Cadaveric Renal Transplantation in High-Risk Donors

Kim, Song Cheol; Kim, Suk Ku; Han, Duck Jong

Abstract

We performed a clinical analysis of the 106 cadaveric renal transplants among the 479 renal allograft patients operated between Jun. 1990 and Oct. 1996 to evaluate the graft outcome in patients with high-risk donor factors. Organ procurement were performed in 73 cases(64.4%) among 113 potential donors. In the remaining 40 cases, 22 cases were given up as organ donors due to medical causes, such as severe organ failure (n=9), HBsAg(+) (n=6), cardiac arrest (n=5),and sepsis (n=2). The incidence of acute tubular necrosis was significantly higher for age >50 yr, cold ischemic time(CIT) >24 hr and prolonged hypotension (P<0.05). Serum creatinine levels at postoperative week 1 and discharge were significantly higher for age >50 yr, CIT>24 hr and prolonged hypotension (P<0.05). The rejection rate did not show any difference. The one-year and two-year graft survival rate were significantly lower for age >50 yr (57.1% vs 87.2% in 1 yr and 57.1% vs 87.2% in 2 yr), for serum Cr>3.0(50.0% vs 87.1% in 1 yr and 50.0% vs 84.8% in 2 yr), for CIT>24 hr(33.3% vs 86.6% in 1 yr and 33.3% vs 84.3% in 2 yr) and prolonged hypotension(50.0% vs 88.0% in 1 yr and 50.0% vs 84.9% in 2 yr). In the multivariate analysis of these variables, serum Cr>3.0, CIT>24 hr and prolonged hypotension were significant factors for graft outcome. A comparison of the early graft function and the graft survival between high risk group (n=75) - age>50 yr (n=7), serum creatinine>3.0 mg/dl (n=4), CIT>24 hr (n=4), history of hypertension (n=17), use of high dose inotropics (dopa>20 microgram, dobu>15 microgram, n=30), episode of cardiac arrest (n=4), prolonged hypotension (<80 mmHg over 6 hr ,n=8), existence of DIC (n=12) or proteinuria (n=23)- and the ideal group (n=31) did not show any significant difference. We conclude that selective high-risk donors can be used to facilitate the expansion of a small donor pool to overcome the organ shortage. However more efforts to develop the preoperative tests to predict the postoperative graft outcome are neccessary to avoid primary nonfunction and delayed graft function, and to achieve a successful graft survival.