The Korean Journal of Medicine

  • 제80권2호
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  • Pages.167-178
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

국내 단일기관에서 시행한 췌장이식의 임상적인 결과

Outcomes of Pancreas Transplantation: Single-Center Experience in Korea

  • 한덕종 (울산대학교 의과대학 서울아산병원 외과) ;
  • 김송철 (울산대학교 의과대학 서울아산병원 외과) ;
  • 박재범 (울산대학교 의과대학 서울아산병원 외과) ;
  • 김영훈 (울산대학교 의과대학 서울아산병원 외과) ;
  • 박관태 (울산대학교 의과대학 서울아산병원 외과) ;
  • 홍정자 (울산대학교 의과대학 서울아산병원 장기이식센터) ;
  • 하희선 (울산대학교 의과대학 서울아산병원 장기이식센터) ;
  • 정주희 (울산대학교 의과대학 서울아산병원 외과) ;
  • 김인구 (울산대학교 의과대학 서울아산병원 외과) ;
  • 박건춘 (울산대학교 의과대학 서울아산병원 외과) ;
  • 민병철 (울산대학교 의과대학 서울아산병원 외과)
  • Han, Duck-Jong (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Song-Cheol (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jae-Berm (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hoon (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Kwan-Tae (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Jung-Ja (Department of Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ha, Hea-Seon (Department of Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Ju-Hee (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, In-Koo (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Kun-Choon (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min, Pyung-Chul (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2011.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 췌장이식은 인슐린 의존형 당뇨병에서 1966년 미네소타대학 병원에서 처음 시행된 수술로써 인슐린을 끊을 수 있는 유일한 치료법으로 이식수술 후 합병증의 감소, 면역억제제 및 수술 후 관리의 개선으로 널리 시행되고 있다. 국내에서는 1992년 첫 췌장이식이 시행된 이래 점차 늘어가고 있지만 아직 활발히 이루어지고 있지는 못하다. 이에 저자들은 1992년 7월부터 2009년 12월까지 국내 단일기관에서 시행한 췌장이식의 임상 결과를 분석하여 보고하고자 한다. 방법: 본원에서는 1992년 7월 이후 2009년 12월까지 18년간 119명의 당뇨병 환자에서 췌장이식을 시행한바 이를 후향적으로 분석하여 췌장 이식의 임상적인 결과를 분석하였다. 결과: 이식수혜자의 당뇨병 분류로 총 119명 중 인슐린 의존형이 93명(78.2%)이었고, 16명(13.4%)에서는 Type II형 이었다. 기증자는 뇌사자가 107명(89.9%), 그리고 12명(10.1%)에서는 가족간 생체기증이었다. 당뇨합병증으로 신 췌장동시 이식이 67명(56.3%)이었고, 42명(35.3%)에서는 췌장단독이식, 10명(8.4%)에서는 이미 신장이식을 받은 환자에서 췌장이식이 시행되었다. 수술 후 췌장 이식편 생존율은 81.6% (1년), 63.4% (5년), 그리고 57.1% (10년)이었다. 면역억제제로 tacrolimus와 MMF를 사용한 1999년 이후(n=96) 췌장 이식편생존율은 89.1% (1년), 72.9% (5년), 그리고 66.2% (10년)이었고, 환자의 생존율은 93.0% (1년), 86.0% (5년), 그리고 86%(10년)이었다. 결론: 최근 췌장이식 수술의 향상된 성적으로 삶의 질과 장기 환자 생존을 고려할 때, 췌장 이식은 당뇨병의 유형에 상관 없이 인슐린 투여가 필요한, 심각한 당뇨 합병증 또는 인슐린 투여 관련 합병증의 위험에 놓여 있는, 비비만형 당뇨병 환자들에게 효과적인 치료로 제시 될 수 있다.

Background/Aims: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. Methods: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. Results: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. Conclusions: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes.

키워드

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