비혈연 간 생체 신이식 시 이식신 생존율에 영향을 미치는 위험인자 분석

Abstract

Purpose: Shortage of donor organs is one of the major barriers to transplantation worldwide, especially, in countries where cadaveric organ donation is still limited. To overcome the donor kidney shortage, living unrelated donor renal transplantation should be one of the options to solve this problem. However, the data on the long-term results after unrelated donor renal transplantation and potential risk factors affecting the graft survival are scarce worldwide. We designed this retrospective study to report the long-term results of 967 renal transplants from unrelated donors in a single center.

Methods: From 1979 to June 2002, 2115 kidney transplantations were performed at Yonsei University Medical Center. Among them, a total of 1945 living donor transplants, excluding 55 cadaveric transplants and early 115 transplant who received azathioprine plus prednisone, were identified as a study cohort. The minimum and mean follow- up periods were 12 and 87.8 months, respectively. Of these, 978 transplants received living related donors (LRDs), and 967 patients underwent kidney transplantation using living unrelated donors (LURDs). For the analysis of risk factors affecting the graft survival, a couple of each demographic, immunologic, and clinical variates were included.

Results: The actuarial graft survival in the LRD and LURD recipients were 88.26% vs. 83.4% at 5 years, and 72.31% vs. 66.9% at 10 years, respectively. The 10-year patient survival rate for LRD and LURD transplants were 82.6% and 84%, respectively with no significant difference. On the multivariate analysis of LURD recipients, history of acute rejection, recipient age over 55 years, preoperative history of diabetes and hepatitis B viral infection were identified as a significant risk factor affecting the graft survival in LURD renal recipients.

Conclusion: Excellent long-term patient and graft survivals were achieved among LURD kidney transplant recipients. Long-term outcome of transplants were not differed by the kinds of kidney donors. Renal transplantations using LURDs should be considered as an alternative way to increase the number of available donors.