RESULTS OF 144 CADAVERIC KIDNEY TRANSPLANTS

Abstract

One hundred and forty-four patients primarily receiving kidneys from cadaver donors between Jan., 1978 and Oct., 1989, were reviewed. The patients' ages ranged 14-53 with a mean±S. D. of 34.7±8.0 years old. There were 100 males and 44 females. Twenty kidneys were harvested from heart-beating donors and 124 from non-heart-beating donors. In harvest from non-heart-beating donors, we perfomed in situ cooling through a double balloon catheter placed in the aorta to minimize prolonged warm ischemia. The number of matched HLA A, B antigens was (mean±S. D.) 1.7±0.8 antigens and for HLA DR antigens, it was 1.2±0.5. One hundred and nineteen of the 144 recipients have had a history of blood transfusion preoeratively. The patients were treated with four different immunosuppressive protocols; regimen I consisting of horse antilymphocyte globulin (ALG), regimen II of large-dose (14mg/kg/day) of cyclosporin (CsA) and steroid, regimen IIIa of low-dose (4mg/kg/day) of CsA, steroid and a short course of ALG (500mg/day) and regimen IIIb of low-dose (6mg/kg/day) of CsA, steroid and a short course of ALG (1000mg/day). Fifteen patients received regimen I therapy from Jan., 1978 to Nov., 1982, 49 received regimen II from Nov., 1982 to Dec., 1986, 23 received regimen IIIa from Jan, 1987 to Dec., 1987 and 57 received regimen IIIb from Jan., 1988 to Oct., 1989.
Graft survival was 40% at 1 year, 33% at 2 years, 26% at 3 years and 19% at 5 years in regimen I group, 78% at 1 year, 74% at 2 years, 71% at 3 years and 64% at 5 years in regimen II, 64% at 1 year and 55% at 2 years in regimen IIIa, and 89% at 1 year in regimen IIIb. Patient survival was 86% at 1 year, 84% at 2 years and 79% at 3 through 5 years in regimen I group, 98% at 1 year and 96% at 2 throug 5 years in regimen II, 92% at 1 through 2 years in regimen IIIa and 100% at 1 year in regimen IIIb.
Present problems in cadaver kidney transplantation are also discussed.