사이크로스포린을 투여한 일차 생체 신이식의 생존률과 예후인자의 분석

Abstract

A total of 1,043 out of the 1,105 kidney transplan- tations(TLXs) performed between 1984 and Sep- tember of 1994 with Cyclosporine(CsA) as the main immunosuppressive agent, excluding 25 re- TLXs, 21 cadaveric and 32 pediatric TLXs, were used as the subjects of this study to find the risk factors which influence the graft survival of the primary living donor TLX recipients in a single center. When the potential donor was living related, at least the HLA 1-haplotype matching relative was selected, and when unrelated, at least DR-1 or A+B2 rnatching was required for selection. Living unrelated donors (n=629) were available through the swap program among the family members of the potential recipients or fully motivated healthy volunteers as well as spouses. CsA and low dose steroids with or without azathioprine was used for maintenance imm- unosuppression. Primary induction with anti-lympho- cyte preparation was not used. For the treatment of acute rejection, steroid pulse, steroid recycling or various kinds of anti-lyrnphocytic preparation were used. The rninimum follow-up period was 12 months. During a mean follow-up of 53.2months, there were 188 cases of graft loss, and 82 recipient deaths. No donor death related to surgery or do- nation occurred. The 1-, 3- and 5-year graft survival were 96.2%, 89.8%, and 82.2%, respectively. No graft survival difference among the identically related (n=82), 1-haplotype matched related(n=332) and unrelated donors(92.1% vs 80.6% vs 81.6% at 5- year, p>0.05) was seen even though a positive trend was noted in the HLA identical pairs. The sigificant risk factors for the related TLXs were the ABO compatibility, episodes of acute rejection within 1 year, and the old age of the donor(above 50), but in unrelated pairs, the old age of the recipient(above 50) and episodes of acute rejection within 1 month influenced the graft outcome significantly. In con- clusion, living related and unrelated kidney donation must continue as an important source of kidneys for patients with end-stage renal failure because we have ascertained the high graft survival rates with negligible donor risk. Living unrelated donation from spouses or through the swap program under the auspices of non-profit national organization are to be encouraged.