Current status of renal transplantation (original) (raw)
Related papers
Renal transplantation is well established as the treatment of choice for selected patients with end-stage renal failure. A renal transplant recipient can enjoy an improved quality of life whilst benefiting from a reduction in the mortality compared with long-term dialysis. However, the success of transplantation is limited by the disparity between an ever growing demand and an insufficient supply of organs. Expansion of the organ donor pool has been achieved through increased utilization of living donor kidneys, transplantation across HLA and ABO boundaries as well as a greater acceptance and consideration of more marginal kidneys from deceased donors. Whilst one-year graft survival rates are significantly higher than a decade ago, the rate of chronic graft loss after the first year remains substantial. Although the surgical procedure has changed little over many years recipients have certainly become more complex with increasing age, obesity, co-morbidity and repeat transplants.
Renal transplantation — An experience of 500 patients
Medical Journal Armed Forces India, 2007
Background: Renal transplantation is the treatment modality of choice for patients with end stage kidney failure. We present our experience of graft and patient survival of initial 500 renal transplants performed between May 1991 and July 2006, at Army Hospital (R&R). Material and Methods: All patients received triple drug immunosuppression with cyclosporine/tacrolimus, azathioprine/ mycophenolate mofetil and steroids. Patients in high risk group received induction therapy with IL-2 receptor blockers/antithymocyte globulin. Results: Majority of the recipients (79%) were males, whereas majority of the donors (59.4%) were females. In the donor profile, 385 (77%) transplants were live related, 108 (21.6 %) were spousal and 7 (1.4%) were cadaveric transplants. Mean age of the donors and recipients was 42.11 ± 11.53 years (range 19-72 years) and 33 ± 9.39 years (range 5-60 years) respectively. Eighty two patients (16.4%) were lost to follow up and the present data on rejections, patients and graft survival pertains to 418 patients. These patients have been followed up for a mean period of 2.63 years (SE, 0.122; median 1.8 years; range 0-13.36 years). Acute rejection episodes occurred in 115 (27.3%) patients and 95% of these could be reversed with steroids/ATG. Sixty eight patients (16%) have died on follow-up. Our one-year, 5 year and 10 year estimated graft survival is 95.4% (SE, 0.01), 80.5% (SE, 0.03) and 53.1% (SE, 0.09) respectively and patient survival at one year is 93.2% (SE, 0.01). The estimated graft and patient survival in our series is 9.83 (95% CI, 8.92-10.73) and 9.80 (8.93-10.67) years respectively. Conclusion: This centre's short-term graft survival of 95.4% is comparable to the best centres of the world.
Guidelines on Renal Transplantation
2003
Policies to enhance living donation 2.3.1 Medical methods to increase number of living donations 2.3.1.1 Acceptance of grafts with anatomical anomalies 2.3.1.2 Laparoscopic living-donor nephrectomy 2.3.1.3 References 2.3.1.4 ABO-incompatible donors 2.3.1.5 Cross-match-positive living-donor kidney transplants 2.3.1.6 Living unrelated kidney donation 2.3.1.7 'Non-directed' living-donor transplantation 2.3.1.8 Payment to living donors from a central organisation 2.3.1.9 References 2.3.2 Ethical ways of showing appreciation for organ donation 2.3.2.1 Donor 'medal of honour' 2.3.3 Organisational ways to encourage organ donation 2.3.3.1 Cross-over transplantation or paired organ exchange 2.3.3.2 Medical leave for organ donation 2.3.4 References 2.4 Kidney donor selection and refusal criteria 2.4.1 Introduction 2.4.2 Infections 2.4.3 Special exceptions for infections 2.4.4 Malignant tumours 2.4.5 Special exceptions for malignant tumours 2.4.6 Vascular conditions and renal function 2.4.7 Marginal donors 2.4.8 One graft or two grafts per recipient 2.4.9 References 2.5 Explantation technique 2.5.1 Technique of deceased donor organ recovery 2.
Renal Transplantation: Progress and Prospects
Artificial Organs, 1996
Abstract: Despite encouraging and improving results, organ transplantation is still hampered by a shortage of organs, chronic transplant loss, and a changed patient population. Liberal inclusion criteria for dialysis and/or renal transplantation and the increasing unwillingness to donate organs in some countries has led to a growing imbalance between the numbers of transplantations performed and patients on waiting lists. Until now, poorly understood chronic transplant dysfunction is responsible for a still unchanged graft loss of approximately 5% per year. The patient population has changed to include more multimorbidity and an increasing number of risk factors (age, diabetes mellitus, former [failed] transplantations, or preexisting cardiovascular diseases). The recommendation for or against dialysis or transplantation has become increasingly difficult for the responsible physician. Newly developed immunosuppressant drugs, an increasing consideration regarding living organ donation, or xenotransplantation in the future may solve this dilemma. New reflections and considerations about the ethical background of transplantation medicine are necessary.
Trends in Kidney Transplantation over the Past Decade
Drugs, 2008
potential for increased longevity and enhanced quality of life; however, the demand for kidneys far exceeds the available supply. This has led to an increase in the number of people on waiting lists and an increase in waiting time. In the US, the overall median wait time was 2.85 years in 2004. The projected median waiting time for adult patients awaiting a deceased donor kidney in 2006 is 4.58 years. The renal transplant community has pursued multiple avenues in an attempt to increase the donor pool, but this remains a major challenge. In the last decade, the number of live donor kidney transplants performed in the US and Canada has doubled and represents just over 40% of all donor kidneys. Among deceased donor kidneys, the largest percentage increases were seen in expanded criteria donor and donation after cardiac death kidneys. In the last decade, the age distribution among donors, and among patients on waiting lists or receiving a renal transplant, has shifted towards older age groups. There have been dramatic shifts in baseline immunosuppression with increased usage of induction agents and the nearly universal replacement of azathioprine by mycophenolate. Additionally, tacrolimus use has increased from 13% to 79% at discharge, while ciclosporin (cyclosporine) use has fallen from 76% to 15%. Although 1-year graft survival rates are excellent, only modest improvements have been observed in long-term graft survival rates in the last decade. Thus, efforts have shifted from improving early graft outcomes to altering the natural course of late graft failure. Death of transplant recipients from cardiovascular disease, infection and cancer remains an important limitation in kidney transplantation. Continued success in kidney transplantation will require increased numbers of donors, both living and deceased, as well as reduction in the primary causes of late transplant loss, namely premature patient death with a functioning graft and chronic allograft nephropathy.
The evolution of renal transplantation in clinical practice: for better, for worse?
QJM : monthly journal of the Association of Physicians, 2008
Kidney transplantation is the optimal form of renal replacement therapy for most patients with end-stage renal disease. Attempting to improve graft and recipient survival remains challenging in clinical practice. To identify the factors that have significantly changed over the past four decades and assess their impact on renal transplant outcomes. Retrospective review of all renal transplant procedures in a single UK region. All 1346 renal transplant procedures performed between 1 January 1967 and 31 December 2006 were reviewed. Clinical data, histological reports and outcomes were available from a prospectively recorded database. The study period was divided into four decades to assess the changes in renal transplantation over time. Significant changes that have occurred include an increase in donor and recipient ages, a greater proportion of recipients with diabetic nephropathy, a longer wait before the first transplant procedure, a fall in the incidence and impact of acute reject...