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Kidney transplantation at UCLA.

J T Rosenthal1, G Danovitch, R B Ettenger

  • 1Department of Surgery, UCLA Medical Center.

Clinical Transplants
|January 1, 1990
PubMed
Summary
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UCLA kidney transplant survival rates improved with individualized immune suppression since 1987, achieving 87% 1-year graft survival. Key factors influencing outcomes include delayed graft function and HLA matching.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Immunology

Background:

  • UCLA has performed over 620 kidney transplants since 1984.
  • An individualized immune suppression protocol has been employed since 1987, following the introduction of OKT3.

Purpose of the Study:

  • To evaluate the impact of an individualized immune suppression strategy on kidney transplant outcomes.
  • To identify key determinants of graft survival in a large cohort of kidney transplant recipients.

Main Methods:

  • Retrospective analysis of 620 kidney transplant cases performed at UCLA.
  • Comparison of outcomes before and after the implementation of individualized immune suppression.
  • Analysis of factors influencing graft survival, including delayed graft function, HLA matching, sensitization, race, age, and diabetes.

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Main Results:

  • Since 1987, 1-year cadaver graft and patient survival rates are 87% and 97%, respectively, for primary and repeat transplants, including high-risk patients.
  • Delayed graft function, HLA matching, and prior sensitization were significant determinants of graft survival.
  • Race, age, and diabetes were not significant determinants of graft outcome.
  • Pediatric recipients (small children) achieved a 94% 1-year graft survival rate.
  • Long-term graft survival shows deterioration, with many patients developing hypertension and hypercholesterolemia; pediatric non-compliance with medication is noted.

Conclusions:

  • Individualized immune suppression has led to improved kidney transplant outcomes at UCLA.
  • Optimizing management of delayed graft function, HLA matching, and sensitization is crucial for enhancing graft survival.
  • Long-term monitoring and management of post-transplant complications like hypertension, hypercholesterolemia, and medication adherence are essential for sustained success, particularly in pediatric patients.