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UW MEDICINE PATIENT EDUCATION TISSUE MATCHING KOREAN 조직적합성검사 신장및췌장이식을위하여 귀하는잠재적기증자와얼마나적합한가를보여줄 4 가지의검사를받을것입니다. 이챕터는그러한검사들과그결과들이어떻게사용되는지를설명합니다. 조직적합성검사란? 조직적합성검사는두사람이양립할수있는지또는비슷한지를알아내는방법입니다.

1 UW MEDICINE PATIENT EDUCATION TISSUE MATCHING KOREAN 조직적합성검사 신장및췌장이식을위하여 귀하는잠재적기증자와얼마나적합한가를보여줄 4 가지의검사를받을것입니다. 이챕터는그러한검사들과그결과들이어떻게사용되는지를설명합니다. 조직적합성검사란? 조직적합성검사는두사람이양립할수있는지또는비슷한지를알아내는방법입니다. 조직적합성검사결과는우리가기증자의장기를환자분몸에넣는 것이안전한지를알아내는것을돕습니다. 기증자양립가능성이란? 기증자양립성이란환자분과기증자의조직이충분히비슷할때환자분의몸이 이식된장기를받아들일가능성이더있다는것입니다. 기증자양립가능성의중요성? 환자분의몸은귀하의몸에위해를끼치는 물질을알아차리는내장된면역체계를 가지고있습니다. 이체계는환자분의몸과다른어떤것이든지맞서서환자분의몸을보호합니다. 이것의주된업무는감염또는질환을일으킬수있는박테리아와바이러스에반응하는것입니다. 이식장기가다른사람의몸으로부터오기때문에한자분의면역체계는이것을자연적으로위협적인존재라고보고거부하려고시도합니다. 만일환자분과잠재적인기증자의양립이가능할경우, 그기증자로부터의장기를귀하의몸이거부할가능성이더낮아집니다. 우리는귀하의이식평가를하는중에귀하의면역체계를알기위하여혈액검사를할것입니다. 어떻게조직적합성검사를합니까? 평가의한부분으로서혈액검사는귀하의면역체계에관하여우리에게말해줄것입니다. 이검사의결과는다음과같은것들을보여줄것입니다 : Page 1 of 4 Tissue Matching

2 혈액형 (O, A, B, or AB) 기증자장기에대항하여반응을할수도있는귀하의혈액속의항체 조직의유형 ( 인체백혈구항원또는 HLA 분석 ) 우리는귀하와특정한기증자의양립가능성을알아내기위하여이검사들의결과를이용할것입니다. 귀하의몸이양립이가능한장기를받아들일기회를향상시키기위하여귀하는이식이후면역억제제또한받을것입니다. 이약들은새로운장기를귀하의면역체계가거부하는것을막기위하여면역체계를억제합니다. 양립가능성검사들 잠재적기증자와의양립가능성을보기위하여 4 가지의검사를받을것입니다. 그것들은 : 혈액형 (ABO) 양립가능성 O, A, B, 그리고 AB 의 4 가지의주요혈액형이있습니다. 우리는혈액형의양립 가능성을보기위하여귀하와잠재적기증자둘다로부터의혈액견본을검사할 것입니다. 이도표는어떤혈액형이일반적으로양립성이있는지를보여줍니다 : 혈액형받을수있음기증할수있음 O O, A2 O, A, B, AB A A, O A, AB B B, O, A2 B, AB AB O, A, B, AB AB O 형인사람은다른모든혈액형에게기증할수있습니다. 이것을 만능기증자 라고부릅니다. AB 형인사람은모든혈액형으로부터받을수있습니다. 이것을 만능수혜자 라고부릅니다. A 형중의어떤사람들은그들의적혈구에독특한단백질을가지고있습니다. 이러한 A 형의 아류형 은 A2 라고불립니다. 이혈액형은면역체계에게 O 형처럼보입니다. 혈액형이 A2 아류형인사람들은 O 형과 B 형인사람들에게혈액을기증할수도있습니다. 기증자와수혜자짝짓기가가능할경우확인하기위하여검사를더할필요가있습니다. Page 2 of 4 Tissue Matching

