The Graft Outcomes of Living Donor Renal Transplantation according to Gender, Age, and BMI Matching between Donors and Recipients / 대한이식학회지

BACKGROUND: Despite significant advances in immunosuppression, supportive therapies, and operative skills, several factors still compromise long-term graft survival of patients who undergo renal transplantation. This study was designed to evaluate the risk factors influencing graft outcomes of living donor renal transplantation. We matched the recipient and donor age, gender, and body mass index (BMI). METHODS: A total of 527 living renal transplantations were evaluated. The patients were divided into matching groups by donor and recipient age; group 1 (50< or =/; 2, 50< or =/<50; 3, <50/50< or =; 4, <50/<50), gender (A, female/female; B, female/male; C, male/female; D, male/male), and BMI ratio (recipient/donor) (I, <0.8; II, 0.8< or =/<1.3; III, 1.3< or =). We compared 1, 3, 5, and 10 year graft survival and analyzed the donor and recipient variables of age, HLA matching, and acute rejection. RESULTS: The risk factors affecting long-term graft survival were recipient gender, acute rejection rate, and HLA-AB matching. In the groups divided according to donor and recipient age, no statistical difference was observed among the groups, but the 3-5 yr graft survival of group 1 (94.1/86.9%) was much higher than group 2 (86.5/75.6%). In the groups divided according to donor and recipient gender, graft survival in group C was higher than that in the other groups. No statistical difference in acute rejection or graft survival were observed in the groups with different BMI ratios. CONCLUSIONS: Meticulous preoperative donor and recipient matching for living renal transplantation may improve graft survival and expand the donor and recipient pool.

The Impact of Elderly Donor in Renal Transplantation / 대한이식학회지

PURPOSE: Kidney transplantation from elderly donors is controversial because of decline of received renal function and increased risk of perioperative complication. METHODS: We retrospectively reviewed the records of the 676 patients from 1985 to 2006 in our center. 42 (6.2%) donors were > or =60 years old, and constitue the group 1, and 634 donors (93.8%) were or =60) are similar to younger donors (<60). We suggest that use of elderly donors may help to expand the donor pool in kidney transplantation.

The Outcome of Renal Transplantation Using Exchange Donor Program / 대한이식학회지

PURPOSE: The availability of living donors is the major limiting factor in living related kidney transplantion. In 1997, Ross et al. proposed that the living unrelated kidney transplantation through exchange arrangement of ABO-incompatible donors-recipient pairs to expand donor pool is ethically acceptable as living related kidney transplantation. We analyzed exchange donor program whether this could expand the kidney donor pool in living donor renal transplantation. METHODS: We retrospectively reviewed the records of the 121 exchange donor renal transplantations performed from 1991 to 2005 in our center. Recipient's and donor's mean age were 38.8 (15~64) and 40.4 (21~60) year-old, respectively. Mean follow up period is 81 months (1~170). The reasons of exchanging donor were ABO incompatibility (92/121, 76%), positive HLA cross matching (20/121, 16%) and patients who received kidneys from unknown volunteer donors (9/121, 7%). We compared graft survival and acute rejection rate of exchange donor group and living related donor group. RESULTS: The graft survival rate (1, 5, 10 year) of exchange donor group (92%, 80.6%, 72%) was similar to living related donor groups (95%, 77%, 66%). The acute rejection rate were 34% (42/121 ) and 24%, respectively. We have observed acute rejections during the same time in both groups from 1991 to 2005. Although acute rejection rate of exchange donor group is higher, we see the similar survival rate of transplanted kidneys in exchange donor group. CONCLUSION: We suggest that exchange donor program could expand the donor pool in living donor renal transplantation, when recipient cannot receive kidney from healthy donor because of ABO incompatibility or positive HLA cross matching.

