PRIMARY LIVING UNRELATED DONOR KIDNEY TRANSPLANTATIONS IN THE CYCLOSPORINE ERA.

Abstract

558 The growing shortage of donor organs continues to serve as a barrier to kidney transplantation. Brain death has not been legally accepted yet in Korea, although we have had social consensus on brain death. Therefore, almost all kidney transplantations were performed with living donors, but living related donor kidney transplantations had limitations in its numbers. To expand the number of donating kidneys, we had to have developed living unrelated donor(LURD) programs including distant relatives, close friends, willing volunteers, and exchange donors. We strictly follow the recommendations of the Transplantation Society and do not accept commercially obtained donors. Here, we analyzed our experiences for LURD kidney transplantations. From Feb. 1984 to Oct. 1997, 751 primary LURD kidney transplantations were performed at our institution. The minimum prerequisite for HLA match was more than 1 class II(DR) or 2 class I(A+B) antigen match. We have used cyclosporine(CsA) based double therapy for both induction and maintenance immunosuppression. Induction immunosuppressive therapy was started 2 days prior to the transplantation using CsA and corticosteroids. Antilymphocyte antibody induction therapy was not used as a routine prophylactic immunosuppression. Ten year patient and graft survival were 80.8% and 60.2%, respectively. There were 182 graft failures. The major causes of graft failure were patient death(79) and chronic rejection(67). The most common cause of patient death was infections(43), followed by cerebrovascular diseases(16). Interestingly, the degree of HLA match did not impact on graft survival. The risk factors affecting graft survival were recipient and donor age, degree of ABO blood group compatibility, episode of acute rejection, and pretransplant diabetes and hepatitis B antigen positivity. Because of the striking discrepancy between organ donation and the increasing demand for transplantation, LURD should be considered as an alternative way to increasing the number of available donors when accompanied by the careful evaluation process.