Cadaveric Renal Transplantation in Seoul National University Hospital

Ha, Jong Won; Cho, Byung Sun; Kim, Sang Joon

Abstract

Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. PURPOSE: We performed this study to know the predicting factors and the survival rate of cadaveric renal transplantation. We also tried to compare our results to that of the western countries to try to establish the correct therapeutic strategy of cadaveric renal transplantation.
MATERIALS AND METHODS
We analyzed 41 cadaveric renal transplants performed at Seoul National University Hospital from August, 1993 to July, 1997. All patients had follow-up period of more than 6 months.
RESULTS
The mean age of recipients was 34.8 years(2~62). All patients except two were primary renal transplants. Male to female ratio was 28:13. Mean HLA mismatching number was 3.66. The immunosuppressive regimen was triple therapy based on cyclosporine. If delayed graft function(DGF) occurred, cyclosporine was held till renal function became normalized. The incidence of DGF was 17.1%. The overall incidence of biopsy-proven acute rejection was 26.8%(11 cases). Seven cases were diagnosed as acute rejection at protocol biopsies performed at 7 days after renal transplantotion, but had normal renal function. The other 4 cases who had both histologic evidence and clinical features of acute rejection were treated with anti-rejection therapy. The factors affecting graft survival in cadaveric renal transplantation were the acute rejection(p=0.0003) and preservation solution (p=0.0033). The graft survival rate at 1, 2, 3, 4 year was 86.9%, 86.9%, 80.7%, 80.7%, respectively. Total 6 renal transplants were lost due to 1 chronic rejection, 1 CMV pneumonia, 1 Kaposi's sarcoma at lung, and 3 sepsis.
CONCLUSION
Our results was comparable to that of the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.