Clinical courses and risk factors for renal graft survival in renal retransplantation patients / 대한내과학회지

BACKGROUND: It has been reported that the results of second renal transplantation are inferior to that of first transplantation and affected by several factors. The purpose of this study is to suggest guidelines for successful retransplantion by evaluating the factors which might affect the clinical courses and graft survival rates in the second renal transplantation. METHODS: Between March 1969 and February 2005, 1476 kidneys were transplanted in Kangnam St Mary's hospital. Among these, 77 cases were retransplantation (72 cases were second transplantation, 5 cases were third transplantation). Especially for the second transplantation, we retrospectively analysed the clinical courses of grafted kidneys and sought the factors which might be related to the long term graft survival. RESULTS: Among second transplant patients, male were 52 cases, female were 20 cases. The mean age at retransplantation was 38.4+/-11 years. Living donor were 62 cases and cadaver donor were 10 cases. The mean duration between primary graft failure and second transplantation was 20.1+/-36 months. The 1 yr, 3 yr, 5 yr survival rates of the second grafts were 86.4%, 78%, 71% respectively, and it is not significantly inferior to that of total primary transplantation at our center. Multivariate analysis showed that the duration of the first graft survival and the postoperative recovery pattern significantly predicted graft survival in the second renal transplantation. CONCLUSIONS: This study suggests retransplantation can be considered for patients who lost primary graft function. And the longer the duration of the first graft survival and the earlier the postoperative graft function recovery, the prognosis of retransplanted graft would be better.

The Impact of Sex and Age Matching on the Long-term Graft Survival in Living Donor Renal Transplantation

PURPOSE: In renal transplantation, the donor age and allograft size are important factors for the outcome of the graft and might be indicators of a functioning renal mass. Females tends to have smaller kidneys, which have 17% fewer nephrons than males, and the number of glomeruli per kidney as well as the mean glomerular volume are closely correlated with the kidney weight and negatively correlated with age. This study evaluated the impact of gender and age matching on the long-term graft survival in a living donor renal transplant. METHODS: 614 renal transplants, patients were divided into 4 groups according to the donor and the recipient's gender: Group 1 was male donor to male recipient, Group 2 was male donor to female recipient, group 3 was female donor to male recipient, group 4 was female donor to female recipient. The long-term graft survival and risk factors among the four groups were analyzed. In addition graft survival was also analyzed according to age matching in each groups. Statistical significance was determined using the Kaplan- Meier method and a log rank test (Precipient age) were better than the younger donor (donor age

Clinical Experience of 60 Pediatric Renal Transplantations at a Single Center / 소아과

PURPOSE: Renal transplantation for the management of end-stage renal disease(ESRD) in children is now the optimal treatment. We analyzed the clinical courses and characteristics of pediatric renal transplantation in Asan Medical Center. METHODS: We reviewed the charts of 60 cases of renal transplantation under the age of 18, admitted to Asan Medical Center, from Oct. 1990 to May 2003. We analyzed retrospectively to clarify the clinical courses, risk factors affecting graft survival, recurrence of the original disease, complications and growth. RESULTS: Graft was taken from 48 living donors, and 12 cadaveric donors. The mean age at transplantation was 13.1 years. The overall graft survival rates were 96.3% at one year, 84.4% at five year, 47.6% at 10 years. The overall patient survival rates were 98.1% at one year, 95.1% at five years, 95.1% at 10 years. A total of 13 grafts were lost(21.7%). The presence of acute rejection within one year after graft(P=0.0045) and recipient less than five years old(P=0.0027) were significant risk factors for poor graft survival. The recurrence rate of original disease was 8.3% and the most common complication was infection(50%). In the group less than 3 percentile of pretransplantation height, there were much longer duration of ESRD and much greater growth after transplantation(P=0.002). CONCLUSION: The graft survival rate for pediatric renal transplantation has been greatly increased, similar to those of adult renal transplantation with the development of operation techniques and immunosuppressants. Further studies into the factors improving graft survival and new immunosuppressants to reduce the rate of rejection, and efforts to reduce the incidence of infection, are needed at this time.

