老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

亲属活体供肾移植52例随访

目的 调查分析亲属活体供肾移植供、受者术后的肾功能及生活质量情况.方法 以行亲属活体供肾移植的供受者52对、接受尸体肾移植的受者56例以及随机抽取的同期健康人60名为研究对象.于移植术前、术后3个月和1年对研究对象进行调查,采用调查问卷和临床检验相结合的方式.调查内容包括年龄、性别、婚姻状况、供受者的关系等以及健康状况调查问卷SF-36量表.结果 供者术后3个月及1年的血Cr和24 h尿蛋白均高于术前,但未超过正常范围.供者术前、术后3个月及1年的血Cr、GFR和24 h尿蛋白与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的血Cr与BUN均低于相应时间点的尸体肾移植受者,差异有统计学意义(P<0.05).供者术后3个月及1年的生活质量与术前相比,差异均无统计学意义(P>0.05);供者术前、术后3个月及1年的生活质量与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的生活质量与相应时间点的尸体肾移植受者相比,差异均无统计学意义(P>0.05).结论 活体供肾移植供者在切除肾脏后肾功能未见减退,生活质量与健康人群相比无明显差异;受者术后的移植肾功能恢复明显优于尸体肾移植受者.     

亲属活体肾移植供者的安全性分析

目的 分析亲属活体肾移植供者手术前后的相关指标变化,探讨活体供者的安全性.方法对132例亲属活体供肾者进行心理和生理分析,包括尿常规、血生化、肾小球滤过率(GFR)、内生肌酐清除率(CCr)和生活质量等指标.结果 132例供肾者的生活质量评分与正常人群比较差异无统计学意义(P＞0.05).供肾切取术前供者血肌酐(SCr)为(78.33±15.94)μmol/L,术后7 d为(108.49±19.88)μmol/L(P=0.000);术后6个月为(112.47±20.38)μmol/L,与术后7 d比较差异无统计学意义(P=0.109).供肾切取术前供者CCr为(95.80±20.92)ml/min,术后7 d为(57.36±14.92)ml/min,与术前比较P=0.017;术后6个月为(65.49±8.25)ml/min,与术后7 d比较差异无统计学意义(P=0.619).术前双肾GFR为(74.08±18.51)ml/min,右肾GFR为(38.43±10.33)ml/min,供肾切取术后6个月保留右肾GFR为(56.49±13.01)ml/min,与术前双肾GFR比较,P=0.000;保留右肾GFR与术前自身比较代偿性增加47.0%.手术并发症包括脾脏包膜下出血1例,降结肠破裂1例,切口脂肪液化5例. 结论 术前对供肾者进行充分系统的医学心理学和生理学评估,严格履行风险告知义务,供受者术中规范操作,围手术期合理管理和建立严密的随访制度,可以有效提高亲属活体移植供肾者的心理和生理安全性.     

扩大供肾标准的亲属肾移植临床效果分析

目的 探讨扩大供肾标准的亲属肾移植临床效果.方法 回顾性分析2005年11月至2011年6月亲属活体肾移植274例的临床资料,按供者情况分为扩大供者标准(供者年龄≥60岁、肾脏解剖结构/功能异常)组(66例)和标准供者组(208例).扩大标准组供者年龄≥60岁36例,其中合并肾囊肿6例,合并肾结石1例;肾囊肿22例,囊肿直径4～40 mm;肾结石4例,结石直径3 ～～6 mm;术侧肾小球滤过率(GFR) ＜35 ml/min 4例.统计学比较两组受者术后3、7d,l、3、6、12个月血清SCr值、并发症发生率、急性排斥反应发生率、移植肾功能延迟恢复(DGF)发生率,1、3年人/肾存活率.结果 扩大标准组及标准供者组受者术后3、7d血清SCr值分别为(242.7±132.2)、( 185.6±148.4) μmol/L和(156.7±86.8)、( 122.2±136.8) μmol/L,两组受者第3天与第7天SCr值比较差异均有统计学意义(P＜0.05);但两组受者术后1、3、6、12个月血SCr、并发症发生率、急性排斥反应发生率、DGF发生率,1、3年人/肾存活率之间比较差异均无统计学意义(P＞0.05).结论 ≥60岁健康高龄、直径＜40 mm供肾囊肿仍可考虑作为亲属肾移植供者;低GFR应结合供者年龄、供受者体表面积比、供受者体质量比、可通过外科处理纠正等方面综合考虑;供肾结石者应慎重选择.     

亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响

目的探讨亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响。方法回顾性分析14例供肾动脉轻度狭窄的亲属活体肾移植与50例标准亲属活体肾移植供、受者的临床资料。比较两组供者术后血清肌酐(Scr)水平。比较两组受者术后1、3、6个月的Scr水平;比较两组受者移植肾存活率及移植物功能延迟恢复(DGF)、急性排斥反应、肺部感染的发生率。结果两组供者术后Scr水平比较,差异均无统计学意义(均为P0.05)。两组术后1、3、6个月Scr水平比较,差异均无统计学意义(均为P0.05)。两组受者移植肾存活率,DGF、急性排斥反应、肺部感染的发生率比较,差异亦均无统计学意义(均为P0.05)。结论亲属活体供肾动脉轻度狭窄对肾移植受者术后肾功能和并发症的影响不大,可纳入标准供体供肾范围。     

亲属活体供肾移植后近期及中长期供者和受者的安全性分析

目的 探讨亲属活体供肾移植术后近期及中长期供、受者的安全性.方法 对106名亲属活体供肾者及其受者进行随访.随访日分别为肾移植后2个月至7年,其中32名供者随访时处于术后3个月内,44名处于术后3个月至1年,30名处于术后1年以上(其中术后1～3年者14名,3～5年者11名,5年以上者5名).以GFR作为评估供、受者肾功能的主要指标,比较供、受者手术前后的肾功能以及血压和尿蛋白.GFR的计算采用同位素发射计算机辅助断层显像法(GFR-ECT法)、24 h尿肌酐(Cr)清除率法(GFR-24 h Urine法)及Cockcroft-Gault公式法(GFR-Cr法).结果 取肾前106名供者的GFR-ECT和GFR-Cr分别为(1.51±0.13)和(1.99±0.42)ml/s,GFR-ECT是GFR-Cr的75.8%;术后第5天,供者的GFR-Cr为(1.40±0.33)ml/s,为术前的70.5%;术后3个月内、3个月至1年和1年以上者的GFR-Cr分别为(1.47±0.28)、(1.36±0.24)和(1.37±0.23)ml/s,分别为取肾术前的73.7%、68.0%和68.6%;术后1～3年者、3～5年者及5年以上者的GFR-Cr与超过1年者整体的GFR-Cr比较,差异无统计学意义(P>0.05).4名供者术后尿蛋白为±,均为术后超过1年者;4名供者血压升高.术后3个月、1年及1年以上,受者的GFR-Cr分别为(1.09±0.26)、(1.20±0.31)和(1.07±0.29)ml/s.结论 术后近期供者的GFR会下降,并小幅波动,术后中长期其GFR接近术前70%的水平,并趋于稳定.亲属活体供肾移植术后供、受者具有良好的安全性.     

70岁以上老年供肾活体肾移植18例疗效分析

目的探讨70岁以上老年供肾活体肾移植的临床疗效。方法以2017年9月至2019年6月中国科技大学附属第一医院(安徽省立医院)肾移植科18例供者年龄超过70岁的活体肾移植供、受者为研究对象, 收集围手术期临床资料和随访数据, 根据单侧供肾肾小球滤过率(GFR)是否低于40 ml/(min·1.73 m2)分为低供肾GFR组(8例)和正常供肾GFR组(10例), 分别对两组血肌酐和移植肾存活率等参数进行统计学分析。同时回顾性分析术后并发症等随访结果。结果 18例供、受者均手术顺利, 未发生严重围手术期并发症和二次手术;受者术后未发生移植物功能延迟, 围手术期出现急性排斥反应1例(5.6%), 术后第3天平均血肌酐(155.7±63.5)μmol/L, 出院时血肌酐(97.6±28.7)μmol/L;随访时间37.5个月(27～48个月), 18例供者术后恢复顺利, 随访期间健康状况良好, 未发生蛋白尿、供肾手术相关住院或死亡, 出院血肌酐(86.8±18.3)μmol/L, 末次随访血肌酐(84.4±15.0)μmol/L, 两组差异无统计学意义(P=0.610);18例受者随访期间受者、...     

