Acute rejection after renal transplantation is still the most common cause of graft failure during the early post-transplant period. To determine whether an acute rejection episode adversely affects long-term graft survival, we retrospectively analyzed our single center patients population of 1266 consecutive living donor kidney transplantations performed between April 1984 and October 1995. Five hundred twenty three recipients(41.3%) experienced 711 acute rejection episodes. Among these 711 episodes, 92.6% were respond to anti-rejection therapy and treatment failure rate was 7.6%. Late onset acute rejection, which developed 1 year after transplantation, showed poor treatment response(79.7%). There was statistically significant difference of graft survival rate between acute rejection free group and acute rejection group. Furthermore, the frequency of acute rejection, response rate the steroid pulse therapy and the degree of remission affected the graft survival rate. Donor source impacted on the development of acute rejection-33.1% in living related donor, 39.9% in living unrelated donor and 57.1% in cadaveric donor transplantation. In living related donor kidney transplantations, HLA identical pairs(11%) showed less acute rejection episodes than HLA haplo-identical pairs(38.7%). In living unrelated donor kidney transplantations, HLA antigen match adversely affected the acute rejection rate-43.9%, 35.8% and 30.6% in 1~2, 3 and 4~5 Ag match group, respectively. ABO blood group compatibility, recipient's age and compatibility of HLA DR Ag did not influenced to the development of acute rejection. These results suggest that the acute rejection could be a major determinant of long-term graft outcome.
Allografts* ; Cadaver ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation ; Living Donors ; Retrospective Studies ; Tissue Donors ; Transplants* ; Treatment Failure ; Unrelated Donors

Acute rejection after renal transplantation is still the most common cause of graft failure during the early post-transplant period. To determine whether an acute rejection episode adversely affects long-term graft survival, we retrospectively analyzed our single center patients population of 1266 consecutive living donor kidney transplantations performed between April 1984 and October 1995. Five hundred twenty three recipients(41.3%) experienced 711 acute rejection episodes. Among these 711 episodes, 92.6% were respond to anti-rejection therapy and treatment failure rate was 7.6%. Late onset acute rejection, which developed 1 year after transplantation, showed poor treatment response(79.7%). There was statistically significant difference of graft survival rate between acute rejection free group and acute rejection group. Furthermore, the frequency of acute rejection, response rate the steroid pulse therapy and the degree of remission affected the graft survival rate. Donor source impacted on the development of acute rejection-33.1% in living related donor, 39.9% in living unrelated donor and 57.1% in cadaveric donor transplantation. In living related donor kidney transplantations, HLA identical pairs(11%) showed less acute rejection episodes than HLA haplo-identical pairs(38.7%). In living unrelated donor kidney transplantations, HLA antigen match adversely affected the acute rejection rate-43.9%, 35.8% and 30.6% in 1~2, 3 and 4~5 Ag match group, respectively. ABO blood group compatibility, recipient's age and compatibility of HLA DR Ag did not influenced to the development of acute rejection. These results suggest that the acute rejection could be a major determinant of long-term graft outcome.
Allografts* ; Cadaver ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation ; Living Donors ; Retrospective Studies ; Tissue Donors ; Transplants* ; Treatment Failure ; Unrelated Donors

