The organization of Kidney Transplantation Services at Ramathibodi Hospital: fourteen years experience on waiting list, kidney donors and kidney transplantation.

The Kidney Transplantation Program at Ramathibodi Hospital was established in 1985. By the end of 1998, there were 1,614 patients on the cumulative waiting list. The first kidney transplantation (KT) was started in 1986 by using kidney from living-related donor (LD) while cadaveric KT (CD-KT) was started in 1987. A total of 528 KT were done, 278 cases (52.7%) were CD-KT and 250 cases (47.3%) were LD-KT. Six patients had two kidney transplants. 278 kidneys were donated from 189 cadaveric donors. Fifty cadaveric donors (26.4%) were from Ramathibodi Hospital while the rest were from other hospitals and the Organ Donation Center, Thai Red Cross Society. For LD, 233 out of 250 (93.2%) were from living-related, more than 50 per cent of these donors were from siblings. 17 spousal donors have been accepted for KT at Ramathibodi Hospital since 1997. Concerning the recipient pools, 522 patients (32.3%) were transplanted, 123 patients (7.6%) died without KT, 111 patients (6.9%) underwent KT at other hospitals, and 78 patients (4.8%) changed to waiting lists at other hospitals. The rest were lost to follow-up. At present, only 265 patients are still actively waiting (send serum every month). The number of KT and living donors has gradually increased, whereas, the number of cadaveric donors has decreased. However, cooperation with the "Organ Donation Center" has improved the number of cadaveric donation in the last two years. Sufficient organ donations and an active working team will provide a good kidney transplant service for the patients.

Increasing the chance to accept HLA-ABDR mismatched donor in kidney transplantation.

Two hundred and fifty-three kidney transplantations (KT) which included 68 (26.9%) living-related (L) and 185 (73.1%) cadaveric (C) KT with 0-6 HLA-ABDR mismatches (MM) were studied for the association of HLA-ABDR-MM specificities and the occurrence of graft rejection (GR). It was found that the incidence of acute and chronic rejection in CKT was significantly higher than that of LKT (42.1% vs 22.1%, p < 0.005). It was also observed that the number of ABDR-MM, AB-MM and BDR-MM which is important in GR were 2 times in CKT compared with LKT. The analysis revealed that HLA-A11, B16, B22, B35, B5, B17 and DR3 were good responders, whereas, HLA-A30, A2, B62, B18, B40, B44, B46 and DR10 were good stimulators for KT. GR were significantly increased with p < 0.01 and < 0.05, respectively. Specific HLA-MM specificities played a significant role in GR, i.e., some HLA-MM specificities were permissible, whereas, some were immunogenic. Careful selection of donor and recipient for KT by avoiding immunogenic HLA-MM and/or accepting permissible HLA-MM will improve graft survival and reduce the demand of kidney for retransplantation.