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A Case Report of Kidney Graft Failure after Duodenal Bypass Surgery

십이지장 우회술을 받은 신장이식환자에서 반복적 급성 거부반응으로 인한 이식 신소실 1예

  • Kim, Ha-Neul (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Cho, Yul-Hee (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Young-Shin (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Chun, Hyun-Ji (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Su-Jin (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Eun-Oh (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yang, Chul-Woo (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 김하늘 (가톨릭대학교 의과대학 내과학교실) ;
  • 조율희 (가톨릭대학교 의과대학 내과학교실) ;
  • 김영신 (가톨릭대학교 의과대학 내과학교실) ;
  • 전현지 (가톨릭대학교 의과대학 내과학교실) ;
  • 최수진 (가톨릭대학교 의과대학 내과학교실) ;
  • 김은오 (가톨릭대학교 의과대학 내과학교실) ;
  • 양철우 (가톨릭대학교 의과대학 내과학교실)
  • Published : 2012.09.01

Abstract

The calcineurin inhibitor-immunosuppressant tacrolimus is widely used in patients undergoing kidney transplantation. Although tacrolimus is absorbed from the entire gastrointestinal tract, the duodenum is the primary site of its absorption and metabolism. Therefore, duodenal bypass surgery in a renal transplant recipient can significantly disrupt tacrolimus absorption and metabolism. Here, we report a case of allograft failure that developed after duodenal bypass surgery. The patient was a 41-year-old woman who received a deceased donor kidney transplantation. She underwent a gastrojejunostomy due to a duodenal perforation and pancreatitis after endoscopic retrograde cholangiopancreatography. After the surgery, her blood tacrolimus level decreased gradually, and remained lower than therapeutic target levels, even after the tacrolimus dose was increased from 5 to 12 mg/day. Repetitive rejection developed and the patient suffered allograft failure 3 months after bypass surgery. This case raises the importance of drug absorption in renal transplant recipients undergoing duodenal bypass surgery.

Tacrlolumus는 calcineurin inhibitor의 한 종류로서 신이식 후 연역 억제위해 널리 사용되고 있다. Tacrolimu의 흡수는 전 장에서 일어나지만, 십이지장이 흡수와 대사에서 가장 많은 부분을 차지하는 것으로 알려져있다. 따라서 신이식환자에서 십이지장 우회술을 받은 경우 tacrolimus의 흡수과 대사 저하가 발생할 수 있다. 저자들은 신이식을 받은 41세 여자환자가 십이지장 우회술을 받은 뒤 이식실패를 경험한 사례를 보고하고자 한다. 환자는 췌장염으로 입원, 십이지장천공으로 십이지장 우회술 및 위공장연결술을 시행받았고, 수술이후 tacrolimus 용량 증가에도 불구하고 혈중 tacrolimus 농도가 치료 목표 수준을 유지하지 못하였으며, 반복적인 거부반응으로 우회술 3개월만에 이식실패를 경험하였다. 이 증례는 신이식환자가 십이지장 우회술을 받은 경우 약물 흡수의 중요성을 보여주는 사례로 생각된다.

Keywords

References

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