50岁以上亲属活体肾移植供者安全性分析

目的 探讨50岁以上亲属活体供肾移植供者的安全性. 方法 1993年4月至2007年12月行年龄>50(51～78)岁亲属活体供肾移植45例,同期年龄≤50岁供者62例作为对照组.比较2组供者手术前后SCr、GFR变化,手术并发症及术后随访情况. 结果 供肾手术均获成功.2组供者术前SCr分别为(82.16±10.86)和(78.66±10.41)μmol/L,术后1周、1个月及12个月分别为(106.00±8.68)、(86.62±10.81)、(83.18±9.19)μmol/L和(103.89±9.29)、(85.65±7.42)、(80.32±8.89)μmol/L,组问比较差异均无统计学意义(P>0.05);2组术前GFR分别为(85.82±6.26)和(88.74±9.44)ml/min,术后1、12个月分别为(49.76±3.57)、(60.32±4.42)ml/min和(51.36±5.39)、(62.10±6.31)ml/min,组间比较差异均无统计学意义(P>0.05).2组供者术后平均住院时间分别为9及8 d.>50岁组术中发生胸膜损伤2例,术后切口疼痛、下腹部麻木感4例,切口脂肪液化1例;对照组发生胸膜损伤1例,术后切口疼痛、下腹部麻木感9例.>50岁组供者随访37(12～180)个月,肾功能正常.结论 高龄不是亲属活体供肾绝对禁忌证,术前全面系统评估及术中仔细操作是高龄供者术后安全性的重要保证.     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变化、Scr最低值、所需时间、术后并发症发生率.结果 49例亲属活体供肾中13例发生病理改变.边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组(均P＜0.05),而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义(均P＞0.05).边缘供肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义.结论 边缘供肾受者的早期临床疗效是理想的,但术后血肌酐基线较非边缘供肾患者高,应严格控制其纳入标准.供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病,对供受者具有重要诊断和治疗价值.     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变化、Scr最低值、所需时间、术后并发症发生率.结果 49例亲属活体供肾中13例发生病理改变.边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组(均P＜0.05),而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义(均P＞0.05).边缘供肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义.结论 边缘供肾受者的早期临床疗效是理想的,但术后血肌酐基线较非边缘供肾患者高,应严格控制其纳入标准.供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病,对供受者具有重要诊断和治疗价值.     

Grandparent donors in paediatric renal transplantation

The outcome of transplantation from grandparent donors in comparison with parental donors in paediatric renal transplantation was evaluated in 53 living related donor (LRD) transplantations performed between January 1996 and August 2003. The donor in 13 cases (25%) was a grandparent (Gpar group), and the remaining donors formed the parent group (Par group). The median age of recipients in the Gpar group was 2.75 (1.7–10.6) years and in the Par group was 12.75 (2.4–22) years (P<0.0001). There was no evidence of a difference in patient and graft survival, glomerular filtration rate (GFR) after transplantation, or the number of biopsy proven episodes of rejection between the groups. Doses of prednisolone in the first year following transplantation were greater in recipients from Gpar donors, but the other immunosuppression doses were similar. The median age of donors in the Gpar group was 56 (50–67) years and in the Par group was 41 (27–58) years (P<0.0001). There was no evidence of a difference between the two donor groups in mean creatinine clearance at last follow-up. There were two major donor complications in the Gpar group and one in the Par group. There was no evidence that the length of stay differed between the two groups in either the donors or recipients. These results support the use of carefully selected healthy grandparents as LRDs in children. This option potentially allows for the use of parent donors for a subsequent transplantation.     

Kidney transplantation from related and unrelated living donors in a single German centre.