3 항체검사 항체는바이러스나박테리아또는이식장기와같은귀하의몸에서 이물질 을확인하고반응하는귀하의혈액속에있는단백질입니다. 귀하의항체는일반적으로이물질에있는항원이라고불리는단백질에반응합니다. 이식장기에맞서서반응하는항체는흔히인간백혈구항원 (HLAs) 에반응하고있습니다. 귀하의몸은보통귀하가이전에그것들에노출됬었던적이있지않는한 HLA 항체를만들지않습니다. 환자분의몸이 HLA 항체생성을초래할수있는사건들의경우는임신, 수혈, 감염, 또는이전의장기이식을포함합니다. 귀하가 HLA 항체를만드는지를알아낼수있는두가지종류의검사가있습니다. 패널반응성항체검사 패널반응항체 (PRA) 검사는혈액을기증한사람들의백혈구와환자분의혈액을비교합니다. 이것은환자분의면역체계가어떻게그들의 HLAs 에 반응 ( 민감성 ) 하는지를보여줍니다. 환자분의패널반응항체는퍼센트로계산됩니다. 예를들어서, 만일귀하의 PRA 가 50 퍼센트로계산되었으면환자분의면역체계가기증자의장기에 50 퍼센트반응할것을의미합니다. 더많은인간백혈구항원들에귀하가반응할수록 귀하의 PRA 퍼센트가더높습니다. 높은패널반응성항체의의미는 : 이식을받았을때거부반응의위험도가더높습니다. 면역억제제가더필요할수도있습니다. 귀하와기증자를맞추기가아마도더어려울수있음. 이것은귀하의이식대기시간을더오래걸리게할수도있습니다. 임신과수혈과감염은환자분의면역체계로하여금귀하의 PRA 를증가시키는새로운 HLA 항체를생성하게만들수있습니다. PRA 검사를받은이후에임신을하거나수혈을받았을경우담당이식코디네이터간호사에게연락하십시오. 환자분은다시 PRA 검사를받아야될것입니다. 교차적합검사 교차적합검사또한 HLA 항체를확인합니다. 이것은환자분의혈액을특정한기증자의혈액과비교합니다. 이것은살아있는기증자나사망한기증자일수있습니다. 살아있는기증자의경우에는교차적합검사는기증자가귀하와양립가능성이있는지를알기위하여환자분의평가과정초기에실행됩니다. Page 3 of 4 Tissue Matching

4 사망기증자의경우에는장기가제공되는때에환자분의혈액을기증자의혈액에대조하는검사를받게됩니다. 환자분의혈액속에있는항체가기증자의혈액에맞서서반응할경우이것은교차적합검사양성반응이라고불립니다. 이것은보통환자분의혈액속의항체가기증자의장기를곧바로거부반응을일으킨다는것을의미합니다. 대부분의경우환자분은그기증자로부터장기를받을수없습니다. HLA 항체를제거하고그것들이더형성되는것을막기위한치료가있습니다. 이치료는둔감화라고불립니다. 이것은환자분과더많은기증자와의교차를허용할수있습니다. 이치료가환자분에게효과가있을수도있을경우우리는둔감화에대해서환자분과상의할것입니다. 하지만비록이치료를하더라도 HLA 항체가다시돌아올수도있고항체가전혀없었던경우보다장기거부반응위험을더높일수도있습니다. 조직적합검사 인체백혈구항원 (HLAs) 은인체의조직이나세포에서발견되는항원 ( 단백질 ) 입니다. 환자분의항원은환자분의유전자에의해서결정됩니다. 누군가와더가깝게연관되어있을수록유전적차이점이더적습니다. 이것은 환자분의항원과더비슷하다는뜻입니다. 환자분의면역체계는환자분과가까운 인척인기증자로부터의장기를받아들일공산이더큽니다. 사람들은그들의부모로부터각각하나씩의일배체형 (haplotypes) 이라고불리는 DNA 복제 2 개를물려받습니다. 이것은환자분이부친이나모친의조직과 반만 적합 하다는것을뜻합니다. 일배체형은환자분과기증자가적합한지의여부를명백히보여줍니다. 문의사항? 귀하의질문은중요합니다. 만일질문이나우려되는점이있으시면담당의나의료제공자에게전화하십시오. 이식수혜자는기증자특정항체 (DSAs) 라고불리는기증자의 HLAs 에반응하는항체를형성할수있습니다. 이것은이식이전뿐만아니라이후에도생길수있습니다. 우리는이식이후에기증자특정항체때문에환자분의혈액을검사할것입니다. 기증자특정항체가있을경우이것은거부반응의초기징후일수도있습니다. 그외의다른검사들에환자분의몸이이식장기를거부하고있다는가능성이보이면우리는거부반응이일어나는것을막기위한치료를시작할수있습니다. 이식서비스 : University of Washington Medical Center Published PFES: 05/2003, 06/2011, 12/2016 Clinician Review: 12/2016 Korean translation by UWMC Interpreter Services Reprints on Health Online: Page 4 of 4 Tissue Matching

UW MEDICINE PATIENT EDUCATION Tissue Matching For a kidney/pancreas transplant You will have 4 tests that will show how compatible you are with a potential donor.

The results of tissue matching help us know if it is safe for us to place a donor s organ into your body. What is donor compatibility?

5 UW MEDICINE PATIENT EDUCATION Tissue Matching For a kidney/pancreas transplant You will have 4 tests that will show how compatible you are with a potential donor. This chapter describes those tests and explains how the results are used. What is tissue matching? Tissue matching is a way of finding out if 2 people are compatible, or alike. The results of tissue matching help us know if it is safe for us to place a donor s organ into your body. What is donor compatibility? Donor compatibility is when your tissues and the donor s tissues are enough alike that your body is more likely to accept the transplanted organ. Why is donor compatibility important? Your body has a built-in immune system that recognizes substances that could harm it. This system protects your body against anything that is different from your body. Its main job is to react to bacteria and viruses that could cause infections or disease. Since a transplanted organ comes from another person s body, your immune system naturally sees it as a threat and tries to reject it. If you and a potential donor are compatible, there is a lower chance that your body will reject an organ from that donor. How is tissue matching done? As part of your evaluation, blood tests will tell us about your immune system. The results of these tests will show: You will have blood tests during your evaluation that tell us about your immune system. Page 1 of 4 Tissue Matching

