Related Experiment Video
Updated: Aug 16, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Kidney transplantation, the Halifax experience
P Belitsky1, A S MacDonald, J Lawen
1Department of Urology, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada.
Insights
Canadian kidney transplant recipients benefit from improved graft survival with cyclosporine (CsA)-based immunosuppression. Key factors include HLA matching and managing chronic graft nephropathy, with older recipients and repeat transplants showing comparable outcomes.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Medicine
Background:
- Canada lacks a national kidney sharing system, limiting cadaveric kidney sources.
- Current recipient selection prioritizes HLA match and wait-list seniority, alongside ABO and crossmatch compatibility.
- Cyclosporine (CsA)-based immunosuppression is standard, with antibody induction reserved for specific cases.
Purpose of the Study:
- To evaluate graft and patient survival rates in Canadian kidney transplant recipients.
- To identify key factors influencing graft survival, including HLA matching, immunosuppression protocols, and donor/recipient characteristics.
- To assess the impact of specific challenges like chronic graft nephropathy, rejection, and prolonged cold ischemic time (CIT).
Main Methods:
- Retrospective analysis of kidney transplant data within a defined Canadian region.
- Comparison of graft survival rates based on HLA matching (especially HLA-DR), immunosuppression strategies (CsA, antibody induction), and donor type (cadaveric vs. live donor).
- Evaluation of causes of graft loss, including acute and chronic rejection, and death with a functioning graft, stratified by recipient age and transplant history.
Main Results:
- Zero HLA-DR mismatches significantly improve graft survival in first cadaveric transplants.
- CsA-based immunosuppression yields graft and patient survival rates comparable to centers using antibody induction.
- Chronic graft nephropathy remains the leading cause of graft loss post-first year, followed by death with a functioning graft.
- Repeat cadaver transplant recipients achieve 5-year survival rates similar to first transplants.
- Steroid-resistant rejection necessitates rescue therapy and leads to poorer long-term outcomes.
- HLA-identical live-related donor transplants show improved long-term survival with CsA versus azathioprine.
- Pre-transplant sensitization adversely affects haploidentical live-related transplants.
- Patients over 60 demonstrate equivalent graft survival to younger recipients.
- Prolonged CIT (>24 hours) is linked to increased ATN, dialysis, rejection, reduced QALYs, and higher costs.
Conclusions:
- Canadian kidney transplant outcomes are improving, particularly with CsA-based immunosuppression and attention to HLA matching.
- Strategies to mitigate chronic graft nephropathy and optimize management of rejection are crucial for long-term success.
- Age and repeat transplant status should not be absolute contraindications, while prolonged CIT requires careful consideration.
Abstract:
In the absence of a national kidney sharing system in Canada, virtually all the cadaver kidneys we transplant come from donors within the 4 provinces we serve. Currently the only criteria we use for recipient selection of cadaver kidneys, apart from ABO blood group matching and a negative anti-T-cell crossmatch, are good HLA match and transplant wait-list seniority. All transplant recipients receive CsA-based immunosuppression. Antibody induction is used only for repeat transplants and pediatric transplants. Recipients of first cadaver kidney transplants with zero HLA-DR mismatches have significantly better graft survival than those with mismatches. Graft and patient survival rates for first cadaver transplants continue to improve within the CsA era, and are comparable to those seen in centers routinely using antibody induction and routine sequential quadruple immunosuppression. Chronic graft nephropathy continues to be the most important cause of graft loss after the first year, unchanged over the past 2 decades, followed closely by death with a functioning kidney. The latter is a more important cause of loss in recipients older than age 60, and in recipients of HLA-identical live donor transplants. Repeat cadaver transplant recipients have a 5-year graft survival rate today equivalent to that seen with first cadaver transplants. Graft loss from acute rejection is modest, but kidneys requiring rescue therapy for steroid-resistant rejection have significantly poorer one- and 5-year graft survival and ultimately are lost from rejection. Patients with HLA-identical live-related donor transplants have better long-term survival with CsA than with azathioprine due to a decrease in graft loss from chronic rejection. Pre-transplant sensitization has an adverse effect on graft survival for haploidentical but not HLA identical live-related transplants. Patients over age 60 have equivalent graft survival to younger recipients for at least 7 years, and should not be precluded from receiving transplants by age alone. Prolonged CIT > 24 hours is associated with a significantly increased incidence and duration of ATN and need for dialysis, significantly increased early and late graft loss from acute and chronic rejection respectively, significantly reduced QALY's, and significantly higher early and late costs of transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management