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장기이식 환자에서 발생하는 위장관 합병증

Gastrointestinal Complication in Transplant Patients

정대영|김진일|김건민
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2010.08|Clinical Endoscopy|제41권 제2호|pp. 65-71

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이식TransplantationImmunosuppressionGastrointestinal diseases면역억제제위장관 질환이식편대숙주병Graft- Versus-Host Disease
주제분류내과학

초록

장기 이식이나 조혈모세포 이식 후 위장관 합병증은 비교적 흔히 발병하며 삶의 질을 감소시키고, 치명적인 경우가 있어 사망률을 증가시킨다. 조혈모세포 이식 후 면역이 저하되는 과정은 생착 전 단계, 조기 생착 단계, 후기 생착 단계로 분류할 수 있으며 각 단계 별로 빈번히 발생하는 합병증이 있다. 장기 이식 후 흔히 발생하는 위장관 합병증으로는 점막염, 구토, 복통 등이 있고, 또한 설사, 혈변, 맹장염 등이 관찰된다. 이중 중요한 합병증으로는 이식편대숙주병이 가장 많고, 거대세포 바이러스를 비롯한 바이러스 감염, C. difficile에 의한 위막성결장염이 등이 나타날 수 있다. 이외에도 위장관 궤양성 질환, 낭성장기종, 혈전미세혈관병증, 이식후림프세포증식질환 등이 발생할 수 있다. 장기 이식 후 발생하는 위장관 합병증의 증상은 비 특이적이어서 진단이 어려우며 또한 면역 기능이 억제된 상태여서 내시경 등의 적극적인 검사를 하기도 어렵다. 또한 항암제나 항생제 뿐만 아니라 대부분의 면역억제제가 위장관 합병증을 일으키므로 감별 진단을 하여야 한다. 이식 후 정확한 조기 진단 및 조기 치료가 이환율 및 사망률을 낮출 수 있으므로 환자의 증상을 중심으로 내시경 검사와 조직 검사, 혈청학적인 검사, 방사선 검사 등의 적극적인 검사를 이용하여 조기에 진단하는 것이 이식 후 위장관 합병증을 치료 하는 데에 매우 중요하다.

Abstract

The gastrointestinal tract is one of the major sites for complications after solid organ and hematopoietic stem cell transplantation, and gastrointestinal complications are the principle cause of morbidity and death. The major gastrointestinal complications after transplantation include mucositis, typhlitis, infectious enterocolitis by virus, bacteria or fungus, pseudomembranous colitis, gastric ulcer, graft- versus-host disease, pneumatosis cystoides intestinalis, thrombotic microangiopathy and post-transplantation lymphoproliferative disease. Symptoms and signs of gastrointestinal complications following transplantation are often non-specific and present with varying severity. Moreover, the suppressed immune state often prohibits invasive studies including endoscopy and blurs the serologic and hematologic results. Therefore, it is hard to reach accurate diagnoses even after thorough investigations. Almost all immunosuppressive drugs can lead to gastrointestinal complications and we need proper strategies to minimize their side effects. On the one hand, we can expect better organ and patient survival through the judicious use of a broad range of immunosuppressive drugs; on the other hand, we should try to not ruin survival through proper precautions and early treatment of gastrointestinal complications following successful transplantation.

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