胰肾联合移植中供体切取和修整的技巧

目的:总结胰肾一期联合移植中供体胰十二指肠及肾脏切取及修整的经验。方法:回顾性分析19例胰肾联合移植术中供体胰十二指肠及肾脏切取的方法与移植物的修整技巧。结果:无1例发生移植物损伤。联合移植术后9 d之内18例完全停用外源性胰岛素,空腹血糖正常，尿糖≤（+）。术后2～4 d，血肌酐和尿素氮降至正常。3例出现移植肾脏急性排斥反应，2例发生移植胰腺急性排斥反应，给予甲泼尼龙冲击治疗后恢复正常。1例术后因移植物加速排斥反应，术后11 d切除移植胰、肾。结论:胰肾联合移植手术中，供体胰十二指肠及肾脏的切取及修整是手术成功的重要因素之一。     

肝胰肾联合移植的免疫抑制治疗

目的 介绍1例存活超过1年的肝胰肾联合移植患者术后免疫抑制治疗方法。方法对1例肝炎后肝硬化合并尿毒症、I型糖尿病、慢性胰腺炎患者施行原位背驮式肝、胰液空肠引流式胰、十二指肠及肾一期联合移植，采用二剂巴利昔单抗（舒莱）诱导，抗胸腺细胞球蛋白（ATG）、他克莫司（FK506）、吗替麦考酚酯（MMF）、泼尼松四联维持治疗。结果 术后移植肝脏及胰腺功能1周内逐渐恢复；肾功能延迟恢复，于术后第16天因消化道大出血致肾脏血流下降，切除移植肾脏，于原移植部位进行第2次肾移植，术后第3天肾功能恢复正常，未发生排斥反应。患者已健康存活超过1年，移植肝、胰、肾功能良好，生活自理。结论 肝胰肾联合移植术前后采用二剂舒莱诱导，同时用ATG、FK506、MMF及泼尼松作为免疫维持治疗安全有效，用药期间进行移植物功能、血药浓度及T细胞亚群（CD4^＋，CD4^＋）监测是防治排斥反应、感染及药物中毒的有效手段。     

肝肾联合移植中肝脏对肾脏的保护作用

目的探讨肝肾联合移植中肝脏对肾脏的保护作用。方法回顾性分析2001年10月至2006年6月18例接受肝肾联合移植患者的资料,并以同一供体的对侧肾脏所完成的单独肾移植18例受者作为对照,2组患者年龄、性别、血型、冷热缺血时间、人类白细胞抗原（HLA）配型、肾病原发病、免疫抑制方案等条件基本匹配。对2组患者间移植肾急性排斥反应（AR）、慢性排斥反应（CR）、移植肾功能延迟恢复（DGF）的发生率以及出院时血肌酐（SCr）水平进行比较。结果肝肾联合移植组AR和DGF发生率均明显低于单独肾移植组,差异有统计学意义（5．6％对33．3％,P= 0．044;0对27．8％,P=0．023）;肝肾移植组CR发生率明显低于单独肾移植组,但差异无统计学意义（0对11．1％,P=0．243）。出院时平均SCr水平肝肾移植组明显低于单独肾移植组,差异有统计学意义[（57．1±6．0）μmol／L对（123．0±11．7）μmol／L,P=0．018）]。结论肝肾联合移植中肝脏对肾脏具有保护作用,能够维持良好的移植肾功能。     

儿童肾移植46例报道

目的探讨儿童肾移植的手术特点、术后并发症及免疫抑制治疗方案。方法回顾性研究1998年2月至2004年12月46例儿童肾移植患者的临床资料。观察受者及移植肾存活情况,受者生长发育情况及术后并发症。结果46例儿童肾移植后发生急性排斥反应10例,肾功能延迟恢复4例,尿漏1例,肝功能损害8例,肺部感染8例,全骨髓抑制3例,粒细胞减少2例,输尿管坏死1例,移植肾动脉狭窄1例。术后4周所有患者肾功能均恢复正常。术后1年人和移植肾存活率均为100%,3年人和移植肾存活率分别为100%和97.4%。结论肾移植是治疗儿童终末期肾病的有效手段。儿童肾移植术后急性排斥发生率高,免疫抑制治疗应根据不同个体的特点制定不同的方案。     