BACKGROUND: Organ transplantation began in 1954 with living related donation (LRD). Because of organ shortage from cadavers, unrelated kidney donation (LURD) has been proposed and shown to have good results despite complete HLA mismatching. This study aims to look at differences and similarities comparing LRD and LURD performed in our centre since the implementation of the German transplant law in 1997. METHODS: Between January 1997 and July 2001, 62 out of 112 potential living donors and their recipients were accepted. Immunosuppression consisted of triple therapy (steroids, cyclosporin, mycophenolate) in patients with three or fewer mismatches, or quadruple therapy including mono- or polyclonal antibody treatment in patients with four or more mismatches or cytotoxic antibodies. LRD and LURD groups were compared for number and type of rejections, complications and kidney function at the end of observation (median 15.5 months, range 1-50 months). RESULTS: Out of 112 pairs presenting, transplantation was performed in only 62 cases (55.4%). Reasons to deny transplantation were medical problems of the potential donors in 19, psychological problems in 13, recipient problems in seven and other reasons in 11 pairs. In 38 cases LRD transplantation and in 24 cases LURD transplantation was carried out. Recipient age was significantly lower in the LRD group (37.7+/-12.1 years) compared with the LURD group (53.6+/-7.8 years). Mean donor age was 49.7+/-9.2 years in the LRD group and 50.3+/-9.1 years in the LURD group (ns). The number of mismatches was lower in LRD (2.1+/-1) than in LURD (4.4+/-0.9) (P=0.001) transplantation. The acute rejection rate was similar in both groups (52.2 vs 54.2%). OKT3 and tacrolimus rescue therapy for more severe rejections was more often applied in the LRD group but the difference did not reach the level of significance. There were more infectious complications in LURD transplantation (66.7 vs 36.4%, P=0.036) and a trend towards more surgical complications in LRD transplantation (28.9 vs 8.3%, P=0.062). One graft was lost due to transplant artery thrombosis and one recipient died 4 months after transplantation subsequent to cerebral ischaemia. Both patients belonged to the LRD group. Creatinine values at the end of observation time were 1.76+/-0.6 mg/dl in the LRD group and 1.62+/-0.5 mg/dl in the LURD group (ns). CONCLUSION: Although kidney transplantation from unrelated donors was performed with a lower HLA match and although the recipients were older, the results are equivalent to living related transplantation. Therefore, kidney transplantation from emotionally related living donors represents a valuable option for patients with end-stage renal disease. Careful selection of donors and recipients is a prerequisite of success.     

Impact of recurrent disease and chronic allograft nephropathy on the long‐term allograft outcome in patients with IgA nephropathy

Although recurrent IgA nephropathy (IgAN) may lead to graft dysfunction after transplantation, donation from living related donor (LRD), with whom the risk of recurrence may be higher, is not a contraindication. Herein, we evaluated the natural history of allograft in recipients with IgAN and the risk factors influencing long‐term allograft outcome. Recurrence rate and graft survival were assessed retrospectively in 221 IgAN patients, including transplants from 139 LRDs (62.9%). Ten‐year cumulative rate for recurrent IgAN was 30.8%. The operation at younger age and donation from LRD were significant for the recurrence by multivariate analysis. Ten‐year graft survival was affected by recurrent IgAN (61.0% in recurrent IgAN group vs. 85.1% in nonrecurrent, P < 0.01). However, transplants from LRDs did not show poor graft survival when compared with those from other types of donors. In transplants from LRDs, the incidence of chronic allograft nephropathy (CAN) was lower than those in grafts from deceased donors (10.8% vs. 19.5%, P < 0.05). When CAN was considered in addition to recurrence, the variance of graft survival was affected significantly by the development of CAN than by the recurrence. These results suggest that the detection and adequate management of CAN could improve graft outcome in transplant recipients with IgAN.     

