Cadaveric Renal Transplantation, before and after KONOS System (Single Center Report) / 대한이식학회지

INTRODUCTION: Comparing with living donor renal transplantation, cadaveric renal transplantation is usually performed as an emergency procedure and has prolonged preservation time and increased incidence of delayed graft function. Korean Network for Organ Sharing (KONOS) was launched from February 2000 to manage the organ transplantation in Korea and expected to increase donor organs supply and an effective organ allocation. PURPOSE: In order to compare the result of cadaveric renal transplantation before and after KONOS system, 108 cadaveric renal transplants performed in Dongsan hospital until October 2003 were reviewed and analyzed. METHODS: Donors and recipients were divided into two groups (group 1; transplantation performed before KONOS, group 2; transplantation after KONOS) and their characteristics and results were analyzed retrospectively. RESULTS: Among donor factors, number of multi-organ procurement increased (23.1% vs 78.6%), and use of inotrophic agent decreased (63% vs 46%) significantly after KONOS, however cold preservation time was not changed even after KONOS system. Procured organs per one donor in our hospital was increased from 2.25 to 2.65. Increased recipient age (from 30.1 to 41.9 years old), more chance to diabetic patient and decreasing number of HLA mismatching (4.6 to 3.9) were considered as a result of KONOS allocation system. However, early results including incidence of acute rejection episode and delayed graft function, and serum creatinine level at the end of one year were no statistic differences. The number of early graft loss were decreased up to 2 years after transplantation. CONCLUSION: Renal transplantation from cadaveric donor after KONOS resulted in lower early graft loss but increased waiting time due to organ shortage is a serious problem to be solved in the future.

Single Center Experience of 500 Consecutive Renal Transplantation / 대한이식학회지

PURPOSE: Five hundreds of renal transplantation were performed in the our institute from November, 1982 to April, 2000. During this period, there were two big changes of immunosuppressive regimen. These are introduction of cyclosporin microemulsion formula (Neoral(R)) in April, 1994 and mycophenolate mofetil (MMF) in April, 1997. So, the result of our 500 consecutive renal transplantation was analysed and compared according to the regimen. METHODS: We analysed the result of our 500 renal transplantation by retrospective chart review. And we compared the result according to the regimen. RESULTS: Mean age of recipients were 33.6 years and male to female ratio was 2.14 : 1. There was 18 retransplantation and 18 pediatric transplantation. Overall 1 year, 3 year and 5 year graft survial was 95.38%, 81.65% and 70.56%. And the patient survival was 96.78%, 92.31% and 89.46%, respectively. Before the introduction of Neoral(R)(n=285), acute rejection during first 6 months (AR6mo) was 0.52+/-1.09 and serum creatinine level at 12 months posttranplant (Cr12mo) was 1.954+/-1.488 and 1 year (1YSR), 3 year (3YSR) and 5 year (5YSR) graft survival was 93.64%, 77.66% and 65.32%. After introduction of Neoraland before MMF (n=134), AR6mo and Cr12mo was 0.62+/-1.83 and 1.625+/-1.203 and 1YSR, 3YSR and 5YSR was 96.27%, 87.03% and 79.97%, respectively. After addition of MMF (n=74), AR6mo and Cr12mo was 0.19+/-0.39 and 1.434+/-0.773 and 1YSR and 3 YSR was 95.93% and 95.93%. Because of short term follow up for the last group, long term survival rate was indefinable. CONCLUSION: With advancement of immunosuppressive agents and accumulation of clinical experiences, short term result of the kidney transplantation was improved. Further evaluation of long term result is needed.