Influence of Mismatching in HLA Cross-Reactive Group on the Graft Survival after Unrelated Kidney Transplantation / 대한임상병리학회지

BACKGROUND: Kidney transplantation(KT) from unrelated donors has been increasing in Korea in recent years. However, the number of HLA antigen mismatches in unrelated donor KTis larger compare with that in related donor KT. Recently, some studies have reported that cross-reactive group(CREG) matching would improve graft outcome. METHODS: We studied a total of 277 cases of kidney transplants from unrelated donors(cadaver donor 195 cases, living unrelated donor 82 cases) in our center from March 1992 to August 1998. HLA class I antigens were assigned to 10 CREG antigens based on the amino acid residue system of Takemoto. HLA-DR antigens were assigned to 10 broad HLA antigens. Antigens present in donor but not in recipient were considered as mismatches. The survival analysis was carried out by Kaplan-Meier method and differences in survival rates were tested by log-rank test. RESULTS: Mean numbers of mismatches in HLA and CREGs were 4.0 and 2.9. Mismatched numbers of CREG-A,B and 5 year survival rates showed a linear association(P=0.01), but those of HLA-A,B did not show a linear association(P=0.88). Probability of finding zero or one CREG mismatched recipients in unrelated KT was 53%(146 cases). A significant statistic difference was noted in survival rates between zero or one and two or more CREG mismatched group(P=0.01). CONCLUSION: Zero or one CREG mismatched group had better survival in unrelated living or cadaveric KT. Applying CREG matching strategy to recipient selection, graft survival will be significantly improved in unrelated living or cadaveric KT.

Pregnancy Outcome in Renal Allograft Recipients / 대한산부인과학회잡지

OBJECTIVE: To assess the pre-pregnancy and pregnancy factors influencing pregnancy outcome in renal transplanted women Materials and METHODS: This retrospective study included all pregnancies in renal transplanted women in Asan Medical Center between June 1996 and February 1998. We collected data from the medical records of allograft recipients. Pre-pregnant status and pregnancy outcome were described. RESULTS: Seventeen pregnancies in 13 allograft recipients resulted in 7 term deliveries, 4 preterm births, 2 spontaneous abortions, and 4 therapeutic abortions. All but one patient received immunosuppressive therapy with cyclosporin A, azathioprine, and prednisolone during pregnancy. The mean interval from the time of transplantation to conception was 28.8+/-14.3 months(range 6-60 months). In live birth group, the mean gestational age at delivery was 37.7+/-1.2 weeks and the mean birth weight of their offspring was 2.85+/-0.37 kilogram. Apgar scores at 5 minutes were 8 or more in all of them. The obstetric complications were distributed as follows: pregnancy induced hypertension in 6 cases(55%), pregnancy aggravated hypertension in 2 cases(18%), fetal growth restriction in 1 case(9%), prematurity in 4 cases(36%). Cesarean sections were done in 4 cases(36%) because of previous Cesarean section(3 cases) and uncontrolled hypertension(1 case). Neonatal complication, transient tachypnea of the newborn, was found in one case. Graft rejection after transplantation occurred in 4 cases: 3 cases in preterm births and 1 case in therapeutic abortions. Maternal renal functions were normal during pregnancy and postpartum period whose pre-pregnant renal functions had been normal. No patient experienced any rejection episode or graft loss during pregnancy. CONCLUSION: Successful pregnancy can be expected in women with a renal transplant, although there was high incidence of pregnancy-related complications, especially hypertensive disorders. Pregnancy can be encouraged to these allograft recipients if they have good renal function.