COMMUNITY TREATMENT OF END-STAGE RENAL FAILURE BY DIALYSIS AND RENAL TRANSPLANTATION FROM CADAVER DONORS

Abstract

A collaborative project involving twenty hospitals and a central tissue-typing service has allowed the treatment by dialysis and transplantation from cadaver donors of all suitable patients who have presented with irreversible renal failure. The rate of presentation of patients was between 45 and 50 per 1,000,000 of population per year. For transplantation all hospitals cooperated in access to donor organs. Potential recipients maintained by repeated dialysis in six of the hospitals formed a common recipient pool. Both donor kidneys were used whenever possible, and one was transplanted to each of the 2 most compatible recipients as determined by tissue-typing. Operations were performed simultaneously in two of the hospitals, and administrative arrangements allowed the free movement of transplantation personnel between hospitals. In two years since August, 1967, 190 patients with end-stage renal failure presented. 175 were treated by dialysis, all but 14 by hæmodialysis; 90 patients subsequently received renal allografts, 55 await operation, 7 have permanent dialysis, and 29 died of complications of renal failure or of dialysis. Of those who underwent operation 68 remain alive, 62 with functioning allografts. 34 patients (71%), including 3 with secondary grafts, have allografts which have functioned for more than a year since transplantation. Although tissue-typing was consistently completed before operation and resulted in improved compatibility, few patients were well matched. It is concluded that hospital collaboration will allow the treatment of all young and middle-aged patients with irreversible renal failure, and that the incidence of end-stage renal failure is at present at least 45-50 per 1,000,000 of population per year in Australia. This incidence can be reduced,