Long-Term Results of Kidney Transplantation Between HLA-Identical Siblings

Surgery Today (Impact Factor: 1.53). 01/2001; 31(2):123-128. DOI: 10.1007/s005950170195


Long-term data on HLA-identical renal transplants are scarce, and the advantages of using cyclosporine (CsA) over azathioprine
(AZA) have yet to be elucidated. In 68 recipients from HLA-identical donors (37 under AZA-steroids and 31 under CsA-steroids),
we estimated the graft and patient survival to posttransplant 120 months, and compared the results between patients on different
protocols. Episodes of rejection, causes of graft loss or patient death, and long-term complications were also compared retrospectively.
The 10-year patient/graft survivals were comparable: 82.7/67.6% for the AZA and 78.4/63.5% for the CsA patients. The incidence
of acute rejection during the first year after transplant was also comparable. We lost 25 grafts. The major causes of graft
loss were patient death (7/13 in AZA and 5/12 in CsA patients) and chronic rejection (3/13 in AZA and 3/12 in CsA patients).
Four grafts were lost due to poor compliance. We lost 12 patients due mostly to cerebrovascular disease and infections. There
was no difference in the prevalence of complications between patients. In conclusion, the long-term outcome was excellent
in this subgroup of transplant patients. We could not find any advantages of using CsA over AZA in these patients after a
long-term follow-up. To achieve better results, continued attention should be paid to the prevention of poor compliance and

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    ABSTRACT: To study the involvement of glycosaminoglycans (GAGs) in the immunological process of renal disease. They are related to cytokines, which are known to play an important role in acute graft rejection after renal transplantation. We studied 40 patients on maintenance hemodialysis for chronic renal failure, who underwent renal transplantation from a live donor. We measured serum GAGs preoperatively, intraoperatively, and on postoperative days (PODs) 2 and 10. The clinical outcome and other biochemical markers, such as blood urea nitrogen and serum creatinine, were also recorded. The total serum GAG levels decreased after renal transplantation in patients with normal graft function (group N). However, in patients with acute graft rejection post-transplantation (group R), the GAG levels remained significantly elevated. Total serum GAGs fluctuate in renal transplantation and their association with graft rejection should be investigated further.
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    ABSTRACT: Recently, it has been revealed that alloantigen-independent causes are important factors for late graft loss in kidney transplantation. We compared the results of living kidney transplantation from HLA-identical siblings with those from HLA-non-identical siblings to analyse the impact of alloantigen-independent factors on long-term graft survival. Two hundred and sixty-six recipients who were grafted from their siblings between 1983 and 2002 were subdivided into those transplanted from HLA-identical donors (n=86) and those from HLA-non-identical donors (n=180). The incidence of acute rejection was significantly lower in the HLA-identical group than in the HLA-non-identical group (9.3% vs 53.9%, respectively; P<0.0001). Graft survival was significantly higher in the HLA-identical group than in the HLA-non-identical group (91.3% vs 79.2% at 5 years, 80.3% vs 66.8% at 10 years and 59.1% vs 51.7% at 15 years, respectively; P=0.0372). Although acute rejection was not seen as a cause of graft loss in the HLA-identical group, death with functioning graft, recurrence of the original disease or chronic allograft nephropathy were observed as the major causes of graft loss in the late period of the HLA-identical group. We concluded that alloantigen-independent causes constitute a crucial factor for graft loss in the late period of HLA-identical kidney transplantation.
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