BACKGROUND: The shortage of living related and deceased donor groups is one of the major problems of kidney transplantation. We examined the results of spouse and spousal exchange among living kidney transplantation. METHODS: Living donor kidney transplants at a single center between 1991 and 2005 were studied, retrospectively (n=593). We compared the graft survival rates of 24 spousal, 53 spousal exchange transplantations with those of 125 sibling, 142 other living related donor (LRD) or 249 other living unrelated donor (LURD) procedures. We analyzed graft survival rate, acute rejection rate among each groups. RESULTS: The 5, 10 year graft survival rates of spousal donor were 75.0%, 69.2%, those of other LURD and spousal exchange were 74.6%, 64.5% (P=0.80) and 86.6%, 84.8% (P=0.11), those of sibling and other LRD were 82.3%, 75.9% (P=0.37) and 75.7%, 65.4% (P=0.84). Spousal exchange donor were more good graft survival rates rather than other LRD and LURD (P=0.01, 0.01). Acute rejection rates of spousal donor were not significant difference among sibling, other LRD and LURD groups. But acute rejection rates of spousal exchange donor (22.6%) were lower than spousal (45.8%) and other LURD (38.7%) (P=0.04, 0.04). In the multivariate analysis of donor groups, other LRD and LURD groups were associated with a high relative odds of graft survival (odds ratio 2.88+/-0.38 (P=0.02), 2.35+/-0.37 (P=0.01)) compared to spousal exchange donor groups. CONCLUSIONS: The spousal exchange donors had more good graft survival rates than other LRD and LURD groups and spousal donors were as good as other living donors. We expect that the spousal and spousal exchange transplantations are one of the good programs for donor pool expansion.
Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Odds Ratio ; Rejection (Psychology) ; Retrospective Studies ; Siblings ; Spouses ; Tissue Donors ; Transplants ; Unrelated Donors

PURPOSE: Currently, donor supply for transplantation is in serious shortage. In Korea, numbers of patients with end- stage renal failure have been increasing, while patients who could have a graft kidney are limited because of donor organ shortage. To alleviate this problem, donor exchange (Swap) program was launched in Korea. After the success of direct Swap program between two families, we have developed the Swap-around program to expand the donor pool by enrolling close relatives, spouses, friends of potential recipients and motivated voluntary donors. Herein, we report our results of Swap program. METHODS: Medical records of 918 renal recipients who have undertaken a transplantation surgery between January 1995 to December 2002 in our units, were retrospectively reviewed in terms of donor-recipient relationship and way of donor recruit, episode of acute rejection, and 5-year patient and graft survival. RESULTS: Transplantation was performed in 90 patients (9.8%) by way of Swap program. The percentage Swap patients among the number of unrelated donor renal transplant has been increasing: 4.2% in 1995, 10.4% in 1997, 40.0% in 2000, 44% in 2002. Five year patient/graft survival rates were 92.1%/90.6% in 90 Swap recipients, which were comparable to 94.3%/90.0% in other kinds of living unrelated recipients (n=240), and 94.5%/90.7% in HLA 1-haplotype mismatched related recipients (n=454). Among the groups, incidence of acute rejection was comparable. CONCLUSION: We could achieve some success in reducing the organ shortage with Swap program in addition to current unrelated living donor programs without jeopardizing the graft survival. Potentially exchangeable donors should undergo careful and strict medical and social evaluation as a pre-requisite to rule out the commercialism and conserve health of potential donor and recipients. Expanding Swap program to a regional or national pool could be an option to reduce donor organ shortage in the near future.
Friends ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Korea ; Living Donors ; Medical Records ; Renal Insufficiency ; Retrospective Studies ; Spouses ; Survival Rate ; Tissue Donors* ; Transplants ; Unrelated Donors

The lack of available cadaveric organs for transplantation has result in an increased number of kidney transplantation from living donors. In order to characterize correlation of variable factors which affect on the renal graft survival and to compare graft survival of living related donor with that of living unrelated donor, the 515 cases of renal transplantation between January 1979 and December 1997 were reviewed. Each effect of factors included recipient age, donor age, infection, acute rejection, tissue typing, type of donor on graft survival was analyzed as well as the interrelationship on graft survival between six risk factors. It was risk factors which effect on the graft survival that acute rejection, tissue typing and type of donor (P=0.00, P=0.001, P=0.00). The 1 and 5 year graft survival rates of cadaveric renal donor group and acute rejection positive group were 64.8-32.4%, 84.5-49.8% for younger recipient group (<30), 81.3-53.9%, 84.5-49.8% for ideal age group (30-49), 0-0%, 44-44% for older recipients group (>50) (0.017). The 1 and 5 year survival rate of cadaveric renal donor group was 42.8% and 28.6% during 1978-1983, 37.5% and 12.5% during 1984-1990 and 100% and 80% during 1991-1997. The grafts survival rate of unrelated living donor is significantly higher than that of cadaveric grafts during 1978-1990 and had a survival rate similar to that of living related donor grafts under all the circumstance given. The tissue typing, acute rejection and type of donor were significant factor which have influence on the graft survival. The cadaveric renal donor & acute rejection had significantly negative effect in older recipients (>50). Recently, the survival rate of cadaveric graft was remarkably increased, but in the future the more data collection for cadaveric graft is required. Living-unrelated renal transplantation provides comparable result to living-related renal transplantation and the unrelated living donor is excellent source of organs for renal transplant recipients.
Allografts* ; Cadaver ; Data Collection ; Graft Survival ; Histocompatibility Testing ; Humans ; Kidney Transplantation* ; Living Donors ; Risk Factors* ; Survival Rate ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