Evaluation of the coagulation and inflammatory responses in solid organ transplant recipients and donors

Abstract: New strategies that modify the coagulation/inflammatory cascades may be applicable to solid organ transplant (SOT) recipients in the treatment of complications. However, data on kinetics of post‐SOT cascades are needed before considering these strategies. Prospectively collected pre‐transplant serum measurements of inflammatory (high‐sensitive C‐reactive protein, HS‐CRP) and coagulation (d ‐Dimer, DD; protein C, PC) markers were compared to post‐operative (day 1–90) values in deceased‐donor liver (DDLT) and renal (DDRT) transplant recipients, living‐related renal recipients (LRT) and donors (LRD). A total of 85 SOT were enrolled: 25 DDLT, 32 DDRT/LRT, 28 LRD. HS‐CRP increased in all groups, mainly immediate post‐SOT and in LRDs. DD had a similar pattern mainly in LRT and LRD. PC increased significantly over time in the DDLT group ( p < 0.01). Compared to those with no complications (infection, rejection or thrombosis), day 30 HS‐CRP (p = 0.04) and DD (p = 0.06) were elevated in the DDRT/LRT group with complications; PC was decreased at day 7 (p = 0.04) and day 30 (p = 0.009) in DDLT and DDRT/LRT groups with complications, respectively. In conclusion, activation of the inflammatory/coagulation cascades occurs after SOT and is least pronounced in DDLT. This activation diminishes over time unless transplant complications occur. Our results support further research in approaches to altering these cascades in SOT recipients.     

Living related kidney donation as an advantage for growth of children independent of glomerular filtration rate

Seventy-two pediatric kidney recipients of living related donors (LRD) and 145 of cadaveric donors (CAD) were analyzed for height standard deviation scores (Ht-SDS) and glomerular filtration rates (GFR) directly after transplantation and over the following 5 years. GFR was significantly higher immediately after transplantation in LRD compared with CAD recipients; however, GFR was not different during the 5-year follow-up period. Although Ht-SDS was comparable at the time of transplantation in both groups, it was significantly higher among LRD recipients over the next 5 years. Multivariate and covariate analyses showed that Ht-SDS after 5 years was mainly influenced only by CAD vs LRD and not by GFR or other factors, namely, donor age, rejections, time of dialysis, preemptive transplantation, age at transplantation, or immunosuppression. Thus, children receiving grafts from LRD showed a better catch-up growth independent of the GFR than those after CAD transplantation. We concluded that the period of donor death and prolonged cold ischemia in CAD grafts may lead to changes in gene expression of cytokines and other mediator molecules that affect bone metabolism. Better growth seems to be an additional factor supporting the policy of LRD kidney transplantation as the best option in children.     

Study of the effect of donor source on graft and patient survival in pediatric renal transplant recipients

Evaluation of the impact of live unrelated kidney donor (LURD) source on the outcome of renal transplantation is not adequately studied. We aimed to compare the long-term outcome of kidney transplantation from LURDs to that from living related donors (LRDs) among a pediatric recipient population. This study comprised 235 pediatric recipients who received their kidney grafts between 1976 and 2005 at our center. These patients were further subdivided into two groups according to donor source (211 with LRDs) and (24 with LURDs). All patients’ data were assessed with special emphasis on graft and patient survival as well as posttransplant medical complications. Both groups were comparable regarding graft and patient survival at 1, 5, and 10 years. Despite higher incidence of acute vascular rejection among recipients with LURD (12%) vs. LRD (2.8%) (P = 0.03), there was no difference in the incidence of chronic allograft nephropathy. Moreover, the overall incidence of posttransplant complications was comparable among the two groups. In our series, kidney survival was poorer in LURDs compared with LRDs. However, the number of patients with LURD was small, and the difference in results was also small and justifies LURD in exceptional cases when LRD is not possible.     

