Abstract
It is about 15 years since the first clinical cadaveric renal allograft succeeded in our country. The total number of patients with renal allografts alive on 31st December 1980 is 1700, of whom 868 has a functioning transplant, and 239 are transplanted with cadaveric kidney. This represents a mean figure 2 cadaveric grafts per million population per fifteen years in Japan, while a mean European rate of transplantation is 6 grafts per million popuration per year.
Cadaveric renal transplantation has become the treatment of choice of endstage renal failure, primarily because of the marked improvement in patient survival, as well as in graft survival.
The role of matching for HLA in cadaveric kidney transplantation becomes the far greater importance. There is resonable agreement in Japan that cadaver kidneys well matched for HLA will show better survival than poorly matched. The National Kidney Center Registry has a file of 2000 potential transplantation recipients sorted by HLA type. Using the match program, cadaveric renal transplantation carry out by this listing of the HLA B, C matched patients, and detailes such as antibody status, blood transfusions, and age.
Health and Welfare Ministry achieves a cadaveric renal transplant shared imformation computer system which has a main computer and a data base in National Kidney Center connected with subcenters' terminals on line.
Blood transfusions before transplantation improve cadaveric graft survival although the mechanisms are unclear. The ultimate goal of transplantation is the induction of specific unresponsiveness to an allograft. This may be achieved by antigen pretreatment of the recipient before transplantation.
There is increasing evidence that immunological unresponsiveness can be induced by either suppressor T cells or antibodies directed against the T cell receptor, that is, anti-idiotypic antibodies. We can expect that the long survival of the renal graft may be due to an immunological unresponsiveness induced by the host immunoregulartory mechanism of transplant patient.
