학술논문
신이식 환자에서 급성 거부반응의 예방에 있어 Mycophenolate Mofetil ( MMF ) 과 Azathioprine 의 비교
Comparison of Prevention for Acute Rejection in Renal Transplantation between Mycophenolate Mofetil ( MMF ) and Azathioprine신이식 환자에서 급성 거부반응의 예방에 있어 Mycophenolate Mofetil ( MMF ) 과 Azathioprine 의 비교
Comparison of Prevention for Acute Rejection in Renal Transplantation between Mycophenolate Mofetil ( MMF ) and Azathioprine신이식 환자에서 급성 거부반응의 예방에 있어 Mycophenolate Mofetil ( MMF ) 과 Azathioprine 의 비교
Document Type
Article
Author
허동 / Dong Heo; 최윤석 / Yun Suk Choi; 박민 / Min Park; 박용기 / Yong Ki Park; 김미선 / Mi Sun Kim; 김중경 / Joong Kyung Kim
Source
Kidney Research and Clinical Practice(구 대한신장학회지). Jan 31, 2002 21(1):117
Subject
Language
Korean
ISSN
2211-9132
Abstract
목 적 : 신이식 후의 급성 거부반응은 만성 거부반응의 원인 인자이며 이식신의 소실 및 환자의 사망과도 관계가 있다. 저자는 생체 신이식에서 면역억제제로 Mycophenolate mofetil (MMF )가 기존의 Azathioprine에 비해 신이식 후 급성 거부반응 발생에 미치는 영향과 부작용에 차이가 있는지 알아보고자 하였다. 방 법 : 대상은 MMF 투여 48명, AZA 투여 60명으로 모두 cyclosporine (Neoral)과 steroid를 복용하였다. 이식 후 1, 3, 6, 12, 18개월 급성 거부반응 발생빈도, 이식신 실패의 원인, 이식신의 기능, 부작용 및 기회감염, 치료 실패의 빈도 등을 비교분석 하였다. 결 과 : 이식 후 3개월 미만의 급성 거부반응의 빈도가 MMF군에서 유의하게 낮았다(14.6% vs 30%, p=0.005). 거부반응의 치료는 steroid 단독 요법과 OKT 3가 필요한 심한 거부반응에서 두 군 간의 차이가 없었다(45.5% vs 56%, p=0.72). 치료실패는 MMF군에서 유의하게 실패율이 낮았고(31.3% v s 55.0% p=0.013), 두 군 공히 급성 거부반응이 가장 흔한 원인이었다. 신이식 6개월 후의 혈청 크레아티닌치는 MMF군이 낮았으며(1.31±0.27 vs 1.50±0.28 mg/dL,p=0.017), 기회 감염의 빈도는 두 군간에 차이가 없었다. 위장관계의 부작용은 MMF군에서 더흔하였으며(14.6% v s 3.3%, p=0.035), 백혈구 감소증은 MMF군에서 적게 발생하였다(4.3% vs 21.7%, p=0.017). 결 론 : MMF는 심각한 부작용 없이 급성 거부반응의 빈도를 감소시켰으며, 만성 거부반응에대한 유용성은 향후 장기적인 연구가 더 필요할 것으로 생각된다.
Background : Acute renal allograft rejection is not only risk factor of chronic rejection but is also a significant cause of graft loss and patient death. MMF has been shown to reduce the incidence and severity of acute rejection. Methods : To compare the risk of acute rejection and side effects of MMF with azathioprine(AZA ), a total of 108 patients, who received living transplants, were divided in two groups : MMF (n=48) and AZA group(n=60). Cyclosporin microemulsion (Neoral) and steroid were administered concomitantly to all patients. Results : The MMF group was significantly lower rate of acute rejection compared with AZA group during the first 3 months after renal transplantation(14.6% vs 30.0%, p=0.005). 54.5% of patients in the MMF group and 44% in the AZA group were treated only with steroid pulsing for acue rejection. 45.5% in the MMF group, compared to 56% in the AZA group, required OKT 3 or Atgam for treatment of severe acute rejection, the difference is not significant. Treatment failure occurred among 31.3% of the MMF group compared with 55% in the AZA group(p=0.013). Serum creatinine of 6 months after transplantation w as significantly lower in the MMF group than in the others (1.31±0.27 vs 1.50±0.28 ㎎/ dL, p=0.017). T he incidence of opportunistic infection was similar in both groups . Gastrointestinal side effects were more common in the MMF group 14.6% than in the AZA group 3.3% (p=0.035), while leukopenia was more common in the AZA group 21.7% than in the MMF group 4.3% (p=0.017). Conclusion : MMF reduced the incidence of acute rejection without notable side effects. Long-term follow up will be needed to establish the protective effect of MMF against immunological attack.
Background : Acute renal allograft rejection is not only risk factor of chronic rejection but is also a significant cause of graft loss and patient death. MMF has been shown to reduce the incidence and severity of acute rejection. Methods : To compare the risk of acute rejection and side effects of MMF with azathioprine(AZA ), a total of 108 patients, who received living transplants, were divided in two groups : MMF (n=48) and AZA group(n=60). Cyclosporin microemulsion (Neoral) and steroid were administered concomitantly to all patients. Results : The MMF group was significantly lower rate of acute rejection compared with AZA group during the first 3 months after renal transplantation(14.6% vs 30.0%, p=0.005). 54.5% of patients in the MMF group and 44% in the AZA group were treated only with steroid pulsing for acue rejection. 45.5% in the MMF group, compared to 56% in the AZA group, required OKT 3 or Atgam for treatment of severe acute rejection, the difference is not significant. Treatment failure occurred among 31.3% of the MMF group compared with 55% in the AZA group(p=0.013). Serum creatinine of 6 months after transplantation w as significantly lower in the MMF group than in the others (1.31±0.27 vs 1.50±0.28 ㎎/ dL, p=0.017). T he incidence of opportunistic infection was similar in both groups . Gastrointestinal side effects were more common in the MMF group 14.6% than in the AZA group 3.3% (p=0.035), while leukopenia was more common in the AZA group 21.7% than in the MMF group 4.3% (p=0.017). Conclusion : MMF reduced the incidence of acute rejection without notable side effects. Long-term follow up will be needed to establish the protective effect of MMF against immunological attack.