Comparison of the Survival Rates of Spousal Kidney Transplantation and Parental Donor Kidney Transplantation / 대한이식학회지

PURPOSE: The continuing shortage of donors has escalated the waiting times for kidney transplantation in most nations. In instances where first-degree relatives of the patient are not appropriate, living unrelated transplantations are considered as the next possible choice. In this category, genetically unrelated but emotionally related spouses are always preferred for organ donation rather than both genetically and emotionally unrelated donors. The aim of this study was to compare the results of parental donor kidney transplantation with spousal kidney transplantation. METHODS: Patient and graft survival were assessed with the Kaplan- Meier curve and statistical significance was determined by log-rank comparisons. RESULTS: In the spousal group, 1-, 3-, and 5-year graft survival rate were 84.6%, 72.3%, and 66.3%, in the parental donor group, 89.2%, 75.4% and 62.3% respectively. 1-, 3-, and 5-year patient survival rate were 84.6%, 80.4%, and 71.5% in the spousal group and 97.3%, 94.3% and 90.6% respectively in the parental donor group. Survival rate of grafts from spouses was comparable to that of parental-donor grafts, despite the average of 4.1 HLA mismatches in the spousal group, as compared with one haplotype sharing in the latter group (P<0.001) and higher donor age in the parental donor group (P<0.001). The survival rates were similar in the wife-to-husband and the husband-to-wife groups. CONCLUSION: While providing the couple with a better quality of life, spousal kidney transplantation also enables the couple to share the joy of giving and receiving the "gift of life" from one another. We believe that transplantation from a healthy volunteer spouse is a good alternative resource to years of dialysis while waiting for another donor that may never appear, to increase the donor pool and reduce the increasing length of waiting lists.

Donor Factors Influencing the Graft Survival of Kidney Transplants / 대한비뇨기과학회지

PURPOSE: The purpose of our study is to analyze the graft survival rates of renal transplantation in view of kidney donors, and to determine the donor parameters influencing kidney graft survival rates. MATERIALS AND METHODS: We have analyzed kidney graft survival rates and duration according to sex, age, relationship and HLA matching performed in Hanyang University Hospital from 1986 to 1997 in 284 cases among 408 donor-recipients over a follow-up period of 24 months. RESULTS: Among 284 recipients, the total graft losses were 34 cases(12%). Matching for the HLA-DR significantly improved kidney graft survival rates. The difference between 0 mismatched group and 2 mismatched group was 19% at 5 years(95% vs. 76%; p0.05). There were no significant differences in graft survival rates according to HLA-A, B, A+B and A+B+DR, respectively. CONCLUSIONS: The age, sex and donor-recipient relationship did not influence the graft outcome, but matching for the HLA-DR and B+DR significantly influenced graft survival rates in the cyclosporine A treated primary kidney recipients.

Exchange-donor Program in Renal Transplantation: A single center experience

BACKGROUND: A shortage of kidney donors has produced a progressively increasing gap between the supply of cadaveric kidneys and the demand for cadaveric transplants. Thus, efforts to expand the donor pool have included the use of the living related and unrelated kidney donors in Korea. In certain countries like ours, cadaveric kidney sources are very limited for various reasons, therefore, the living kidney donors have been a major source for uremic patients in our hospital. We propose a new program for donation, in which is an exchange-donor program. It is a program in which the donation is not commercial, but voluntary, thus overcoming the shortage of cadaveric donors, and giving the opportunity for transplant to as many uremic patients as possible. METHODS: Between Jan. 1991 and Dec. 1997, 411 living-donor renal transplants were performed in our hospital. Of those, 61 patients received grafts from exchange donors. We compared the graft survival rate of the exchange-donor transplantations with that of the living related donor transplantations based on the recipient's age and sex, the donor's age and sex, human leukocyte antigens (HLA) mismatching, and the frequency of acute rejection. RESULTS: Fifty-nine (59) of 61 patients were still alive in Dec. 1997, with a median follow-up of 31 months (6-76 months), and the mean serum creatinine level was 1.64 mg/dL. The graft survival rates of the exchange-donor renal transplantations at 1 and 5 years were 92.12% and 80.27%, respectively, and there were no significant differences compared with those of the living related renal transplantations (p=0.1424). The graft survival rates at 1 and 5 years were 93.75% and 81.25%, respectively, for those with more than one HLA-haploidentical pair, and 91.89% and 78.76% for those with less than a one-haplotype match, respectively. The frequency of acute rejection was 37.7% in the exchange-donor group. The renal function of the exchange donors after the donation was not altered, and the postoperative complication rate was 1.6%. CONCLUSIONS: The results show that the graft survival rates of the exchange-donor program were similar to those of the living related renal transplantations, and that the good graft survival rates for the exchange-donor group could not be attributed to better HLA matching. We propose an exchange-donor program that will be able to expand the donor pool and overcome the shortage of cadaveric organ donors.

