Excellent long-term results of cadaveric kidney transplantation in Korea   

Doctors in the division of transplantation surgery Department of surgery, chonnam National University medical school, Kwangju, Korea and the department of urology Christian hospital Kwangju, Korea conducted a retrospective study analyzing the various factors the  affects allograft function in cadaveric kidney transplantation

The first cadaveric kidney transplantation was performed in the May 1993 in chonnam national university hospital thereafter, 52 cases of cadaveric kidney transplantation were performed from 28 cadaver donors till December 1999. The most frequent cause of brain death was head injury due to road traffic accident. Male to female donor ratio was 1.5:1 and their mean age was 25.6years.  Three HLA mismatch were 7 cases (13.5%) and six –HLA mismatch were cases (11.5%). There were 2 cases of multiple renal arteries. Organ procurement and kidney transplantation were performed at the same time in the centre and the operation method followed for cadaveric kidney transplantation was the same as that for conventional living donor transplantation.

There were 17 cases (32.7%) of acute rejection episodes four graft were lost within 1 year and the major cause of graft loss was patient death . Recipient age was a significant risk variable for graft survival rate was 92.15% which meant that the long –term outcome was excellent in the group of transplant patient the only factor to be kept in mind is that the cold ischemia time in cadaveric kidney transplantation should be no longer than that for living donor transplantation.

Hepatitis B & C Virus infection in renal transplant recipients

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) related liver diseases is an important cause or morbidity and mortality in renal transplant recipients. Further proof of this was given when doctor at the command hospital central command, Lucknow, India followed up the incidence of these infections in 72 renal transplant recipients at their infections in 72 renal transplant recipients at their centre. They also found that there was a higher incidence of HCV (34.7%) as compared to HBV 23.1%) infection. Most of these infections were acquired during the pre-transplant maintenance hemodialysis phase.

The average post- transplant follow-up period for the study group was 54.5 months (range 6 to 171 months). The mean age at the time of transplantation was 33.1 years. HBsAg was tested using ELISA and anti- HCV using 3^rd generation ELISA test, the result were as follows –

Both HBV and HCV negative                       38(52.7%)

HBV positive and HCV negative                  9(12.5%)

HCV positive and HBV negative                  17(23.6)

Both HBV and HCV positive                        8(11.1%)                    

There was no significant difference in the number of blood transfusions in the pre-transplant period between the two groups. The average duration on dialysis in the pre-transplant period was 6.1 months in the group which was negative for both HBV and HCV and 7.3 months in the two groups respectively. In the positive group, two patients died of liver cell failure and five had clinical/ biochemical evidence of chronic liver disease. 

Non-heartbeating donor kidneys associated with excellent patient and graft survival

A study of 31 uncontrolled non-heart beating donor (NHBD) kidneys put to rest the concern of poor function when using cold storage preservation for these kidneys. The median warm ischemia time (WIT) was 30 minutes (range 7-60). All cases prior to kidney recovery had in situ preservation by combined intravascular and intraperitoneal cooling (mean time =145 minutes, range 60-382). Pulsatile machine preservation (PMP) was used for all recovered from brain dead donors (BDD); mean pressure = 24.87 (sd=4.5); flow=134.03 (sd=24.17); resistance = 0.190 (sd=.05) kidneys with immediate function (IF) had lower mean resistances (0.160, sd=.04) than did kidneys with delayed function (DGF), (.200,sd=.04,p=.02).

The result showed that the IF rate was 29.03% , while the DGF rate was 64.51%.two kidneys that failed to function (6.455) were lost from renal artery thrombosis and hyperactue rejection mates to those kidneys functioned appropriately. 1 year actual graft survival (GS) for kidneys transplanted at various local centers was 89%.2-year was 78%.3; 3-year was 78%;4-year was 58% and patient survival (PS) was 93% , nothing that both kidneys were functioning normally at death. For 21 kidneys transplanted at the institution PS was 100% and GS 91%. One kidney (SCr of 1.1 mg %) was removed because of recurrent nephritic syndrome; the other kidney failed from noncompliance after three years of normal function. None of the 31 kidneys were lost from acute rejection. Renal Function of NHBD and BDD was equivalent after three months.

