Abstract
Fifty-five renal transplant patients who had received HD for more than ten years before transplantation (long term group) were compared with 723 patients who had received HD for 0 to 9 years (non-long term group). The mean age and ratio of cadaveric transplantation were higher in the long term group. Patient survival rates after five years were 88.4% in the long term group and 91.8% in the non-long term group. Graft survival rates after five years were 79.3% in long term patients and 78.1% in short term patients. There were no significant differences in allograft and patient survival between the two groups.
In the long term group, hypotension changed to normal blood pressure in all hypotensive patients. In 25% of hypertensive patients, hypertension changed to normal blood pressure, and normal blood pressure changed to hypertension in 23% of patients with normal blood pressure after transplantation. Total cholesterol levels after transplantation increased significantly.
Three of 19 secondary hyperparathyroidism (2°HPT) cases received total parathyroidectomy after transplantation in the long term group. In one case, a graft stone was found to be due to 2°HPT, and the graft function was lost.
In long term group, pretransplant urinary volumes were significantly low, and almost all patients suffered from urinary disorders one to two months after transplantation. Two cases of urinary leakage, one of graft stone, and one of graft VUR were found in the long term group. The patient with graft VUR had a neurogenic bladder but graft function was maintained under self catheterization.
We found 3/55 (5.3%) cases of neoplasia in the long term group, and 9/723 (1.2%) cases of neoplasia in the non-long term group. Two of the three cases were renal tumors which had existed prior to transplantation in the long term group, and one was accompanied by acquired cystic disease of the kidney that was evident after transplantation.
In conclusion, long term hemodialysis patients have good graft outcome and no severe complications. Specific complications in the long term hemodialysis patients do not interfere with kidney transplantation. Therefore kidney transplantation is indicated in long term hemodialysis patients who suffer from uncontrollable complications.
