생체 신장이식 후 사용한 Calcineurin Inhibitor의 종류에 따른 이식성적 비교

Abstract

Purpose: In order to achieve an adequate immunosuppression and avoid side effects of immunosuppressant, various combination of immunosuppressant have been tried. Methods: To review the result of living donor renal transplantation according to the type of calcineurin inhibitor (group 1: microemulsion cyclosporine with mycophenolate mofetil and steroid (n=53) / group 2: tacrolimus with mycophenolate mofetil and steroid (n=44))，we retrospectively reviewed renal transplant recipients between January 1997 through December 2001 in Dongsan medical center. Results: The biopsy proven acute rejection rate were 30.2% in cyclosporine group, while 20.5% in tacrolimus group. Among the 9 cases of acute rejection in tacrolimus group, four cases were associated with BK virus infection. The response rate of acute rejection to steroid pulse therapy was 75.0% and 66.7% in group 1 and 2 respectively. There were no statistical difference in serial changes of serum creatinine after transplantation, number of recipients whose semm creatinine more than 2.0 mg% and proteinuria more than 100 mg/dL, checked at one year. To treat the side effect and intractable acute rejection, calcineurin inhibitors were exchanged each other in 5 recipients. Average steroid daily dosage at one year was 7.10±2.82 mg in cyclosporine group while 5.27±1.45 mg in tacrolimus group. Overall graft survival were no significant difference between groups up to 24 months but in recipients who developed acute rejection showed better graft survival in cyclosporine group while recipients without acute rejection had better survival in tacrolimus group. Conclusion: Tacrolimus based immunosuppression showed lower incidence of acute rejection and better steroid sparing effect but developed more polyoma virus infection which eventually deteriorate graft function and survival up to two years.