Tacrolimus in Delayed Graft Function in Cadaveric Renal Transplantation / 대한신장학회잡지

BACKGROUND: In the presence of anticipated or established acute tubular necrosis (ATN) immediately after cadaveric kidney transplantation, induction with monoclonal or polyclonal antibody is recommended in preparation of increased risk of acute rejection caused by ATN. Tacrolimus is a potent immunosuppressive agent than cyclosporine. In this study, we analyzed retrospectively the clinical outcome of patients who had taken tacrolimus as a replacement of cyclosporine in the period of delayed graft function(DGF) to determine the eligibility of tacrolimus instead of antilymphocyte antibody in this situation. METHODS: Between March 1, 1991 and August 31, 2000, DGF developed in eighteen first cadaveric renal transplant recipients in our center. During DGF period, twelve patients received tacrolimus based immunosuppression without OKT3. We reviewed the complete clinical course of the 12 patients. RESULTS: Among the 12 patients, 1 patient underwent graft nephrectomy at postoperative 27 days, because of poor renal function and concomitant aspergillosis infection. In the remaining 11 patients, however, for whom tacrolimus was maintained continuously without OKT3 therapy, renal function was recovered successfully. One acute rejection developed at postoperative 15 months. One patient died at postoperative 5 months with functioning graft. One-year graft survival rate was 83%. CONCLUSION: Tacrolimus could be used in replacement of cyclosporine for the prevention of acute rejection in DGF. This could provide a graft survival comparable to that by the monoclonal or polyclonal antibodies without the potential risk of life- threatening side effects in this situation.

Cadaveric Renal Transplantation between Donor and Recipient Both are Hepatitis B Virus Positive / 대한신장학회잡지

There has been studies constantly reporting on high rate mortality of renal transplantation of hepatitis B virus(HBV)-positive subject because the direct and indirect effect of immunosuppressive agent which was administrated after a transplantation worsens hepatitis or causes hepatic failure. But recent studies have reported that there is no difference in graft rejection, infection and survival rate of the graft or the host between hepatitis positive and negative groups. And, after lamivudine which suppresses HBV replication is introduced into renal transplantation, transplantation of HBV-positive subjects has taken on a new aspect. But it has been hard to find the reports about renal transplantation between donor and recipient both are hepatitis B virus positive in documents, because, in most cases of those reports, the recipient was hepatitis B virus positive but the donor who offers kidney was hepatitis virus negative. This study selected all 9 cases of cadaveric renal transplantation between HBV-positive cadaveric donor and HBV-positive chronic renal failure(CRF) patient who were operated at Samsung medical center from March of 1997 to August of 2000, then analyzed the medical records of five donors and nine recipients retrospectively. Six cadaveric donors(5 male, 1 female, age 15-52) and nine recipients(4 male, 5 female, age 23-52, median dialysis period 23 months) were included. During following up periods of 42 to 12 months (median 24 months) after renal transplantation with HBV DNA, serum ALT and serum creatinine change of hepatic function and renal function were observed and a development of infection and other complication were also investigated. Any case didn't come out fulminant hepatitis or liver cirrhosis. Four cases came out hepatic dysfunction. Among these, one case was diagnosed to CsA hepatotoxicity. One case came out a transient increase of ALT more than six months, since then was normilized. One case came out acute hepatitis and one case recurrent hepatitis. The rest constantly came out normal hepaitc function. In all the cases lamivudine treatment was practiced and the major indication were positive HBV DNA and a increase of ALT. In the recent test the eight cases came out a normal ALT and the only one case came out a little increase of ALT, 60 IU/L. Renal function was relatively well maintained. Three cases came out acute rejection, but it was successfully recovered. Chronic rejection didn't occur. In the recent test the eight cases came out a normal serum creatinine except one case(28 month after transplantation) which 1.5 mg/dL of serum creatinine appeared. When we consider our situation possessing much more recipients than donors of renal transplantation, this trial to expand the scope of donor to HBV- positive patients as well as the activation of cadaveric renal transplantation is a clinically meaningful effort especially in Korea and Asian countries which have a plenty of hepatitis carriers and chronic hepatitis patients. And we consider this new trial needs to continue comparative analyzation through long term observation.

Cadaveric Donor Renal Transplantation; Review of 39 Cases / 대한이식학회지

To improve the graft survival in cadaveric donor renal transplantation, various factors that affect the results of allograft function has been analysed and reported. From January 1994 through December 1998, 39 cases of renal transplantation were performed using 20 cadaver donor. Thirty five of them were from brain dead donor and four from cardiac arrest donor. The most frequent cause of brain death was head injury by traffic accident, mostly autobicycle accident. Male donor ratio was 85.0% and their mean age were 29.3 years old. Mean cold ischemic time was 347.5 minutes and warm ischemic time of 4 cardiac arrest cases were 55-60 minutes. The number of HLA mismatch more than 4 were 64.1%. There were 8 cases of multiple renal arteries and 4 cases of double ureter. Donor hypotension during and before kidney procurement and warm ischemic time were factors that cause the delayed graft function in our cases. The number of HLA mismatch and use of Cellcept as immunosuppressant were two factors that affected the development of acute rejection during 6 months after renal allograft. Among the 39 kidneys of 20 donors, 12 paired kidneys showed different graft result in each recipient. Recipient age, number of HLA mismatch, cold ischemic time, duration of hemodialysis before transplantation, and level of hemoglobin were factors that cause the diffrerent result in paired kidney. One and two year graft survival rate were 89.6% and 76.5% respectively. In summary, the early results of our cadaver donor renal transplantation was comparable to living donor transplantation. Adequate donor management and HLA matching between donor and recipient are factors that can improve the graft result.

