腎移植患者にみられた網膜黄斑部病変

Macular lesions in patients after renal transplantation

　腎移植後の患者45例90眼の網膜黄斑部病変について検討した。網膜黄斑部病変は18例24眼（26.7％）に認められ，うち黄斑部疾患は12例14眼（15.6％）であった。主な黄斑部疾患は中心性漿液性網脈絡膜症，多発性後極部網膜色素上皮症，網膜色素上皮剥離，黄斑変性であり，これらの疾患は，死体腎移植例の36.8％に認められ，生体腎移植例の19.2％よりも多かった。

　HLA A2,24 B35 Bw54 Cw1,3 DR2,4の抗原保有者は網膜色素上皮障害を生じやすく，免疫抑制剤，副腎皮質ステロイドの大量投与およびウイルス易感染性に加え，免疫遺伝学的影響も大きいと推論した。

We reviewed macular lesions in 90 eyes of 45 patients who underwent renal transplantation. Retinal lesions were present in 24 eyes of 18 patients, 27%. Maculopathy was seen in 14 eyes of 24 patients and included: central serous chorio-epitheliopathy, multifocal posterior retinal pigment epitheliopathy detachment of retinal pigment epithelium and macular degeneration. Maculopathydeveloped at a higher frequency when the trans-planted kidney was obtained from cadaver than from living donor, at 37% and 19% respectively. Following factors were identified as contributing to maculopathy: use of immunosuppresants, massive corticosteroid, liability to viral infection and im-munogenetic incompatibility to transplanted kid-ney in addition to the presence of HLA A2, A24, B 35, Bw54, Cw1, Cw3, DR2 or DR4.