Journal List > J Korean Soc Transplant > v.28(1) > 1034442

Hong, Shin, Moon, Lee, Kim, Park, Kwon, Joh, Lee, and Kim: Analysis of 1,500 Kidney Transplantations at Sungkyunkwan University



The most effective treatment for end-stage renal disease is kidney transplantation, and the number of kidney transplantations has shown a rapid increase. The aim of this study was to determine graft survival and functional outcome of 1,500 kidney transplant cases in a single center. We also investigated the factors affecting graft failure after kidney transplantation.


We retrospectively reviewed the clinical data of 1,500 pairs of donors and subsequent recipients who underwent kidney transplantation in Samsung Medical Center, from February 1995 to January 2012.


The mean follow-up period was 2,241.5±1,609.4 days. There were 851 (56.7%) male recipients; 62 (4.1%) recipients were younger than 19 years old. Eleven (0.7%) cases were ABO blood group incompatible kidney transplant. A total of 531 (35%) deceased and 969 (65%) living donors were included. Among them, 191 (12.7%) recipients were experienced in graft failure. The most common cause of graft loss was chronic allograft nephropathy. One-year, 5-year, 10-year, and 15-year graft survival were 97.3%, 92.8%, 81.6%, and 75.1% (85.2% for living, 75.4% for deceased donor), respectively. Higher incidence of graft failure was observed in recipients who received deceased donor kidneys or experienced a rejection episode.


In our experience, overall 10-year graft survival after kidney transplantation was 81.6%. This report demonstrated that the type of donor (living or deceased) and history of allograft rejection are the only significant factors affecting graft survival.


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Fig. 1.
Number of kidney transplantation according to donor types from 1995 to 2012.
Fig. 2.
Distribution of age (A) and gender (B) in recipients and donors.
Fig. 3.
Relationship of donors and recipients. (A) Donor type. (B) Relationship of donor and recipients in living related kidney transplantation. (C) Relationship of donor and recipients in living unrelated kidney transplantation. (D) Donor criteria in deceased donor.
Fig. 4.
Newly developed malignancies after kidney transplantation.
Fig. 5.
Long-term outcomes after kidney transplantation: graft survival. (A) Overall graft survival. (B) Living donor kidney transplantation (LDKT): deceased donor kidney transplantation (DDKT) graft survival.
Fig. 6.
Causes of graft failure after kidney transplantation.
Fig. 7.
Long-term outcomes after kidney transplantation: patient survival. (A) Overall patient survival. (B) Living donor kidney transplantation (LDKT): deceased donor kidney transplantation (DDKT) patient survival.
Table 1.
Baseline demographics of kidney transplantation
Characteristic No. of patients (%)(n=1,500) Living donor Deceased donor P value
Related Unrelated Living
Sex (male/female)            
Recipient 851/649 347/293 205/124 552/417 299/232 0.830
Donor 883/617 365/275 149/180 514/455 369/162 0.000
Age (yr), mean±SD (range)            
Recipient 40.36±12.11 39.28±12.49 43.38±9.44 40.67±11.71 39.79±12.80 0.180
Donor 38.74±12.89 38.18±12.49 43.88±9.44 39.67±10.90 37.03±15.77 0.001
Type of donor (living/deceased) 969/531
Glomerulonephritis/nephropathy 200 (13.3)
Hypertension 221 (14.7)
Diabetes mellitus 186 (12.4)
IgA nephropathy 159 (10.6)      
Polycystic kidney disease 42 (2.8)      
Etc. 692 (46.1)      
Pretransplant renal replacement            
Hemodialysis 1,046
Peritoneal dialysis 185
Pre-emptive 138
Others 121
HLA matching   3.42±1.30 1.94±1.02 2.91±1.40 1.89±1.39 0.000
0 114 (7.6)          
1 267 (17.8)          
2 336 (22.4)          
3 473 (31.5)          
4 161 (10.7)          
5 70 (4.7)          
6 79 (5.3)          
PRA positive (above class 30%) (+)/(−) 82/116 32/48 18/32 50/80 32/36 0.288

Abbreviations: HLA, human leukocyte antigen; PRA, panel reactive antibody.

Table 2.
Use of immunosuppressive agents
Immunosuppressive agent No.
Induction agent  
Anti-thymocyte globulin 218
Anti-CD3 antibody 10
Anti-IL2 receptor antibody 488
Anti-CD52 antibody 9
Maintain agent  
Calcineurin inhibitor  
Cyclosporin 993
Tacrolimus 484
Azathioprine 183
Mycophenolate mofetil 797
Mycophenolic acid 94
mTOR inhibitor 9

Abbreviation: mTOR, mammalian target of rapamycin.

Table 3.
Immediate and late complications after kidney transplantation
Complication No.
Immediate operation related complications  
Lymphocele 74
Postoperative bleeding 20
Urinary leakage 26
Urinary stricture 9
Renal artery stenosis/thrombosis 3
Wound dehiscence 13
Late metabolic complications  
Dyslipidemia 543
Posttransplant diabetes mellitus 131
Avascular necrosis of femoral head 60
Osteoporosis 98
Table 4.
Infectious complications after kidney transplantation
Types of infection No.
Cytomegalovirus 624
Parvovirus 175
Polyomavirus 365
Urinary tract infection 203
Pneumonia 111
Sinusitis 21
Fungus 28
Tuberculosis 28
Pneumocystis jiroveci 14
Table 5.
Causes of patient death after kidney transplantation
Cause of death No. (%)
Bleeding 2 (3.5)
Cardio & cerebrovascular 5 (8.7)
Malignancy 9 (15.7)
Infection 21 (36.8)
Liver failure 3 (5.2)
Trauma 3 (5.2)
Unknown 6 (10.5)
Others (including suicide) 7 (12.2)
Table 6.
Impact factors affecting graft failure after kidney transplantation
Variable P value
Univariate analysis  
Ischemic time (cold/warm) 0.081/0.555
Male gender 0.090
Donor age 0.052
Recipient age 0.947
Recipient body mass index 0.067
Medical comorbidity (hypertension/diabetes) 0.396/0.219
Recipient with hepatitis virus (HBV/HCV) 0.529/0.063
Duration of the pretransplant dialysis 0.068
Pretransplant estimated glomerular filtration rate 0.072
Deceased donor kidney 0.004
Extended criteria donor kidney 0.773
Number of HLA mismatch 0.089
Anti-thymocyte immunoglobulin at perfusion 0.080
Maintenance immunosuppression  
Tacrolimus 0.152
Cyclosporin 0.053
Sirolimus 0.139
Without mycophenolate mofetil 0.080
Steroid withdrawal 0.653
History of allograft rejection during follow-up period 0.005
Delayed graft function 0.058
Multivariate analysis  
Type of donor (living vs deceased) 0.002
Rejection (positive vs negative) 0.003

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HLA, human leukocyte antigen.

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