致敏受者肾移植术后疗效观察

目的 探讨致敏受者经严格的HLA配型及HLA交叉反应组配型后行肾移植的效果。方法 对63例移植前群体反应性抗体（PRA）水平较高的患者进行严格的供，受者HLA配型筛选，并按照美国国立器官分配中心（UNOS）制定的HLA交叉反应组（CREGs)配型原则进行供，受者配型筛选，按常规肾移植方法进行移植，术前未行血浆置换。结果 63例患者，44例术后1周内移植肾功能恢复正常；10例术后出现移植肾急性排斥反应，经静脉滴注单克隆抗体OKT3，7例肾功能恢复正常。3例切除移植肾；9例术后发生移植肾功能延迟恢复。8例于术后2周至2个月移植肾功能逐渐恢复正常；死亡2例；总急性排斥反应发生率及总移植肾功能延迟恢复发生率分别为15.9%和14.3%；按CREGs配型原则，供，受者0、1、2个位点错配分别为11例（17.5%),39例（61.9%)和13例（20.6%)；明显高于传统HLA抗原配型结果。结论 致敏受者必须严格按照HLA配型及HLA交叉反应组配型原则进行供，受者的筛选，这对减少移植肾排斥反应，提高移植肾的存活率有重要意义。     

肝肾联合移植术中肝脏对肾脏的保护作用

目的：探讨肝肾联合移植术中肝脏对肾脏的保护作用。方法：给1例肾移植术后移植肾失功并肝炎后肝硬化患者先行丧失功能移植肾切除术，术后第5天始每天口服环磷酰胺50mg，连服3个半月。经两次血浆置换，群体反应抗体(PRA)由66％降至22．5％，施行一期肝肾联合移植。供肝血流开放前及开放后每间隔半小时动态检测PRA，共7次，术后1个月、3个月、9个月复查PRA。术后免疫抑制治疗采用FK506、霉酚酸酯(MMF)和激素联合应用。结果：术后供肝、肾立即发挥功能，肝动静脉血流开放后，PRA由22．5％降至5％，并维持在7．5％(见图1)，术后未发生排斥反应现象。随访9个月，移植肝、肾功能正常，术后1个月、3个月、9个月复查PRA分别为7．5％、8．33％和7．5％。结论：肝肾联合移植术中肝脏对肾脏有一定的保护作用。     

他克莫司联合霉酚酸酯应用于胰肾联合移植的初步经验

目的 总结他克莫司(FK506)联合霉酚酸酯(MMF)应用于胰液膀胱引流式胰肾联合移植受者的初步经验. 方法 胰肾联合移植患者14例,术后应用FK506 0.07～0.15mg·kg-1·d-1加MMF 1.0～1.5 g/d加泼尼松25 mg/d三联免疫抑制治疗方案.采用微粒子酶免疫分析法每周测定口服FK506后全血峰谷浓度,依此调整剂量维持最初3个月内FK506全血浓度峰值10～20 μg/L,谷值5～15μg/L.并观察排斥反应的发生及药物的肝肾毒性. 结果 9例患者术后胰肾功能恢复良好,早期无排斥反应发生,血糖及肌酐水平恢复正常.随访18～70个月,平均34个月.存活1～3年者3例,3年～者1例,4年～者1例,>5年者4例,胰肾功能良好,血糖正常,均未使用降糖药.1例因超急性排斥反应术后第2天切除移植胰腺,随访2年肾功能良好.4例死亡,死因分别为术后急性右心功能衰竭、呼吸骤停、急性排斥反应及十二指肠瘘.胰肾联合移植术后各时期FK506全血峰、谷浓度差异均有统计学意义(P<0.05).术后共发生肾脏急性排斥反应4例次,肾毒性2例次,肝毒性1例次. 结论 FK506与MMF在药效上有协同作用,联合应用于胰肾联合移植具有良好的免疫抑制效果,能有效降低排斥反应发生率和提高移植物长期存活率.     

