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2002, Number 2

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Cir Gen 2002; 24 (2)

Renal transplantation from living related donors and from cadaveric donors. Experience with 500 cases

Holm CA, Jiménez DA, Hernández DM, Camarena AA, Sánchez RJ, Pérez ML, Muñiz TV, Lagunas MJ, Espinosa GA, Soberanes HA, Bonilla RLC, Zaldívar CJ

Language: Spanish
References: 34
Page: 116-123
PDF size: 86.53 Kb.


ABSTRACT

Objective: To inform our 10-year experience in renal transplant (RT) with living related (LRD) and cadaveric (CAD) donors, emphasizing rejection, long-term survival of patients and grafts, and comparative results with triple immunosuppression regimens in a subgroup of 300 patients.
Design: Case reports. Retrospective, longitudinal, with intragroups and multivariate analysis, study.
Setting: Third level health care hospital.
Material and methods: We analyzed 500 patients with end-stage chronic renal insufficiency (CRI), type and duration of pre-transplant dialysis, ABO blood group, IgG cytomegalovirus in the receptor, associated pathology, HLA, type of procurement (LRD or CAD), perfusion and preservation of grafts, surgical registry, immunosuppressive therapy, acute and chronic rejection rate, mortality and actuarial survival of the patient and the renal graft. All patients received the triple immunosuppressor scheme, i.e., azathioprine, prednisone, cyclosporine-A (CyA). Three-hundred recepients were, in turn, divided in two sub-groups according to the CyA used: Group I (156 n (56%) with Sandimmune vs. Group II (144 n) with Neoral.
Results: RT from LRD in 280 n (56%) and from CAD in 220 n (44%); 138 (63%) of the receptors received a RT from single renal harvesting and 82 (37%) from multiple organ harvesting. Actuarial survival (%) for patient and graft at one, five, and ten years was for LRD of 93 (89%), 90 (82%), and 75 (70%), respectively, and for CAD recepients of 89 (79%), 86 (76%), and 71 (60%), respectively. Survival of the graft, depending on the type of CyA used, revealed for Group-I (LRD 80% and CAD 60%) vs. Group-II (LRD 87% and CAD 70%) a p‹0.05. The rate of acute rejection at ‹1 year for LRD and CAD was 22 and 36%, respectively, p = Not Significant (NS). Loss of renal graft, including all immunological types of rejection in the 300 patients from groups I and II, was of 60 n (20%) [LRD, 166; CAD, 134]; [LRD 25 n (15%) vs CAD 35 (25%)] p = NS; but, due to chronic rejection was of 20 (58%) in 36 patients of Group I with Sandimmune vs. 8 (33%) of 24 cases in Group-II with Neoral, p‹ 0.05. Mortality up to 30 days was for LRD 28 n (10%) vs CAD 30 n (14%), p ‹ 0.05.
Conclusion: Rejection is still the main cause of graft loss. Survival of the graft and rate of acute rejection was not statistically different between both groups; but the loss due to chronic rejection was significantly lower in Group-II (Neoral). Extrarenal organs procurement can be accomplished successfully in Mexico, offering a therapeutic alternative for chronic end-stage patients.


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