6 Your blood type (O, A, B, or AB) Antibodies in your blood that may react against the donor organ Your tissue type (human leukocyte antigens or HLA analysis) We will use the results of these tests to find out if a certain donor is compatible with you. To improve the chances that your body will accept a compatible organ, you will also receive immunosuppressant drugs after transplant. These drugs suppress your immune system to keep it from rejecting your new organ. Compatibility Tests You will have 4 tests that will show if you are compatible with your potential donor. They are: Blood Type (ABO) Compatibility There are 4 main blood types O, A, B, and AB. We will test blood samples from both you and the potential donor to see if your blood types are compatible. This chart shows which blood types are usually compatible: Blood Type Can Receive from Can Donate to O O, A2 O, A, B, AB A A, O A, AB B B, O, A2 B, AB AB O, A, B, AB AB People with blood type O can donate to all other blood types. It is called the universal donor. People with blood type AB can receive from all other blood types. It is called the universal recipient. Some people with blood type A have unique proteins on their red blood cells. This subtype of type A blood is called A2. This type of blood looks like blood type O to the immune system. People with subtype A2 blood may be able to donate to people with blood types O and B. More tests are needed to see if this is possible for a donor-recipient pair. Antibody Testing Antibodies are proteins in your blood that identify and react against a foreign object in your body, such as a virus, bacteria, or a transplanted organ. Your antibodies usually react to proteins called antigens that are on the foreign object. Page 2 of 4 Tissue Matching

7 Antibodies that react against a transplanted organ are often reacting to human leukocyte antigens (HLAs). Your body usually does not make HLA antibodies unless you have been exposed to them before. Events that can cause your body to produce HLA antibodies include pregnancies, blood transfusions, infections, or a previous organ transplant. There are 2 types of tests to find out if you make HLA antibodies: Panel Reactive Antibody Test A panel reactive antibody (PRA) test compares your blood to the white blood cells of people who have donated blood. This shows how reactive (sensitive) your immune system is against their HLAs. Your PRA is calculated as a percent. For example, if your PRA is calculated as 50%, this means that your immune system will react against organs from 50% of donors. The more HLAs you react against, the higher your PRA percent. A high PRA means: There is a higher risk of rejection when you get a transplant. You may need more immunosuppressant medicines. It may be harder to match you with a donor. This may make your wait for a transplant longer. Pregnancy, blood transfusions, and infections can make your immune system create new HLA antibodies, which increases your PRA. If you become pregnant or have a blood transfusion after you have had your PRA test, contact your transplant nurse coordinator. You will need to have another PRA test done. Cross Matching Cross matching also checks for HLA antibodies. It compares your blood to a certain donor s blood. This can be a living donor or a deceased donor. With a living donor, cross matching is done early in your evaluation to see if that donor is compatible with you. With a deceased donor, your blood is tested against the donor s blood when the organ becomes available. If antibodies in your blood react against the donor s blood, it is called a positive cross match. This usually means the antibodies in your blood would cause rejection of the donor organ right away. Most times, you would not be able to receive an organ from that donor. There is a treatment that removes HLA antibodies and keeps more of them from forming. This treatment is called desensitization. This may allow more donors to be a match for you. Page 3 of 4 Tissue Matching

8 We will talk with you about desensitization, if it might work for you. But even with this treatment, the HLA antibodies may return, making the risk of organ rejection higher than if you never had the antibodies at all. Tissue Typing HLAs are antigens (proteins) found on human tissue or cells. Your antigens are decided by your genes. The more closely related you are to someone, the fewer genetic differences you have. This means your antigens are more alike. Your immune system is more likely to accept an organ from a donor who is closely related to you. People inherit 2 copies of DNA called haplotypes from their parents, 1 set from each parent. This means you are a tissue half match with each of your parents. These haplotypes define whether or not a donor is a match for you. Transplant recipients can develop antibodies against the donor HLAs, called donor-specific antibodies (DSAs). This can happen both before and after transplant. We will check your blood for DSAs after your transplant. If you have DSAs, it may be an early sign of rejection. If other tests show that you might be rejecting the transplanted organ, we can start treatment to keep this from happening. Questions? Your questions are important. Call your doctor or healthcare provider if you have questions or concerns. Transplant Services: University of Washington Medical Center Published PFES: 05/2003, 06/2011, 12/2016 Clinician Review: 12/2016 Reprints on Health Online: Page 4 of 4 Tissue Matching

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본문01 Ⅱ 논술 지도의 방법과 실제 2. 읽기에서 논술까지 의 개발 배경 읽기에서 논술까지 자료집 개발의 본래 목적은 초 중 고교 학교 평가에서 서술형 평가 비중이 2005 학년도 30%, 2006학년도 40%, 2007학년도 50%로 확대 되고, 2008학년도부터 대학 입시에서 논술 비중이 커지면서 논술 교육은 학교가 책임진다. 는 풍토 조성으로 공교육의 신뢰성과