肾移植病人群体反应性抗体的检测

肾移植是治疗晚期肾功能衰竭的最佳方法,而影响移植肾存活主要原因排斥反应,尤其是超急性排斥反应及早期急性排斥反应造成移植肾不可逆损伤导致手术失败。组织配型是肾移植病人寻找合适供者,减少术后排斥反应发生,提高移植成功率和移植肾存活率的重要措施。本文对389例肾移植受者术前进行群体反应抗体(PRA)检测,探讨其与淋巴细胞交叉配合试验(CDC)和术后排斥发生的关系及该技术在临床肾移植工作中的实用价值。     

免疫抑制方案对移植肾早期各种功能状态的治疗影响

目的：分析肾移植术后早期 不同的肾功能状态下，三种免疫抑制用药方案对移植效果的影响。方法：将1196例肾移植患者根据其初始的免疫抑制用药方案分为A、B、C三组。A组：环孢素A（CsA) 硫唑嘌呤(Aza) 泥尼松（Pred);B组：CsA 霉酚酸酯（MMF）＋Pred;C组：他克莫司（FK506）＋MMF（或Aza) Pred。根据移植后早期肾功能状态，将患者分成肾功能即刻恢复正常（IGF）、缓慢恢复正常（SGF）、未恢复正常（AGF）和延迟恢复正常（DGF）四种情况。统计四种肾功能状态下，A、B、C三组患者的1年移植肾存活率、急性排斥发生率及治疗逆转率、药物副作用和相关并发症。结果：在四种不同肾功能状态下，B组或C组患者的移植肾1年存活率高于A组；B组和C组的急性排斥发生率均低于A组，急性排斥反应逆转率高于A组，但差异无显著性；B组或C组的肝功能损害、肾毒性、高血压的发生率明显低于A组。结论：在肾移植后各种肾功能状态下，B组和C组的免疫抑制方案，都可减少急性排斥反应、药物毒副作用及相关并发症的发生率，提高移植肾的存活率。     

胰肾联合移植治疗肝移植后糖尿病合并肾功能衰竭二例

目的 总结肝移植后再行胰肾联合移植治疗糖尿病合并肾功能衰竭的临床处理经验.方法 2例肝移植受者术前合并有2型糖尿病,分别于肝移植后7年余和4年余发生肾功能衰竭,遂行胰肾联合移植,2例的移植肝功能均正常.采取腹部器官联合快速切取技术整块切取双肾、全胰及十二指肠节段,先行肾移植,再行胰腺移植,供肾移植于左侧髂窝,供胰移植于右侧髂窝,供者的十二指肠与受者的空肠侧侧吻合,供者的十二指肠内置管,通过受者的空肠引流出体外.例1采用抗白细胞介素受体单克隆抗体诱导的四联免疫抑制方案预防排斥反应;例2术中给予抗胸腺细胞球蛋白和甲泼尼龙,术后继续使用2d,采用他克莫司+吗替麦考酚酯+皮质激素预防排斥反应.结果 2例手术过程顺利,术后移植胰腺功能正常,血糖均于术后10d左右恢复正常,无需胰岛素治疗,移植肾功能1周时恢复正常,第2例1周后血清肌酐渐进性升高,经验性抗排斥反应治疗效果不明显,移植肾活组织检查未见明显排斥反应征象,遂将他克莫司替换为西罗莫司,之后受者的肾功能逐渐恢复正常.目前2例受者已分别随访36个月及9个月,移植肝、肾及胰腺功能均正常.结论 肝移植后合并糖尿病、肾功能衰竭时可考虑行胰肾联合移植,但术后免疫反应复杂,需严密监测移植物功能.     

Analysis of the United Network for Organ Sharing database comparing renal allografts and patient survival in combined liver-kidney transplantation with the contralateral allografts in kidney alone or kidney-pancreas transplantation

BACKGROUND: Combined liver-kidney transplantation (LKT) is the accepted treatment for patients with liver failure and irreversible renal insufficiency. Controversy exists as to whether simultaneous LKT with organs from the same donor confers immunologic and graft survival benefit to the kidney allograft. This study compares the outcomes of simultaneous LKT with the contralateral kidneys used for kidney alone transplantation (KAT) or combined pancreas-kidney transplantation (PKT) to understand the factors that account for the differences in survival. METHODS: From October 1987 to October 2001, LKTs with organs from 899 cadaver donors were reported to the United Network for Organ Sharing; 800 contralateral kidneys from these donors were used in 628 KAT and 172 PKT recipients. These 800 paired control patients were the basis of this analysis. RESULTS: Graft and patient survival rates were lower among LKT recipients compared with KAT (P<0.001) and PKT recipients (P<0.001), because of a higher patient mortality rate during the first 3 months posttransplant. Among human leukocyte antigen-mismatched transplants, LKT recipients demonstrated the highest 1-year rejection-free survival rate (LKT 70%, KAT 61%, and PKT 57% ) (P=0.005 vs. KAT, P=0.005 vs. PKT). There was a lower incidence of renal graft loss resulting from chronic rejection among LKT recipients (LKT 2% vs. KAT 8% vs. PKT 6%, P<0.0001). CONCLUSIONS: Patients undergoing LKT exhibit a higher rate of mortality during the first year posttransplant compared with patients undergoing KAT and KPT. Analysis of the data indicates an allograft-enhancing effect of liver transplantation on the renal allograft.     

