Clinical Outcomes between Living Related and Living Unrelated Kidney Transplantation in ABO-Incompatible Kidney Transplant Recipients / 대한내과학회지

BACKGROUND/AIMS: Kidney transplantation (KT) is the best treatment for end-stage renal disease patients. Although previous studies have demonstrated that the clinical outcome following living related (LR) KT is better than that following unrelated (LUR) KT in ABO-compatible KT recipients, recent studies showed no differences in clinical outcomes between the two treatments. In this study, we compared the clinical outcomes of LR and LUR KT in ABO-incompatible KT recipients. METHODS: From January 2011 to August 2013, 19 cases of ABO-incompatible KT were analyzed retrospectively. Eight kidneys (7 cases of parent-offspring and 1 case of siblings, Group 1) were donated from living-related donors and 11 (all spousal donors, Group 2) from living-unrelated donors. We investigated patient survival, graft survival, acute rejection, graft function, and complications. RESULTS: On Kaplan-Meier analysis, patient and graft survival during follow-up were 87.5% and 87.5% in Group 1; both were 100% in Group 2. Acute rejection, graft function, and medical and surgical complications were not significantly different between the two groups. CONCLUSIONS: The short-term clinical outcomes between LR and LUR KT in ABO-incompatible KT recipients were equivalent. Most domestic cases of LUR KT are from spousal donors and the spousal donor will be a major donor in ABO-incompatible KT patients.

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.