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[Kidney transplantation at the Brno Transplantation Center]
1II. vnitrní FN U Sv. Anny, Brno.
Insights
Increasing kidney transplantations in Brno requires more organ donors. Cyclosporin A improved graft survival, but infections and non-immune factors remain significant challenges for renal transplant recipients.
Area of Science:
- Nephrology
- Immunology
- Transplantation Surgery
Context:
- Brno Transplantation Center (TC) activity increased significantly since 1994.
- Current transplantation rates are 30 per million population, below the national and European average of 40.
- Cyclosporin A (CyA) use has impacted graft survival and loss causes.
Purpose:
- To evaluate the impact of immunosuppression, particularly Cyclosporin A, on renal transplant outcomes at Brno TC.
- To analyze causes of graft loss and recipient mortality post-transplantation.
- To identify areas for improvement in immunosuppressive strategies and patient care.
Summary:
- Renal graft survival rates at one, five, and ten years improved by 20%, 35%, and 15% respectively with Cyclosporin A compared to conventional immunosuppression.
- Graft losses due to rejection decreased from 63% to 21% with CyA.
- Graft losses from non-immune causes (approx. 20%) and surgical-urological issues (approx. 6%) remained unchanged.
- Recipient mortality declined from 14.4% to 8.4%, with infections (40%) and cardiac deaths (17%) being primary causes.
- High infection rates are linked to aggressive immunosuppression and high-dose corticoids, necessitating regimen revision.
Impact:
- Cyclosporin A significantly reduced graft rejection, enhancing long-term graft survival.
- Non-immune graft loss and recipient mortality, particularly from infections, require further investigation and management strategies.
- Optimizing immunosuppressive protocols and implementing protective measures are crucial for improving overall renal transplant outcomes.
Abstract:
The transplantation activity in the Brno TC has increased significantly since 1994 and there are now 30 transplantations per 1 million population of the catchment area per year. It is, however, necessary to get more organ donors to attain the national average of 40 renal transplantations per 1 million inhabitants per year, which is also the average value in advanced European countries. With the use of immunosuppression with cyclosporin A the one, five and ten-year survival of grafts increased by 20, 35 and 15% resp., as compared with the period of conventional immunosuppression. The greatest losses of grafts were recorded in the Brno TC during the first year after transplantation and they accounted roughly for 25% during immunosuppression without and immunosuppression with cyclosporin A. The graft losses due to rejection declined from 63 to 21%. However, there was no decline of graft losses for non-immune reasons which accounted during all investigated time intervals for cca 20%. The ratio of graft losses on surgical--urological grounds did not change (before cyclosporin A, 5.9%, and with immunosuppression with cyclosporin A 6.6%). Also graft losses due to the recipient's death declined only insignificantly (14.4% before CyA and 8.4% with CYA). The most frequent causes of death of recipients were infections (40%), followed by cardiac deaths and haemorrhagic conditions (17% in both instances). The high rate of infections is due to aggressive immunosuppressive regimes and large doses of corticoids. Revision of immunosuppressive regimes and protective procedures is necessary. Haemorrhagic conditions such as disseminated coagulopathies remain unexplained so far. The cardiac deaths are associated above all with the rising age of renal transplant recipients and in the majority these deaths could not be prevented (acute myocardial infarctions and sudden deaths at home).