Incidence of Renal and Liver Rejection and Patient Survival Rate Following Combined Liver and Kidney Transplantation

Multiple organ transplantations are used to treat chronic multiple organ failure. However, long-term mortality and graft tolerance remain to be evaluated. We carried out a retrospective and comparative analysis of 45 patients who underwent a combined liver and kidney (LK) transplantation (LKT) from the same donor. They were compared to 86 matched patients who underwent kidney (K) transplantation (KT). All patients had an organic renal failure associated with cirrhosis (n = 35) or with inherited disease (n = 10). Nineteen (42.9%) had been transplanted previously. The patients' survival rate was 85% at 1 year and 82% at 3 years. Seven patients died within the first 3 months, due to severe polymicrobial infection. Two patients in the LK population (4.2%) developed acute rejection of the kidney graft compared to 24 of the 86 matched renal transplanted patients (32.6%). In parallel, acute liver rejection was observed in 14 cases (31.1%) in the LK population. The occurrence of acute rejection was not associated with panel-reactive lymphocytotoxic antibodies (n = 16), nor with positive cross-matches (n = 3). Four of the 45 patients (8.8%) subsequently developed chronic renal allograft rejection, and 16 cases of chronic hepatic dysfunction were noted (42.2%). In conclusion, the overall survival rate following combined liver kidney transplantation is acceptable, and LKT can be proposed to patients with kidney failure associated with liver dysfunction, primary oxaluria or amyloid neuropathy. The main cause of mortality in this population was severe infectious complications. The frequency of acute kidney rejection was lower than in single transplantation.     

Effect of donor age on the outcome of living-related kidney transplantation

The study compared the results of kidney transplantation from living-related donors older and younger than 60 years. The 273 kidney graft recipients were divided into group 1 (115 recipients of older grafts) and group 2 (158 recipients of younger grafts). The frequency of acute rejection (AR) episodes was similar in both groups but slow graft function occurred more frequently in group 1. The frequency of chronic renal allograft dysfunction in the first post-transplant year was significantly higher in group 1 than in group 2. Patient and graft survival was significantly worse in group 1. Risk factors for graft loss were the difference between donor and recipient age and AR. Donor age and graft function were risk factors for patient death. Although kidneys from older donors provide a statistically poorer transplant outcome, they are clinically acceptable, especially when waiting time is prolonged and access to dialysis limited.     

亲属活体供肾移植62例经验

目的 总结活体供肾移植的临床经验,提高其临床疗效.方法 同顾分析62例活体供肾移植的临床资料及供者情况.62例中,60例为三代内直系亲属供肾,2例为夫妻问供肾.移植前按程序对供、受者进行评估.供、受者 ABO血型均相同,供、受者间补体依赖淋巴细胞毒均为阴性,受者群体反应抗体阳性2例.53例行HLA配型,其中无抗原错配者5例,1个抗原错配者5例,2个抗原错配者20例,3个抗原错配者18例,4个抗原错配者2例,5个抗原错配者2例,全错配者1例.取左肾51例,取右肾11例.采用抗CD25单克隆抗体及甲泼尼龙(MP)诱导者36例,单纯采用MP者26例.术后采用环孢素A(或他克莫司)霉酚酸酯及泼尼松方法排斥反应.结果 供者住院时间为(9.4±2.2)d,取肾前血肌酐(Cr)为(66.8±16.4)μmol/L,取肾后第1天、第7天以及3个月以后的血Cr分别为(109.3±23.6)ttmol/L、(101.1±24.4)μmol/L和(91.1±15.5)tanol/L,虽明显高于取肾前(P＜0.05),但仍在正常范围.供肾热缺血时间为(70.9±41.7)s,冷缺血时间为(148.2±37.4)min.供者术后的并发症有气胸(3例,4.8%)、淋巴漏(2例,3.2%),切口愈合延迟(2例,3.2%),经治疗后痊愈.受者随访最长者达42个月,人、肾1年存活率均为100%.术后并发症包括急性排斥反应6例(9.7%),移植肾功能恢复延迟4例(6.5%),移植肾破裂1例(1.6%),移植肾动脉吻合口狭窄1例(1.6%),骨髓抑制2例(3.2%),有症状的巨细胞病毒感染3例(4.8%),一过性肝功能异常12例(19.4%),结核2例(3.2%).结论 活体供肾移植的长期效果良好,并发症少;活体供肾是安全的;完善的术前评估程序是保障供、受者良好预后的关键之一.     

