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Living related renal transplantation: the Christchurch experience
M Mantha1, J B Morton, R R Bailey
1Department of Nephrology, Christchurch Hospital.
Insights
Living related donor renal transplants show good outcomes, with 66% of grafts functioning at study end. Patient survival rates were high, but sensitization and vascular disease impacted graft survival.
Area of Science:
- Nephrology
- Transplantation Immunology
- Surgical Outcomes
Background:
- Living related donor kidney transplantation is a vital treatment for end-stage renal disease.
- Assessing long-term graft and patient survival is crucial for optimizing transplant protocols.
Purpose of the Study:
- To evaluate the outcomes of renal transplants performed using living related donors.
- To identify factors influencing graft survival and patient outcomes in this cohort.
Main Methods:
- Retrospective analysis of 33 living related donor renal transplants.
- Data collected from March 1976 to December 1994 at Christchurch Hospital.
- Exclusion of one ABO incompatible transplant from statistical analysis.
Main Results:
- 66% of 32 analyzed grafts remained functional.
- 1, 5, and 10-year graft survival rates were 82%, 73%, and 48%, respectively.
- Introduction of cyclosporine improved 1 and 5-year graft survival to 90% and 80%.
Conclusions:
- Excellent outcomes were observed in non-highly sensitized recipients.
- Recipient sensitization and atherosclerotic vascular disease were key factors in graft loss due to rejection and vascular complications.
Aim:
To determine the outcome of renal transplants from living related donors.
Methods:
Retrospective analysis of 33 living related donor renal transplants done between March 1976 and 31 December 1994 at Christchurch Hospital.
Results:
One of the 33 renal transplants patients received an ABO incompatible kidney and was excluded from the statistical analysis. Twenty-one (66%) of 32 grafts continue to function. The 1, 5 and 10 year graft survival rates were 82%, 73% and 48%, respectively. The estimated 1 and 10 year patient survival rates were 96% and 94%, respectively. With the introduction of cyclosporin the 1 and 5 year graft survival rates increased to 90% and 80%, respectively. Three patients received donor specific transfusion preconditioning and one patient a skin graft from the prospective donor. Four patients (12.5%) had current and/or peak panel reactive antibody titres of more than 25%. Three of these grafts failed after 2, 95 and 463 days. Two grafts were lost due to catastrophic vascular complications.
Conclusion:
The overall outcome for patients who were not highly sensitised was excellent. The degree of sensitisation of the recipient, and the extent of atherosclerotic vascular disease in the recipient, were major predisposing factors for the graft loss due to rejection and vascular complications during the early post transplant period.