Outcomes of kidney transplant tourism in children: a single center experience

Transplant tourism is a necessity for children with end-stage renal disease living in regions without established local transplantation programs. The use of kidneys from living unrelated donors (LURDs) was common practice in Asia prior to the recent global condemnation of commercial organ transplantation. Objective information on the outcomes of pediatric transplant tourism is scarce. Here, we report the Dubai experience with 45 renal allograft transplantations performed outside the United Arab Emirates (UAE) between 1993 and 2009. Transplantation from 33 LURDs, ten living related donors (LRDs) and two deceased donors was performed in 14 different countries. The mean number of human leukocyte antigen (HLA) A/B/DR allele matches was 1.4 ± 0.8 in the LURD graft recipients and 3.9 ± 0.7 in the LRD recipients. Outcomes were compared with those of a matched group of 3,150 pediatric LRD transplantations from the Collaborative Transplant Study (CTS). Ten-year patient survival was 100% in the LRD patients, 91.2% in the LURD patients, and 92% in the CTS patients. The three deaths in the LURD group occurred within the first 4 months after transplantation and were related to acute rejection. One-year and 10-year graft survival was 100% in the LRD group and 94.8% and 66.7% in the CTS-LRD groups, vs 87.8% and 43.4% in the LURD group. Major viral infections [Epstein–Barr virus (EBV), cytomegalovirus (CMV), varicella zoster (VZV)] were four-times more common in patients that had received LURD grafts than in those that had received LRD grafts. In conclusion, whereas LRD kidney transplantation performed abroad yields excellent long-term results, transplantation of LURD kidneys is fraught with a high complication rate affecting graft and even early patient survival.     

Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: is there a difference in survival?

OBJECTIVE: To compare the outcome of simultaneous pancreas-kidney transplantation (SPK) and living related donor renal transplantation (LRD) in patients with diabetes. SUMMARY BACKGROUND DATA: It remains unanswered whether diabetic patients with end-stage renal failure are better served by LRD or SPK. METHODS: Using a longitudinal database, data from all diabetic patients receiving LRD or cadaveric renal transplants or SPKs from January 1986 through January 1996 were analyzed. Patient and graft survival, early graft function, and the cause of patient and graft loss were compared for 43 HLA-identical LRDs, 87 haplotype-identical LRDs, 379 SPKs, and 296 cadaveric renal transplants. RESULTS: The demographic composition of the SPK and LRD groups were similar, but because of less strict selection criteria in the cadaveric transplant group, patients were 10 years older, more patients received dialysis, and patients had been receiving dialysis longer before transplantation. Patient survival was similar for the SPK and LRD groups but was significantly lower for the cadaveric renal transplant group. Similarly, there was no difference in graft survival between SPK and LRD recipients, but it was significantly lower for recipients in the cadaveric renal transplant group. Delayed graft function was significantly more common in the cadaveric renal transplant group. Discharge creatinine, the strongest predictor of patient and graft survival, was highest in the SPK group and lowest in the HLA-identical LRD group. The rate of rejection within the first year was greatest in SPK patients (77%), intermediate in the haplotype-identical LRD and cadaveric transplant groups (57% and 48%, respectively), and lowest (16%) in the HLA-identical LRD group. Cardiovascular disease was the primary cause of death for all groups. Acute rejection, chronic rejection, and death with a functioning graft were the predominant causes of graft loss. CONCLUSIONS: This study demonstrates that there was no difference in patient or graft survival in diabetic patients receiving LRD or SPK transplants. However, graft and patient survival rates in diabetic recipients of cadaveric renal transplants were significantly lower than in the other groups.     

Analysis of donor selection procedure in 139 living-related kidney donors and follow-up results for donors and recipients

In 1981 an active programme was started in our centre for living-relatedkidney donation (LRD). The structure of this LRD programme isdescribed in this paper. Retrospectively the results of this LRD programme were studied.Between 1981 and 1988 139 potential living donors were evaluated.Of all potential donors 47 (34%) actually donated a kidney,including 24 HLA non-identical combinations. Follow-up was obtained until 1990. An acceptable incidence ofmorbidity and mortality for donors and recipients was observed.A high number of potential donors was excluded during the selectionprocedure (66%). They were often refused for medical reasons(29%), with a high incidence of renal dysfunction (16%). Nolong-term adverse effects of nephrectomy regarding decreasedrenal function, hypertension, or proteinuria were seen. Of allactual donors 23% experienced minor complications after donation.Living-related kidney transplants showed better graft functionthan cadaveric grafts.