The Effect of Donor Age on the Outcome of One HLA-haplotype Mismatched Living Related Kidney Transplantation / 대한내과학회지

OBJECTIVES: Renal transplantation has become the ther apy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the num ber of ideal kidneys available for transplantation, increas ing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal def inition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we per formed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mis matched living related kidney transplantation. METHODS: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(> OR =55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retro spectively reviewed. Patient death with a functioning graft was considered graft loss. RESULTS: Demographic characteristics between 2 groups were similar. The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regard less of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly dif ferent (91.4% and 63.9% vs 92.7% and 79.3%, respec tively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). CONCLUSION: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kid neys may be used from donors over 55 years old on con dition that the donors undergo complete and exhaustive work-up.

Renal Transplantation in Korean Children: Cooperative study / 대한이식학회지

Renal transplantation is the optimal therapy for children with end-stage renal disease. A successful renal transplantation allows normal growth and development and enables children to return to normal lifestyle. The graft survival rate for renal transplantation has been greatly increased with the developments in immunology, operation techniques, and with the use of effective immunosuppressants. We analyzed retrospectively the results of renal transplantation in Korean children, who were under 19 years of age at the time of renal transplantation. Data were collected from 11 hospitals where pediatric renal transplantations were performed. 181 pediatric renal transplantations were performed from July, 1973 to Aug., 1994. There were 121 male and 60 female recipients. The mean age was 14.2+/-3.6 years (mean+/-SD) and the youngest was 2 years old at the time of transplantation. All donors except two were living donors and among them, living-related donors were 136(75.1%) and living-unrelated donors were 43(23.8%). The most common causes of end-stage renal disease were chronic glomerulonephritis 35 cases(19.3%), reflux nephropathy 25 cases(13.8%), focal segmental glomerulosclerosis 24 cases(13.2%), IgA nephropathy 11 cases(6%), and Alport's syndrome 9 cases(5%). Overall patient and graft survival rates were 96.1% and 93% at 1 year, 91.8% and 70% at 5 year, respectively. ABO matching was a significant risk factor affecting graft survival rate; 1 and 5 year graft survival rate was 93.8% and 75.1% in ABO identical group, when compared to 89.6% and 47.7% in ABO compatible group. Five year graft survival rate by the renal replacement modality prior to renal transplantation was 79% in no renal replacement prior to renal transplantation(preemptive) group, as compared to 51% in continuous ambulatory peritoneal dialysis group, showed a significant difference. There was no significant difference in graft survival rate by the source of donor, HLA compatibility, or immunosuppressants. Of the 181 grafts, 37(20.4%) showed graft failure. Twenty-two(59.5%) of these graft failures were caused by chronic rejection. Complications of operation occurred in 10 cases(5.5%). And complications of immunosuppressants occurred in 53 cases(29.3%). Finaly, vigorous attempts should be made to perform renal transplantation as early as possible at the diagnosis of end-stage renal disease to achieve proper development and prevention of growth retardation.