One-month Serum Creatinine Level is the IndePendent Predictor of Long Term Graft Function Following Renal Transplant / 대한이식학회지

PURPOSE: The current organ shortage in renal transplantation underscores the importance of optimizing long- term graft survival. Despite the significant improvement in the results of renal transplantation since the introduction of cyclosporine, graft loss after fist year of transplantation remains a significant and unresolved problem. This study showed renal function at 1 month after transplantation as a prognostic factor influencing long-term renal graft survival. METHODS: The results of 683 cases of renal transplantations performed from 1978 to 2001 in our center were analysed. We divided into 3 groups according to the serum creatinine level (group 1: 60), donor sex, donor type (related, unrelated, cadevaric), recipient age (60), recipient sex, HLA matching, acute rejection, delayed graft function were also analysed. RESULTS: The acute rejection rates in each group were 17.1%, 40.6%, 71.7% retrospectively (P=0.000). The frequencies of delayed graft function were 3.9%, 9.0%, 36.2% retrospectively (P=0.000). There was significant difference of graft survival between each group (P=0.000). In addition, graft survival in group with acute rejection showed significant difference according to creatinine level at 1 month. CONCLUSION: We can predict long-term graft survival and early renal function through serum creatinine levels after transplantation. Therefore, serum creatinine level at first month of transplantation was prognostic factor in predicting long-term graft survival.

The Impact of Donor and Recipient Age in the Outcome of Kindney Transplatation / 대한이식학회지

PURPOSE: As general population survival has improved in the last few decades, the age of patients participating in renal transplantation also has increased. This study aimed to investigate the impact of donor and recipient age as predictor of long-term graft survival in renal transplantation. METHODS: We analyzed the transplantation outcome in 598 patients, who received renal transplantation from 1978 to 2003 at Hanyang Universitiy. Patients were divided into four groups according to the age at renal transplantation. Group A (donor age> or =50, recipient age> or =50, n=19/3.2%), group B (donor age> or =50, recipient age or =50, n=69/11.6%), group D (donor age<50, recipient age<50, n=357/59.8%). Univariate analysis was used to assess the effect of donor and recipient age as predictor factors of graft outcome. We used Kaplan Meier log-rank method for graft survival and P values less than 0.05 were considered significant. RESULTS: In elderly donor group, graft survival was 89.8% at 1 year, 76.4% at 3 years and younger donor group was 92.8 at 1year, 84.0% at 3 years and the differences showed statistic significance (P=0.009). Univariate analysis of age factor showed a significant reduction of graft survival in recipients transplanted with kidneys coming from donors older than 50 years, however recipient age greater than 50 years was not found as an independent risk factor. The incidence of rejection was 24.6% in elderly donor group and 23.5% in younger donor group (P=NS). Among the four groups, the most valuable result was group D and the 1 year and 3 years graft survival were 93.1%, 84.5% respectively but it was not significant statistically (P=0.50). CONCLUSION: This result is important for the design of allocation and transplantation strategies for kidneys procured in elderly donors and recipients.

Long-term Graft Outcome of Living Donor Renal Transplantation: Single Center Experience / 대한이식학회지

PURPOSE: The number of potential renal transplant recipients far exceeds the number of cadaveric donors. For this reason, living-related donors (LRD) and living-unrelated donors (LURD) have been used to decrease the cadaveric donor shortage. We analyzed 571 living donor transplants for 25 years in our center. METHODS: From 1978 to 2003, 571 patients underwent LRD (n=253) or LURD (n=318) kidney transplantation. The patients were divided into precyclosporin era (1978~1987, n=43, era I), cyclosporin era (1988~1997, n=368, era II), and cyclosporin plus mycophenolate- mofetil era (1998~2003, n=160, era III). We compared the graft survival rate of the recipients according to the immunosuppressants and analyzed the variables such as donor's and recipient's age, sex, HLA matching and acute rejection rate. We also compared the long-term survival rate between LRD and LURD. RESULTS: 1 and 10-year graft survival rates of all patients were 94.3% and 75.5%, respectively. 1 and 10-year graft survival rates were 74.4% and 36.2% in era I, 94.3 % and 78.4% in era II. 1 and 5-year graft survival rates were 96.7% and 90.5% in era III (P<0.001). The occurrence rate of acute rejection was 23.3% (era I), 22.3% (era II), and 14.3% (era III) (P=0.000). 1 and 10-year graft survival rates were 92.3% and 81.3% in LRD transplants, and 94.1% and 86.5% in LURD transplants, respectively (P =0.1909). CONCLUSION: The graft survival rates of living donor transplants are improving due to advances of patient care and new immunosuppressive agents. We suggest that living donors will be an important source of kidney transplantations.

A Case of Pulmonary Leiomyoma in a Renal Transplanted Patient / 대한신장학회잡지

The overall incidence of malignancy in a renal transplanted patient is 3 to 5 times higher compared with general population. We report a very rare case of multiple leiomyoma originated from lung after renal transplantation. 33-year-old male underwent renal transplantation in November, 1989. A 5 mm sized pulmonary nodule was found in the left lower lobe incidentally in March, 2001. The size of pulmonary nodule increased and same lesion was found on the opposite side of the lung on chest roentgenogram after one year, so we proceeded with computed tomography of the chest. Variable sized multiple nodules in the whole lung field were noted, which were thought be metastatic lesions, and for detection of the primary site of malignancy, further study including esophagogastroduodenoscope, colon study, abdominal ultrasound, abdominal CT, bone scan and tumor marker were checked, but there was no evidence of primary cancer. After open lung biopsy low malignant potential smooth muscle tumor was noted, and Epstein-barr virus (EBV) DNA was detected. The patient had been maintained on immunosuppressive therapy with cyclosporine and mycophenolate mofetil (MMF), and after the diagnosis of leiomyoma administration of MMF was stoped, and cyclosporine dosage was reduced. With the reduction of immunosuppressants, intravenous immunoglobulin trial was done for the first cycle, but the efficacy of treatment is not clear.