Korean Journal of Nephrology 1994;13(1):179-186.

체내 철 과부한 환자에서 신이식후 혈청 Ferritin치의 변화

박성배 , 김현철 , 조원현 , 박철희 , 전효진 , 전동석 , 이성문

Abstract

Background
Following successful kidney transplantation, renal anemia is corrected during the first 3-4 months and serum ferritin (SF) levels decreased markedly during the first 3 months posttransplant. However, renal transplant recipients (RTR) with severe iron over- load had a gradual decrease of SF levels after transplan- tation. It is suggest that evolution of SF levels after transplantation is mainly determined by previous state of iron storage. Methods: Twenty-four patients (16 males, 8 females, mean age 35.6±2.2 years) underwent renal transplantation between February 1989 and September 1992. All patients were living-donor kidney recipients with high basal SF levels (> 350 ng/ml). Group I (N =12, SF: 350 -800 ng/ml) had above normal basal SF levels and Group II (N = 12, SF: > 800 ng/ml) had a high basal SF levels. SF levels quantified with microparticled enzyme immunoassay technique in all patients at pretransplant, 3, 6, 9 and 12 months after transplantation. Five patients in group Il were intermittent phlebotomized 3 months after transplantation. Magnetic resonance (MR) images of 6 patients were obtained using a 2.0 tesla spectro 20, 000. Results: Mean Hb Levels increased in 24 RTR from 7. 3±.2g/dl before transplantation to 13.3±0.3g/dl 3 months after transplantation. The mean SF level of Group I showed a rapid decreased from 572± 37 ng/ml before transplantation to 195±60 ng/ml at 3 months after transplantation. In Group II, the mean SF level decreased gradually from 1,806±389 ng/ml before trans- plantation to 1,084±387ng/ml, 774±147ng/ml, at 6 months and 12 months posttransplant. At the 24 months posttransplant, mean SF level was 616±99 ng/ml. Five patients of Group II who underwent intermittent phlebotomy, SF level decreased from 2,384±641ng/ml before transplantation to 1,094±278 ng/ml at 12 months posttransplant. MR imaging of 6 patients in Group II (basal SF: > 1,000 ng/ml) was evaluated. Signal intensity of liver was relatively lower than paraspinal muscles and nearly equal to background noise. Conclwion: RTR with high basal SF or hemo- chromatosis should receive more intensive form of therapy including intermittent phlebotomies for prevent progress to subsequent liver dysfunction. SF level be monitored with regular intervals because of their persistent high ferritin levels after transplantation. Also, MR imaging serve as a noninvasive diagnostic tool and guidance for therapeutic decisions.