Analysis of Risk Factors Affecting the Graft Survival in Living Unrelated Donor Kidney Transplantation / 대한이식학회지

PURPOSE: Shortage of donor organs is one of the major barriers to transplantation worldwide, especially, in countries where cadaveric organ donation is still limited. To overcome the donor kidney shortage, living unrelated donor renal transplantation should be one of the options to solve this problem. However, the data on the long-term results after unrelated donor renal transplantation and potential risk factors affecting the graft survival are scarce worldwide. We designed this retrospective study to report the long-term results of 967 renal transplants from unrelated donors in a single center. METHODS: From 1979 to June 2002, 2115 kidney transplantations were performed at Yonsei University Medical Center. Among them, a total of 1945 living donor transplants, excluding 55 cadaveric transplants and early 115 transplant who received azathioprine plus prednisone, were identified as a study cohort. The minimum and mean follow- up periods were 12 and 87.8 months, respectively. Of these, 978 transplants received living related donors (LRDs), and 967 patients underwent kidney transplantation using living unrelated donors (LURDs). For the analysis of risk factors affecting the graft survival, a couple of each demographic, immunologic, and clinical variates were included. RESULTS: The actuarial graft survival in the LRD and LURD recipients were 88.26% vs. 83.4% at 5 years, and 72.31% vs. 66.9% at 10 years, respectively. The 10-year patient survival rate for LRD and LURD transplants were 82.6% and 84%, respectively with no significant difference. On the multivariate analysis of LURD recipients, history of acute rejection, recipient age over 55 years, preoperative history of diabetes and hepatitis B viral infection were identified as a significant risk factor affecting the graft survival in LURD renal recipients. CONCLUSION: Excellent long-term patient and graft survivals were achieved among LURD kidney transplant recipients. Long-term outcome of transplants were not differed by the kinds of kidney donors. Renal transplantations using LURDs should be considered as an alternative way to increase the number of available donors.

Intraexaminer Variability of Nerve Conduction Study in Healthy Person

BACKGROUND: Nerve conduction study (NCS) is an objective and quantitative test in evaluating peripheral nerve disorders. Several physiological and technical factors are well known to influence the results of NCS, which can be controlled and regulated by standardization of environment and through the process to make range of normality. However, most electromyographers do not pay much attentions about inter- and intra-examiner variabilities, and there are only a few and incomplete reports on these topics. We examined the intra-examiner variability of NCS on the basis of periods of practice. METHODS: Twenty-eight electromyographers were divided into two groups: residents and neurologist-technicians. All, having variable NCS training periods, have performed NCS on one of other 27 electromyographers ten times within two weeks where each study was made once a day. RESULTS: Coefficient of variation and external quotient increased according to the following order - nerve conduction velocities (NCV), terminal latencies (TL), and amplitudes of compound action potentials (AMP). There were significant differences between the two groups in NCV and TL, but no statistical difference in AMP. CONCLUSIONS: Our results suggest that errors from intra-examiner variability should be considered when interpreting NCS and that those electromyographers who have enough training should perform NCS.