Living unrelated donor kidney transplantation: A fourteen-year experience

Abstract

Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ? 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.Uvod/Cilj. U zemljama koje nemaju nacionalnu organizaciju za prikupljanje i distribuciju organa od umrlih osoba, nedostatak organa jos uvek je neresen problem. Program transplantacije bubrega od zivog nesrodnog davaoca - supruznika zapocet je da bismo povecali broj transplantacija. Cilj ispitivanja bio je da se uporedi prezivljavanje bolesnika, grafta i funkcija grafta kod primalaca kojima su davaoci nesrodnici - supruznici sa onima kojima su davaoci bili zivi srodnici. Metode. Retrospe ktivnom analizom identifikovali smo 14 bolesnika koji su dobili bubreg od supruznika u periodu od 1996. do 2009. godine (grupa I). U kontrolnoj grupi bilo je 14 bolesnika koji su bubreg dobili od zivog srodnog davaoca. Odabrani su iz postojece baze uparivanjem sa bolesnicima grupe I prema polu, zivotnoj dobi, osnovnom bubreznom oboljenju, imunoloskom i virusoloskom pretransplantacionom statusu, prvom modalitetu lecenja terminalne bubrezne slabosti i ABO kompatibilnosti. U periodu pracenja, 41 ? 38 meseci, registrovani su imunosupresivna terapija, hirurske komplikacije, epizode akutnog odbacivanja, infekcija citomegalovirusom i funkcija grafta preko nivoa serumskog kreatinina na pocetku i kraju pracenja. Svi bolesnici su pretransplantaciono imali negativanu unakrsnu reakciju. Pretransplantacioni titar ABO izoaglutinina kod krvno-grupno nepodudarnih bolesnika iznosio je nula. Rezultati. Bolesnici sa supruznickim graftom imali su znacajno losiju HLA podudarnost (p < 0,01). Nisu uocene razlike medju grupama u pracenim parametrima. Dva bolesnika iz prve grupe vratila su se na hemodijalizu nakon 82, odnosno 22 meseca zbog teskih komorbiditeta. Zakljucak. Uprkos losijoj HLA podudarnosti, supruznicki graftovi imali su podjednako dobro prezivljavanje i funkciju kao i bubrezi dobijeni od srodnog davaoca.