중국에서 신장 이식수술을 받고 귀국한 환자의 문제점

Abstract

Purpose: The number of patients awaiting for renal allograft is continuously increasing as the kidney donors are limited worldwide. Undesirably, for this reason, more and more patients are currently visiting China for renal allograft worldwide, and Koreans are not an exception in this unhappy environment.

Methods: We analyzed 21 patients who are on follow-up in our hospital after receiving a renal allograft in China and return back to Korea. Surgical complications at the time of their arrival, prevalence of infection and kinds of immunosuppression, and finally their outcome were evaluated.

Results: Of 21 patients, 15 patients were male. The age ranges from 30 to 62 years old. At the time of their arrival, 14 were on tacrolimus-, and 7 were on cyclosporine-based triple immunosuppression including mycophenolate mofetil (MMF) and steroids. The doses of MMF were different (1~1.5 g/day in 5, 2 g/day in 15, and 2.5 g/day in 1 patient) center to center in China. Most of patients had received daclizmab for once or twice doses during their stay in China. They recommended further doses in Korea. Acute rejection episode was detected in 3 patients 17, 36, and 39 days after operation. All of them recovered completely after steroid pulse therapy. Three patients developed HCV-RNA-PCR positive C-viral hepatitis and 3 patients developed CMV-IgM positive viral infection. Two patients died during the follow-up. One patient died 15 months after operation due to rapid progression of liver failure after acquiring C-viral hepatitis immediately after renal transplantation. The other patient died 39 day after operation due to systemic sepsis caused by Aureobasidium Pullulans fungal infection. In 2 patients, significant urinary leakage were developed requiring surgical intervention.

Conclusion: Patients who had received renal allograft in China and returned back seem to be exposed more likely and easily to infections and surgical complications. Therefore, at the arrival of patients, strict evaluation of viral, fungal infection should be carried out and net amount of immunosuppression should be tailored.