Cadaveric Donor Renal Transplantation; Review of 39 Cases / 대한이식학회지

To improve the graft survival in cadaveric donor renal transplantation, various factors that affect the results of allograft function has been analysed and reported. From January 1994 through December 1998, 39 cases of renal transplantation were performed using 20 cadaver donor. Thirty five of them were from brain dead donor and four from cardiac arrest donor. The most frequent cause of brain death was head injury by traffic accident, mostly autobicycle accident. Male donor ratio was 85.0% and their mean age were 29.3 years old. Mean cold ischemic time was 347.5 minutes and warm ischemic time of 4 cardiac arrest cases were 55-60 minutes. The number of HLA mismatch more than 4 were 64.1%. There were 8 cases of multiple renal arteries and 4 cases of double ureter. Donor hypotension during and before kidney procurement and warm ischemic time were factors that cause the delayed graft function in our cases. The number of HLA mismatch and use of Cellcept as immunosuppressant were two factors that affected the development of acute rejection during 6 months after renal allograft. Among the 39 kidneys of 20 donors, 12 paired kidneys showed different graft result in each recipient. Recipient age, number of HLA mismatch, cold ischemic time, duration of hemodialysis before transplantation, and level of hemoglobin were factors that cause the diffrerent result in paired kidney. One and two year graft survival rate were 89.6% and 76.5% respectively. In summary, the early results of our cadaver donor renal transplantation was comparable to living donor transplantation. Adequate donor management and HLA matching between donor and recipient are factors that can improve the graft result.

Cadaveric Renal Transplantation in Seoul National University Hospital / 대한이식학회지

Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. PURPOSE: We performed this study to know the predicting factors and the survival rate of cadaveric renal transplantation. We also tried to compare our results to that of the western countries to try to establish the correct therapeutic strategy of cadaveric renal transplantation. MATERIALS AND METHODS: We analyzed 41 cadaveric renal transplants performed at Seoul National University Hospital from August, 1993 to July, 1997. All patients had follow-up period of more than 6 months. RESULTS: The mean age of recipients was 34.8 years(2~62). All patients except two were primary renal transplants. Male to female ratio was 28:13. Mean HLA mismatching number was 3.66. The immunosuppressive regimen was triple therapy based on cyclosporine. If delayed graft function(DGF) occurred, cyclosporine was held till renal function became normalized. The incidence of DGF was 17.1%. The overall incidence of biopsy-proven acute rejection was 26.8%(11 cases). Seven cases were diagnosed as acute rejection at protocol biopsies performed at 7 days after renal transplantotion, but had normal renal function. The other 4 cases who had both histologic evidence and clinical features of acute rejection were treated with anti-rejection therapy. The factors affecting graft survival in cadaveric renal transplantation were the acute rejection(p=0.0003) and preservation solution (p=0.0033). The graft survival rate at 1, 2, 3, 4 year was 86.9%, 86.9%, 80.7%, 80.7%, respectively. Total 6 renal transplants were lost due to 1 chronic rejection, 1 CMV pneumonia, 1 Kaposi's sarcoma at lung, and 3 sepsis. CONCLUSION: Our results was comparable to that of the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.

Cadaveric Renal Transplantation in Seoul National University Hospital / 대한이식학회지

Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. PURPOSE: We performed this study to know the predicting factors and the survival rate of cadaveric renal transplantation. We also tried to compare our results to that of the western countries to try to establish the correct therapeutic strategy of cadaveric renal transplantation. MATERIALS AND METHODS: We analyzed 41 cadaveric renal transplants performed at Seoul National University Hospital from August, 1993 to July, 1997. All patients had follow-up period of more than 6 months. RESULTS: The mean age of recipients was 34.8 years(2~62). All patients except two were primary renal transplants. Male to female ratio was 28:13. Mean HLA mismatching number was 3.66. The immunosuppressive regimen was triple therapy based on cyclosporine. If delayed graft function(DGF) occurred, cyclosporine was held till renal function became normalized. The incidence of DGF was 17.1%. The overall incidence of biopsy-proven acute rejection was 26.8%(11 cases). Seven cases were diagnosed as acute rejection at protocol biopsies performed at 7 days after renal transplantotion, but had normal renal function. The other 4 cases who had both histologic evidence and clinical features of acute rejection were treated with anti-rejection therapy. The factors affecting graft survival in cadaveric renal transplantation were the acute rejection(p=0.0003) and preservation solution (p=0.0033). The graft survival rate at 1, 2, 3, 4 year was 86.9%, 86.9%, 80.7%, 80.7%, respectively. Total 6 renal transplants were lost due to 1 chronic rejection, 1 CMV pneumonia, 1 Kaposi's sarcoma at lung, and 3 sepsis. CONCLUSION: Our results was comparable to that of the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.