Living-Donor Renal Transplantations, Analysis of Risk Fanctors Influencing the Outcome of 190 Cases

ABSTRACT

We have performed 190 renal transplantations from August 1990 to June 1996. No cadaveric donor was used and all except one were first grafts. We conducted a clinical analysis, especially concerning the factors affecting acute rejection and graft function at 1 year. The results were as follows : 1) The mean ages of donor and recipient were 35.3 years and 37.4 years respectively. The ratio of male to female was 1.4 : 1 and 1.5 : 1, respectively. 2) One hundred and six cases(55.8%) were living unrelated donors and eighty four cases(44.2%) were living related donors. 3) One hundred and sixty six potential recipients were given 3 donor specific transfusions(DST), started about 5 weeks prior to transplantation with cyclosporin coverage. Six of these patients(3.6%) developed sensitization by DST that precluded the subsequent transplantation and the remaining 160 patients received the kidney from the blood donors. Another 28 recipients were given DST 24 hours prior to operation. 4) Most of initial acute rejection episodes(71 episodes, 95%) appeared within the first month of post-transplantation. 5) We analyzed the possible factors affecting the incidence of acute rejection. Donor age and HLA incompatibility were significant statistically(p<0.05). 6) Multiple regression analysis showed that a number of acute rejection episodes(p<0.001) was the only independent risk factor for the graft function at 1 year. 7) Overall graft and patient survival rate were 97.2% and 98.6% at 1 year, 94.1% and 95.5% at 3 years.