The lack of available cadaveric organs for transplantation has result in an increased number of kidney transplantation from living donors. In order to characterize correlation of variable factors which affect on the renal graft survival and to compare graft survival of living related donor with that of living unrelated donor, the 515 cases of renal transplantation between January 1979 and December 1997 were reviewed. Each effect of factors included recipient age, donor age, infection, acute rejection, tissue typing, type of donor on graft survival was analyzed as well as the interrelationship on graft survival between six risk factors. It was risk factors which effect on the graft survival that acute rejection, tissue typing and type of donor (P=0.00, P=0.001, P=0.00). The 1 and 5 year graft survival rates of cadaveric renal donor group and acute rejection positive group were 64.8-32.4%, 84.5-49.8% for younger recipient group (<30), 81.3-53.9%, 84.5-49.8% for ideal age group (30-49), 0-0%, 44-44% for older recipients group (>50) (0.017). The 1 and 5 year survival rate of cadaveric renal donor group was 42.8% and 28.6% during 1978-1983, 37.5% and 12.5% during 1984-1990 and 100% and 80% during 1991-1997. The grafts survival rate of unrelated living donor is significantly higher than that of cadaveric grafts during 1978-1990 and had a survival rate similar to that of living related donor grafts under all the circumstance given. The tissue typing, acute rejection and type of donor were significant factor which have influence on the graft survival. The cadaveric renal donor & acute rejection had significantly negative effect in older recipients (>50). Recently, the survival rate of cadaveric graft was remarkably increased, but in the future the more data collection for cadaveric graft is required. Living-unrelated renal transplantation provides comparable result to living-related renal transplantation and the unrelated living donor is excellent source of organs for renal transplant recipients.
Allografts* ; Cadaver ; Data Collection ; Graft Survival ; Histocompatibility Testing ; Humans ; Kidney Transplantation* ; Living Donors ; Risk Factors* ; Survival Rate ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

To observe the changes of renal function in the remaining kidney after donor nephrectomy, we prospectively examined renal Function of 213 living donors (Donor group) and they were compared with that or other (not related to genitourinary tact) 20 operated patients (Control group). We measured the blood pressure, serum BUN. creatinine, 24-hour urine protein and creatinine clearance before and after operation. The significant differences were observed in serum BUN. creatinine, 24-hour urine protein and creatinine clearance between donor group and control group. In conclusion. there were significant changes of renal function in the remaining kidney after donor nephrectomy and we must perform follow-up study of renal function periodically.
Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Kidney* ; Living Donors ; Nephrectomy* ; Prospective Studies ; Tissue Donors*

The increasing waiting times for deceased donor kidneys have focused attention on living donors as a useful way to increase the organ supply. However, living donors with potential medical risks for renal transplantation raise medical and ethical questions for donor nephrectomy about conditions such as hypertension, hematuria, obesity, and old age. Data on the long-term risks of conditions are sparse and potential acceptance criteria are under development. Many older donors hope to donate to their offspring, despite the presence of elevated blood pressure. Transplant professionals have internal debates on these situations that require a well-defined scoring system for donating risk. This review summarizes the characteristics and risk of marginal living donors in renal transplantation and discusses strategies for overcoming the current limitation.
Blood Pressure ; Hematuria ; Humans ; Hypertension ; Kidney ; Kidney Transplantation ; Living Donors ; Nephrectomy ; Obesity ; Tissue Donors ; Transplants

