소아 신장이식 후 성장에 대한 평가
Evaluation of Effect of Renal Transplantation on Growth in Children with Chronic Renal Failure
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목 적 : 소아 신장이식 환아의 현황을 파악하고, 특히 신장이식이 이식 후 성장에 미치는 영향을 알아보고자 하였다. 방 법 : 1992년 4월부터 2004년 6월까지 인제대학교 부속 부산백병원에서 소아 신장이식을 받은 17명의 환아를 진료 기록지를 통하여 연령 및 성별 분포, 원인 질환, 공여자 분석, 환아 생존율, 이식신 생존율, 신장이식 후 경과, 신장이식 후 성장과 발달 등을 후향적 분석하였다. 결 과 : 신장이식을 시행한 17명(남자 8명, 여자 9명)의 이식 당시 평균연령은 15.8±3.5세였다. 신장이식 전까지 투석 기간은 평균 22.4±18.0개월이었다. 공여자는 생존 혈연 공여자가 11명, 이중 부모가 10명, 형제가 1명이었으며, 사체 공여자는 7명이었다. 환아들의 1년, 5년 생존율은 각각 100%였고, 이식신의 1년, 5년 생존율은 각각 88%, 36% 이었고, 이식신 기능상실의 가장 많은 원인은 만성 거부반응이었다. 14명 중 10명에서 신장이식 후 최종 추적관찰 기간까지 신장증가(1.0-23.0 cm)가 나타났다. 최종 신장치는 여자 8명의 경우 154.5±12.1cm(135.8-160.0 cm)이었고, 남자 6명의 경우는 162.8±10.0 cm (143.0-172.5 cm)이었다. 전체 환아군의 신장이식 전 신장 SDS는 -1.95로 신장이식 후 신장 SDS -1.53와 비교하였을 때 신장 SDS는 호전되었으나 통계적으로 유의한 차이는 없었다(P= 0.4474). 환아 개개인을 대상으로 한 신장이식 전 후의 신장의 변화도 통계적으로 유의하지 않았다. 생존 혈연 공여자군와 사체 공여자군 사이에도 유의한 차이가 없었다(P=0.3077). 결 론 : 본 연구는 신장이식 자체만으로는 신장이식 전부터 나타난 성장저하를 치료하지 못한다는 사실을 뒷받침해 주고 있다. 그러므로 만성 신부전 환아에서 신장이식 후 보다 효과적인 성장의 증대를 기대하기 위해서는 초기 만성신부전의 고식적 치료시기에 대사 및 영양장애의 효율적 관리, 빈혈 조절 등 성장증진을 위한 일반적인 치료와 함께 성장호르몬 치료를 이용한 적극적인 성장증진을 유도하는 것이 필요하며, 조기 신장이식을 권장하고 투석치료 기간을 가능한 단축하는 것이 바람직할 것으로 생각된다.
Abstract
Purpose : We aim to identify the clinical and demographic characteristics in children who underwent renal transplantation(RTx) and to evaluate the influence on growth of RTx in children. Methods : We reviewed 17 medical records of chronic renal failure patients who underwent RTx from April 1992 and June 2004 at Busan Paik Hospital. Age and sex distribution, cause of disease, donor analysis, patient and graft survival rate, and the status of growth after RTx were analysed by retrospective study. Results : Eighteen RTx were performed in 17 patients(8 boys, 9 girls). The mean age at the time of RTx was 15.8±3.5 years and the mean duration of dialysis therapy before RTx was 22.4±18.0 months. The 1 year and 5 year patient survival rate were each 100%, and the 1 year and 5 year graft survival rate were 88%, 36% respectively. The most common cause of graft failure was chronic rejection. The mean final height of male patients was 162.8±10.0 cm(143.0-172.5 cm) and of female patients was 154.5±12.1 cm(135.8-160.0 cm). The mean height standard deviation score(Ht SDS) increased after RTx from -1.95 to -1.53 but the increment rate was not statistically significant. Similar changes were noted in individual patient analysis. Also there was no significant difference between the living-related donors and cadaveric donors. Conclusion : Our data shows that even successful RTx rarely results in full growth rehabilitation. To overcome retarded growth in children with chronic renal failure, appropriate combined management of metabolic and nutritional problems, correction of anemia, proper use of recombinant growth hormone therapy, early renal transplantation and shortening of the duration of dialysis would be necessary.
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