신장 이식 후 동정맥루 문합이 좌심실 질량 및 기능에 미치는 영향
Effects of Closure of The arteriovenous Fistula on Left Ventricular Mass and Function In Kidney Transplantion Patients
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배경 및 목적 : 신이식 환자에서 좌심실 비대는 사망률을 예측하는 독립적인 위험 인자이며, 혈액 투석을 위해 동정맥루를 형성한 경우좌심실 비대를 유발할 수 있다. 안정적인 신이식 환자에서 동정맥루를 문합하는 것이 좌심실의 질량 및 기능에 미치는 영향에 대하여 알아보고자 하였다. 방 법 : 만성 신부전으로 신장이식을 시행한 환자를 대상으로, 46명의 기능성 동정맥루를 가진 신장이식 후의 환자를 23명씩 두군으로 나누어 한 군은 동정맥루 문합을 시행하고 (FC group,n=23), 나머지 한 군은 시행하지 않았다 (FM group, n=23).11Effects of Closure of the Arteriovenous Fistula｜San Kim, et al.Journal of Cardiovascular Ultrasound 15 ｜March 200712이 두 군에서 0, 1, 6개월 간격으로 경흉심초음파와 혈액검사를 시행하였다. 결 과 : 동정맥루 문합을 시행한 군에서, LVMI가 문합을 시행하기 전보다 시행한 후에 유의하게 감소한 양상을 보였다. 특히 문합 시행 후 1개월째가 그 이후 (6개월) 보다 LVMI의 유의한 감소 양상을 보였다 (시행 전 137±33, 1개월 130±32, 6개월 128± 33, 시행 전과 1개월의 p=0.014, 시행 전과 6개월의 p=0.003, 1개월와 6개월의 p=0.185). 결 론 : 신장이식 후에도 동정맥루는 좌심실 비대를 유발 시킬 수 있 으며, 동정맥루 문합은 좌심실 비대를 호전시킬 수 있다. 그러 므로 신이식후 이식신 기능이 잘 유지되는 환자의 경우는 좌심 실 비대의 호전을 위해 동정맥루 문합 시행을 고려할 수 있다.
Abstract
Background : Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplantion recipients. Enhanced cardiac load by the persistence of functioning AVF in posttransplant period is associated with LV hypertrophy and may adversely influence cardiac outcome. Methods : To investigate the impact of AVF on LV mass and function in kidney transplant recipients, 46 patients with functioning AVF were randomly assigned to surgical closure of AVF (fistular closing group, FC, n=23) or maintenance of fistula (fistular maintenance group, FM, n=23). Serum creatinine of all participants was stable(1.4±0.3). Mean age was 46±11. Mean posttransplant month was 78±53 (12-161). Echocardiography and determination of N-terminal pro-BNP, cTnT and CRP were done at 0, 1 and 6 months in group 1 (FC), and at 0 and 6 months in group 2 (FM). Results : Baseline echocardiographic indices of systolic and diastolic LV function such as EF, E/A, E/E’and Tei index were not significantly different between groups. In patients whose AVF was surgically closed, LV mass (247.7±76.8 to 235.2±66.5, p=0.015) and LV mass index (144.0±10.1 to 137.1±8.6, p=0.02) significantly reduced at one month after closure, and no further significant change was observed at 6 months. In two groups no significant change in LV systolic and diastolic performance indices were observed. BNP, cTnT and CRP did not differ between groups in baseline value and did not change after closure. Conclusion : We conclude that the persistence of functioning AVF in kidney transplantation recipients is associated with LVH, and which can be reduced by closure of fistula. As LVH is one of major determinants of cardiovascular outcome in transplant patients as well as in general population, it would be prudent to close the fistula in patients with stable graft function.
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