We have performed 190 renal transplantations from August 1990 to June 1996. No cadaveric donor was used and all except one were first grafts. We conducted a clinical analysis, especially concerning the factors affecting acute rejection and graft function at 1 year. The results were as follows : 1) The mean ages of donor and recipient were 35.3 years and 37.4 years respectively. The ratio of male to female was 1.4 : 1 and 1.5 : 1, respectively. 2) One hundred and six cases(55.8%) were living unrelated donors and eighty four cases(44.2%) were living related donors. 3) One hundred and sixty six potential recipients were given 3 donor specific transfusions(DST), started about 5 weeks prior to transplantation with cyclosporin coverage. Six of these patients(3.6%) developed sensitization by DST that precluded the subsequent transplantation and the remaining 160 patients received the kidney from the blood donors. Another 28 recipients were given DST 24 hours prior to operation. 4) Most of initial acute rejection episodes(71 episodes, 95%) appeared within the first month of post-transplantation. 5) We analyzed the possible factors affecting the incidence of acute rejection. Donor age and HLA incompatibility were significant statistically(p<0.05). 6) Multiple regression analysis showed that a number of acute rejection episodes(p<0.001) was the only independent risk factor for the graft function at 1 year. 7) Overall graft and patient survival rate were 97.2% and 98.6% at 1 year, 94.1% and 95.5% at 3 years.
Blood Donors ; Cadaver ; Cyclosporine ; Female ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Male ; Risk Factors ; Survival Rate ; Tissue Donors ; Transplants ; Unrelated Donors

PURPOSE: Shortage of donor organs is one of the major barriers to transplantation worldwide, especially, in countries where cadaveric organ donation is still limited. To overcome the donor kidney shortage, living unrelated donor renal transplantation should be one of the options to solve this problem. However, the data on the long-term results after unrelated donor renal transplantation and potential risk factors affecting the graft survival are scarce worldwide. We designed this retrospective study to report the long-term results of 967 renal transplants from unrelated donors in a single center. METHODS: From 1979 to June 2002, 2115 kidney transplantations were performed at Yonsei University Medical Center. Among them, a total of 1945 living donor transplants, excluding 55 cadaveric transplants and early 115 transplant who received azathioprine plus prednisone, were identified as a study cohort. The minimum and mean follow- up periods were 12 and 87.8 months, respectively. Of these, 978 transplants received living related donors (LRDs), and 967 patients underwent kidney transplantation using living unrelated donors (LURDs). For the analysis of risk factors affecting the graft survival, a couple of each demographic, immunologic, and clinical variates were included. RESULTS: The actuarial graft survival in the LRD and LURD recipients were 88.26% vs. 83.4% at 5 years, and 72.31% vs. 66.9% at 10 years, respectively. The 10-year patient survival rate for LRD and LURD transplants were 82.6% and 84%, respectively with no significant difference. On the multivariate analysis of LURD recipients, history of acute rejection, recipient age over 55 years, preoperative history of diabetes and hepatitis B viral infection were identified as a significant risk factor affecting the graft survival in LURD renal recipients. CONCLUSION: Excellent long-term patient and graft survivals were achieved among LURD kidney transplant recipients. Long-term outcome of transplants were not differed by the kinds of kidney donors. Renal transplantations using LURDs should be considered as an alternative way to increase the number of available donors.
Academic Medical Centers ; Azathioprine ; Cadaver ; Cohort Studies ; Graft Survival* ; Hepatitis B ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors ; Multivariate Analysis ; Prednisone ; Retrospective Studies ; Risk Factors* ; Survival Rate ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation ; Transplants* ; Unrelated Donors*