儿童心脏死亡器官捐献供者双肾整块移植早期临床疗效观察

目的：观察儿童心脏死亡器官捐献（ DCD ）供者双肾整块移植的早期临床疗效。方法回顾性分析中山大学附属第一医院器官移植中心2010年2月至2013年9月儿童DCD供者双肾整块移植供、受者临床资料。6例儿童DCD供者中位年龄3岁（10个月～6岁）,均捐献给相同血型受者。6例受者中位年龄39．5岁（17～48岁）,成年人5例,17岁男性1例,原发病均为慢性肾小球肾炎;均为首次肾移植,群体反应性抗体均阴性, HLA错配数1～4个。均采用右侧髂窝整块移植法。结果6例受者手术均获成功。移植肾热缺血时间中位数为17．5 min （0～23 min）,冷缺血时间中位数为6．6 h （4．8～7．4 h）。术后肾功能恢复均较顺利,未发生急性排斥反应、移植肾原发性无功能和移植肾功能延迟。其中4例为移植肾功能立即恢复（即术后第5天血清肌酐≤265μmol/L ）,2例为移植肾功能缓慢恢复（即术后第5天血清肌酐＞265μmol/L）。1例受者术后7 d右侧移植肾动脉血栓形成;1例受者术后15 d诊断为肺结核行正规抗结核治疗;1例受者术后1年出现移植肾动脉吻合口狭窄,介入治疗后恢复。术后随访1～36个月,受者和移植肾全部存活,所有受者肾功能均正常。结论儿童DCD供者双肾整块移植早期临床疗效良好,是一种扩大供者来源的良好途径。     

Identification of patients best suited for combined liver[ndash ]kidney transplantation: Part II

Liver-kidney transplantation (LKT) should be reserved for those recipients with primary disease affecting both organs. However, increasing transplant list waiting times have increased the development and duration of acute renal failure before liver transplantation. Furthermore, the need for posttransplant calcineurin inhibitors can render healing from acute renal failure difficult. Because of the increasing requests for and controversy over the topic of a kidney with a liver transplant (OLT) when complete failure of the kidney is not known, the following article will review the impact of renal failure on liver transplant outcome, treatment of peri-OLT renal failure, rejection rates after LKT, survival after LKT, and information on renal histology and progression of disease into the beginnings of an algorithm for making a decision about combined LKT. (Liver Transpl 2002;8:193-211.)     

肝肾胰联合移植的围手术期处理

目的总结肝胰肾联合移植围手术期处理的经验。方法报告肝、胰、肾一期联合移植治疗1例乙型肝炎后肝硬化、肝功能不全合并慢性肾功能不全伴慢性胰腺炎导致胰岛素依赖型糖尿病患者的临床特点及治疗体会。对患者围手术期处理及相关资料进行回顾性分析。结果采用胰液空肠内引流及原位背驮式同期尸体肝、胰、肾联合移植。手术顺利，移植肝脏及胰腺功能1周内逐渐恢复，肾功能延迟恢复。术后第16天因移植肾血流下降，切除移植肾脏，于原移植部位行第2次肾移植，肾功能逐渐恢复正常。至2005年11月随访10个月，患者未发生排斥反应及明显感染，移植肝、胰、肾功能均正常，一般情况良好。结论肝胰肾联合移植技术安全，术后因各脏器对功能恢复所需内环境各不相同，矛盾较多，围手术期处理对患者的长期存活至关重要。     

Stable kidney function in the second decade after kidney transplantation while on cyclosporine-based immunosuppression

