Clinical analysis of 100 cases of relative living kidney transplantation in the minorities / 中华器官移植杂志

ABSTRACT

Objective To summarize the experiences of 5-year relative living kidney transplantation in the minorities. Methods The clinical data of HLA matching, rejection, survival and causes of death were retrospectively analyzed from 2004 to July 2009. There were 97 blood relative donations, including 1 case of father → son, 1 case of daughter → father, 1 case of mother → son, 24 cases of donation between brother and sister, 2 cases of non-blood relative donors (husband and wife),1 case of inter-ethnics, and the remaining were collateral relative donors. All the donations were voluntary, and all the recipients were minorities and all donors were their blood relatives. There were no mismatch of gene matching of 6 antigenic sites (0 MM) in 1 patient, 1 mismatch point (1 MM) in 2 patients, 2 mismatch points (2 MM) in 5 patients, 3 mismatch points (3 MM) in 10 patients, 4 mismatch points (4 MM) in 21 patients, 5 mismatch points (5 MM) in 39 patients and complete mismatch in 22 patients. Results All donors were discharged after 1 week and followed up for 3-6 months. Blood creatinine was normal and urine protein was negative. Up to July 2009, the conditions of the recipients were as follows (1) Ninety-one receptors survived after transplantation. The longest survival time was up to 5 years. Among 9 deaths, 1 case died from myocardial infarction, 1 case from hemorrhagic shock and the others from respiratory failure (7 %) ; (2) Two renal grafts lost their functions and the patients restarted dialysis, in whom the preoperative panel reactive antibodies (PRA) of 1 patient was high and the patient had postoperative acute rejection, and the other patient stopped immunosuppressive agents on his own, leading to renal function loss; (3) After transplantation 10 patients had acute rejection, of which 2 cases received methylprednisolone plus OKT3, and the remaining 9 patients were treated with methylprednisolone. All rejections were reversed; (4) Urethral fistula occurred in one case and was improved after 45 days. Three patients had vesicoureteral anastomotic stenosis and were cured surgically. lyrnph leakage occurred in one case and was improved after 2 months. Fourteen patients had lung infection, including 7 mild lung infections which were improved after treatment, and 7 severe lung infections which died from respiratory failure.Other complications included secondary diabetes mellitus (4 cases), urinary tract infection (2 cases),acute renal failure (2 cases), deep venous thrombosis (3 cases), drug-induced liver damage (5 cases),polycythemia (5 cases), hepatitis C (3 cases), chronic allograft nephropathy (3 cases), and all were improved after treatment. Conclusion Comprehensive assessments of the donors and receptors before transplantation are guarantee to successful living kidney transplantation from relative donors; Living kidney transplantation from relative donors has the advantages of good matching, short ischemia period of donated kidney, less rejections and high survival rate of transplanted kidneys.