AI. In conclusion, adrenal insufficiency developed in patients with higher cumulative dose and longer duration of steroid treatment. Older age and acute rejection were associated with the occurrence of AI. The development of AI adversely affected renal and patient outcomes.
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