BACKGROUND: Calcineurin inhibitors (CNIs) have been the mainstay of immunosuppressive protocols in kidney transplantation over the past 20 years. However, in some recipients, the adverse effects of CNIs contribute to chronic allograft nephropathy and death with function--the two leading causes of late graft loss. Other recipients maintain stable graft function. METHODS: We studied the impact of continuing CNI-based immunosuppression in the second decade after kidney transplantation. From 1984 through 1996, a total of 1,263 patients underwent a primary kidney transplant at the University of Minnesota and received cyclosporine-based immunosuppression. Antibody induction was used only in deceased donor recipients. RESULTS: The actuarial 20-year patient survival rate was 38%; graft survival, 30%; and death-censored graft survival, 60%. The annual mean serum creatinine level for recipients whose grafts survived > or =1 year remained stable, although recipients with a history of > or =1 acute rejection episode had a higher serum creatinine level vs. recipients who were rejection-free. The annual mean calculated creatinine clearance was also stable over time. In addition, for recipients who were acute rejection-free, chronic allograft nephropathy/chronic rejection was only responsible for 9% of graft losses. CONCLUSIONS: Our study suggests that some kidney transplant recipients tolerate long-term CNI-based immunosuppression with stable creatinine levels. Identifying certain recipients' predisposition to CNI toxicity and individualizing immunosuppressive therapy may be important in order to improve long-term kidney function, while simultaneously preserving low short-term acute rejection rates.     

Combined liver kidney transplantation: critical analysis of a single-center experience

Combined liver kidney transplantation (LKT) can be successfully performed on patients with liver and renal failure; however, outcomes are inferior to liver transplantation alone (OLT). Our aim was to determine the indications for and outcome of LKT and whether patients with longer wait times required more frequent LKT versus OLT alone.We included 18/93 adults who underwent LKT from August 2007 to August 2010 for hepatitis C virus (HCV, n = 7), alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), primary biliary sclerosis, polycystic kidney disease with liver involvement, hepatic adenomatosis, and ischemic hepatitis. Eleven were originally listed for LKT and 7 required listing for-kidney transplantation while awaiting OLT. Eight were on dialysis when first listed and 10 had a low glomerular filtration rate or known kidney disease.The mean calculated Model for End-Stage Liver Disease (MELD) score for LKT was 31.2 ± 3.54. Seven had hepatocellular carcinoma in explants. Two patients had acute cellular kidney rejection that responded to treatment. Recurrence of HCV was documented in 5 patients within 6 months of LKT; 2/5 received HCV therapy (interferon and ribavirin) without renal allograft rejection. One-year liver graft/patient survival was 94% after LKT. One patient died at 6 months post LKT due to severe HCV recurrence. Last mean serum creatinine level was 1.35 ± 0.28 mg/dL for LKT patients.LKT is a safe procedure with favorable outcomes even in patients with a high MELD score. Transplantation of patients with a high MELD score due to regional variations in organ allocation results in additional use of kidneys by OLT patients. Improved organ allocation algorithms in OLT would help to reduce combined transplants, sparing more kidneys.     

The fate of glomerular mesangial IgA deposition in the donated kidney after allograft transplantation

OBJECTIVE: To investigate the fate of the mesangial IgA deposits in the donor kidney after allograft transplantation. METHODOLOGY: Routine pre-transplant cadaveric donor kidney biopsy and repeated renal biopsies were performed at months 1, 3, and 6 after renal transplantation. The patients, 342 in number, were divided into IgA positive deposition kidney group (group A, n = 83) and non-IgA deposition kidney group (group B, n = 259). There were no significant differences between the two groups' sex, age, time of hemodialysis, warm ischemia time, cold ischemia time, complement-dependent cytotoxicity, level of panel-reactive assay, and the distribution of original disease. RESULTS: Recipients in group A received donor kidney with glomerular mesangial proliferation and marked diffuse granular IgA deposition. All of them showed edema, nephrotic range protienuria, microhematuria, hypoalbuminemia, hypertension, and delayed graft function. Borderline change was higher in group A than in group B, 37.3 and 16.2% (p < 0.001), respectively. Acute allograft rejection was higher in group A than in group B, 31.3 and 19.3% (p < 0.001), respectively. The glomerular mesangial IgA deposits gradually disappeared from the mesangial regions in grafts of acute rejection. Graft survival in both groups was not significant, being 93.8 and 95.6% in 1 yr, and 86.7 and 88.3% in 3 yr. CONCLUSION: Clinical features of the recipients which received from donor kidney with glomerular mesangial proliferation and marked diffuse granular IgA deposition: edema, proteinuria, microhematuria, hypoalbuminemia, hypertension, and delayed graft function. The presence of IgA deposits on donated kidney, by a possible increase of the immunogenicity of these kidneys, might be a cause of increased rejection. There were no significant differences between the two groups on long-term allograft survival.