TWENTY FIVE YEARS GRAFT SURVIVAL OF LIVING RELATED KIDNEY TRANSPLANTATION. - THIRTY FIVE YEARS EXPERIENCES-

Abstract

P341 Aim: The outcome of renal transplantation has markedly improved since the advent of treatment with cyclosporine(CsA).Several recent well-controlled prospective clinical trials have demonstrated a decreased frequency of acute rejection episodes and better graft survival in patients treated with CsA as compared with conventional forms of immunosuppression.Despite these promising results, chronic rejection continues to be a common complication in renal transplantation. When present, it inevitably leads to an inexorable decline in renal function, eventually leading to loss of the graft. In this study, we displayed the results of the graft survivals and complications in renal transplant patients following up to for more than 25yr. Methods: Between April 1970 and April 1978, 100 consecutive renal transplantations were performed in 100 patients at the Second Department of Surgery, Kyoto Prefectural University of Medicine. These patients were followed up for more than 25 yr. There were 77 male and 23 female, with a mean age of 27±7.0 yr. They recieved a renal allograft from one haploidentical donors. As for the initial immunosuppressive therapy, a combination of azathioprine (AZ) and prednisolone (PSL) was used in all patients. AZ was started at a dose of 3 mg/kg/d and the dose was gradually reduced and adjusted according to the white blood cell count. When liver dysfunction or bone marrow suppression had occurred, a dose of AZ was reduced and mizoribine (MZ) was added. Results: (1) 40 patients died until 25 years post operation with or without a functionimg graft due to complications(infection, malignancies et al).Therefore, 25 years patient survival was 60.0%. (2) 34 patients returned to hemodialysis until the 25th years after transplantation. Actual 25 years graft survival is 26.0%. Most longest survival of the graft is 30 years and 2 months. (3) Main cause of death was infectious disease and malignancy. (4)73% of graft loss was due to chronic rejection. (5) mean serum creatinine of the patient with functioning graft over 25 years is 1.2 mg/dl and 75% of the patients displayed under 1,5mg/dl. (6) One paients was free of immunosuppression and four patients were maintained with very low dose immunosuppression. Mean dosage of Az was 69 mg/day and steroid was 6.3 mg/day. (7) Pathological examination of some patients displayed the high grade of chronic rejection pattern, even the serum creatinine is well controlled. Conclusion: It is generally accepted that the use of cyclosporine or tacrolimus was a major factor in the improvement in medium-term results of organ transplantation during the last 20 years. The development of new anti-infectious drug or tool for early detection of infectious disease contributed to the decrease of death due to infection. New method to prevent chronic rejection will be required.