Renal Transplantation

Summary BACKGROUND: Clinical renal transplantation has been performed successfully since 1955. With the introduction of Cyclosporin A to the market, 1982, results markedly improved, and allogeneic renal transplantation became a standard therapy in the treatment of end stage kidney failure. Life expectancy and quality of life is superior in kidney recipients in comparison with patients on dialysis. METHODS: In our center 699, renal transplantations have been performed since 1968. 98.1 % of the transplanted kidneys were from cadaveric donors, 1.9 % from living related donors. Mean age of the recipients was 30.7 ± 13.9 years from 1968 to 1983, and is now 45.9 ± 13.1 (1999 to 2002). The kidneys are normally transplanted to the common iliac vessels in end-to-side fashion. A Politano-Leadbetter antirefluxive implantation of the ureter is obligatory. RESULTS: 5-year graft survival was 19.4 % from 1968 to 1983, 74.3 % from 1984 to 1995, and 81.2 % from 1995 to 1998. Typical surgical complications are hematoma, lymphocele, ureter stenosis and ureter necrosis. The rate of necessary reoperations is 3.9 %. 5-year patient survival is 90 %. Heart disease (50 %), cancer (16 %), and sepsis (15 %) are the most frequent causes of death after renal transplantation. CONCLUSIONS: Renal transplantation continues to be the optimal treatment of terminal kidney failure. New immunosuppressive agents have improved the outcome after kidney transplantation. Enlargement of the donor pool is being attempted by the acceptance of older organs and by the acceptance of pediatric organs for adult recipients, too.