Report of 1,000 Kidney Transplants at the Sungkyunkwan University of Korea

Hui Taek Jung; Gum O Jung; Gyu-Seong Choi; Choon Hyuck Kwon; Sung-Joo Kim; Jae-Won Joh; Suk-Koo Lee

doi:10.4285/jkstn.2009.23.2.141

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

Original Article

J Korean Soc Transplant 2009;23(2):141-148.

Published online: 11 September 2009

DOI: https://doi.org/10.4285/jkstn.2009.23.2.141

Report of 1,000 Kidney Transplants at the Sungkyunkwan University of Korea

Hui Taek Jung, M.D., Gum O Jung, M.D., Gyu-Seong Choi, M.D., Choon Hyuck Kwon, M.D., Sung-Joo Kim, M.D., Jae-Won Joh, M.D., Suk-Koo Lee, M.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

책임저자：김성주, 서울특별시 강남구 일원동 50 성균관대학교 삼성서울병원 외과, 135-170 Tel: 02-3410-3476, Fax: 02-3410-0040 E-mail: kmhyj111@skku.edu

Received 29 May 200916 July 2009 Accepted 17 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Kidney transplantation, Graft survival, Risk factors

REFERENCES

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Fig. 1.

Number of kidney transplantation from 1995 to 2008.

Fig. 2.

Distribution of age in recipients and donors.

Fig. 3.

Relationships of donor and recipient.

Fig. 4.

(A) Overall graft survival, (B) Graft survival according to type of donor, (C) Causes of graft failure.

Fig. 5.

(A) Overall patient survival, (B) Patients survival according to type of donor, (C) Causes of patient death.

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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