Journal List > J Korean Soc Transplant > v.23(2) > 1034284

Jung, Jung, Choi, Kwon, Kim, Joh, and Lee: Report of 1,000 Kidney Transplants at the Sungkyunkwan University of Korea

Abstract

Background:

This study aims to report clinical outcome and long term graft and patient survival rate of one thousand kidney transplantation. We analyzed risk factors that impact on graft survival in the 1,000 case of kidney transplantation through this study.

Methods:

We have performed 1,000 cases of kidney transplantation in Samsung Medical Center, Seoul, Korea from February 1995 to January 2008. We retrospectively reviewed medical record of recipients and donors.

Results:

The mean follow up period was 69 months. Composition of type of donor was living donor, 653 cases and deceased donor, 347 cases. Type of donor source was mostly living-related type. 94 cases had graft failure. Major cause of graft failure was chronic allograft nephropathy. And major viral infection was cytomegalovirus infection. Major non-viral infection was urinary tract infection. 47 cases of immediate post operative complication was diagnosed as lymphocele. Overall 10-year graft survival rate was 83.9% respectively. 10-year patient survival rate was 95.7% respectively. 10-year graft survival and patient survival of recipient were significantly different between living donation group and deceased donation group.

Conclusions:

In this report, only two risk factor were statically significant difference.

REFERENCES

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Fig. 1.
Number of kidney transplantation from 1995 to 2008.
jkstn-23-141f1.tif
Fig. 2.
Distribution of age in recipients and donors.
jkstn-23-141f2.tif
Fig. 3.
Relationships of donor and recipient.
jkstn-23-141f3.tif
Fig. 4.
(A) Overall graft survival, (B) Graft survival according to type of donor, (C) Causes of graft failure.
jkstn-23-141f4.tif
Fig. 5.
(A) Overall patient survival, (B) Patients survival according to type of donor, (C) Causes of patient death.
jkstn-23-141f5.tif
Table 1.
Basic characteristics of 1,000 case of kidney transplantation
Characteristic     Living donor Deceased donor P-value
Recipients Sex M/F 557 (57.7)/423 (42.3) 375/278 202/145 0.43
Donor Sex M/F 597 (59.7)/403 (40.3) 353/300 244/103 0.000
Recipient age Mean 39.0±11.3 39.7±11.1 37.7±11.6 0.01
Donor age Mean 37.2±12.1 39.3±10.7 33.2±13.5 0.000
Type of donor Living/deceased donor   653 (65.3) 347 (34.7)  
Etiology Glomerulonephritiis/nephropathy 174      
  IgA nephropathy 94      
  Hypertension 116      
  Diabetes mellitus 104      
  Polycystic kidney disease 25      
  Unknown 437      
  Other (SLE et al) 33      
  Graft failure (more than 2 nd KT) 17      
HLA matching 0 48 3.3±1.4 2.1±1.4 0.000
  1 153      
  2 199      
  3 277      
  4 172      
  5 63      
  6 83      
HLA-DR matching 0 201 1.2±0.6 0.7±0.7 0.000
  1 554      
  2 241      
Panel reactive antibody Negative 728 501 227 0.21
  Positive 83 53 30 0.21
HBV recipients   45 (4.5) 26 19 0.16
HCV recipients   19 (1.9) 6 13 0.003
Table 2.
Number of patients according to immunosuppressive agent
Immunosuppresive agent    
Induction   Maintain  
ATG induction 164 CsA + AZA + PD 179
OKT3 induction 10 CNI (CsA or TAC) + MMF + PD 802
Anti IL2 receptor 40 mTOR inhibitor + PD 7
antibody      

Abbreviations: ATG, anti-thymocyte antibody; OKT3, murine mon-oclonal IgG2a antibody; CsA, Cyclosporine, AZA, azathioprine; PD, prednisolone; CNI, calcineurin inhibitor; TAC, tacrolimus; MMF, mycophenolate mofetil.

Table 3.
Complication, infection, and malignancy after kidney transplantation
Complication
Immediate complication   Late complication  
Lymphocele Dyslipidemia 47 344
Bleeding 20 PTDM 66
Urinary leakage 12 AVN 39
Ureter stenosis 5 Osteoporosis 24
Post op renal artery thrombosis or stenosis 0    
Infection      
Viral infection 661 Bacterial infection 156
CMV 410 UTI 111
Parvovirus 109 Non-UTI 45
Polyoma virus 78    
Herpes zoster 64    
Fungal infection 13 Other infection 16
    PCP 8
    Tuberculosis 8
Malignancy      
Stomach 5 Urethral 2
PTLD 4 Cervix, ovary 2
Colorectal 3 Breast 2
Thyroid 2 RCC 1

Abbreviations: PTDM, post transplant diabetes mellitus; AVN, avascular necrosis of femoral head; UTI, urinary tract infection; PCP, pneumocystis carinii pneumonia; PTLD, post transplant lymphoproliferative disease; RCC, renal cell carcinoma.

Table 4.
Cox proportional hazard model of graft survival
Univariant analysis Risk ratio 95% CI P-value
Recipient age (>50 vs ≤50) 1.04 0.592 1.832 N/S
Donor age (>50 vs ≤50) 1.68 0.976 2.915 N/S
Recipient sex (male vs female) 0.94 0.552 1.627 N/S
Donor sex (male vs female) 1.46 0.833 2.580 N/S
Etiology DM (positive vs negative) 1.33 0640 2.785 N/S
Etiology hypertension (positive vs negative) 1.05 0.398 2.807 N/S
Type of donor (living vs deceased) 2.20 1.197 4.045 0.000
HLA matching ( ≤3 vs >3) 0.55 0.232 1.142 N/S
HLA-DR matching ( 0 vs 1∼2) 1.14 0.609 2.154 N/S
PRA (positive and negative) 1.87 0.581 6.063 N/S
Type of pre Op Dialysis (CAPD vs HD) 1.16 0483 2.795 N/S
Duration of Dialysis (≤36 mon.vs >36 mon.) 1.09 0.609 1.949 N/S
Recipients with HBV 3.22 0.437 23.770 N/S
Recipents with HCV 1.34 0.177 10.148 N/S
Rejection (positive vs negative) 2.35 1.251 4.444 0.008
CMV infection (positive vs negative) 1.31 0.550 3.160 N/S
Multivariant analysis Risk ratio 95% CI P-value
Type of donor (living vs deceased) 2.248 1.306 3.871 0.003
Rejection (positive vs negative) 2.876 1.578 5.240 0.001
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