It was therefore heartening to note that PMP eliminated primary nonfunction from ischemic injury associated with NHBD. Kidney function recovered satisfactorily after 60 minutes WIT, six hours in situ preservation and 56 hours total preservation. PS, GS and renal function of NHBD kidneys was equivalent to those achieved with BDD kidneys. Other factors that contribute to good result are: donor age of less than 60 years; recipients of low immunologic risk: antilymphocyte therapy to be used with delayed introduction of cyclosporine/tacrolimus; ischemia and preservation times to be kept as short as possible.

Issues related to organ donation trends in living related organ donation

What role does gender and financial status play in a person agreeing to be a live – related kidney donor? Attempting to answer these questions was a study conducted by doctors from postgraduate Institute of Medical Education and Research, Chandigarh, India.

180 renal failure patients underwent live – related renal transplantation between June 2000 and June 2002. Out of these, 91 recipient had 370 (first – degree relative) available donors in the family as per the Transplant of Human Organ Act – 1994 on an average each recipient had four donors available for donation in the family. Out of 91 donor (88 were first degree and three were second degree relatives). Finically, 67 (73.6%) were dependent and 24 (26.4%) were remaining 28(29.8%) were males. Mean donor age of males and females was 43.4 and 46.3 years respectively. Out of the 63 females donor 36 (57.1%) were mother, 14 (22.2%) were sisters, 13(20.6%) were wives. Of the female donors 55(87.3%) were dependent and 8 (12.7%) were independent p= 0.01.(57.1%) were independent p = ns. The study concluded that majority of live related donors were females (others, sisters and wives) and definitely financially dependency appeared to be one of the influencing factors in motivation to donate an organ.

 Another study, which looked at the trends in kidney donation among blood relatives, was done ta the Sanjay Gandhi Postgraduate Institute of medical Science, Lucknow, India. It also found that the majority of the donors were female, especially mothers and wives, while the recipients were male. A retrospective data analysis of 1011 kidney transplant was done. These constituted living related donors between the year 1989 and 2001 with the time frame being divide into the non – spousal era(N = 331, June’ 89-Apr’) and the spousal era (N= 680, May ’96- Dec ’01). Female donors constituted the major donor pool (60.7%), but only 13.2% of females donors to male recipient (54.7%), but only 13.2% of females donors to male recipient (54.7%), but in spousal era this  donation had significantly decreased.  It was found that in the era due to the wife donor, the donation from mother to son( <.07) had decreased, there was an even more significant decrease(<.007) in donation from father to son. Of 22.8% of spousal donation, the majority of donation was from wife to husband ( 20.3%). Within at trends in urban versus rural areas, donation from male donor to female recipient was significantly higher(<.002) fro urban patients. In urban patients donation from brother to sister( <.04), and in rural patient donation from mother to son (<.008 )as well as father to son (<.003) was significantly higher.  The study clearly indicated that in the spousal era due to wife donor the donation from parent donor had significantly decreased, especially donation from father to son.

Computerized registry for transplant waiting list and organ matching software

Science the Transplantation of Human Organ Act was passed in 1994, the total number of cadaver transplants done for various solid organs is as follows( Jan 1995 – Jun 2001) : Kidney -379, Heart – 34, Liver – 12,Pancreas – 02.also over 600 corneas and about 502 heart valves have been donated. However, almost 165 donor organs were wasted due to the lack of waiting list information of patients in different region of the country. MOHAN Foundation (Multi Organ Harvesting Aid Network) , an NGO based in Chennai, India, recognized the need for a computerized network to streamline the process of Organ allocation and avoid wastage of organs. The foundation as now developed a software for a computerized registry that can be used in all parts of the country for keeping transplant waiting list and for organ matching. This programme available on the web and has the following objectives:

1. To store and maintain a common waiting list of cadaver organs required by patients on central computer from hospitals in the country.
2. To remotely view the most current waiting list data for any particular organ by any of the member hospitals in the network at any given time.
3. To be able to “match” an organ when available with the centrally available data on the server and appropriately allocate organs depending on sharing criteria of various regions.

The advantage of a central waiting list and matching software are as follows:

1. Prevention of organ wastage
2. Better matching of organ
3. Time factor- a central computerized system will give quick access to essential information about organ availability and information about where the patient resides. This will help in working out the logistics about sending the organ to that particular region.
4. Auditing of long – term results.