Premasathian N, Vongwiwatana A, Taweemonkongsap T, Amornvesukit T, Limsrichamrern S, Jitpraphai S, Kositamongkol P, Mahawithitwong P, Sritippayawan S, Chanchairujira T, Nualyong C, Vareesangthip K, Vasuvattakul S, Sirivatanauksorn Y
Division of Nephrology, Department of Medicine, Siriraj Organ Transplant Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Transpl. 2010:141-8.
With 37-years of experience, a total of 801 kidney transplantations (59.4% were deceased donors and 40.6% were living donors) performed at Siriraj hospital were reported. The point system parallel to OPTN/UNOS for waitlists was utilized. Most of the recipients of deceased donor kidney transplantations had 3 HLA mismatches. Due to the point allocation system, none of them had 6 HLA mismatches. Extended criteria donor comprised 7.8% of all deceased donors. Mean duration of dialysis prior to deceased donor transplant was 53 +/- 34 months. Delayed graft function (DGF) was found in 54% of deceased donor kidney transplantation and resulted in significantly higher rate of 1 year biopsy-proven acute rejection, longer duration of kidney transplant admission, higher admission cost and lower patient survival compared to those with immediate graft function. Most of living donor kidney transplant recipient had 1 haplotype match. Mean donor age was 35.9 +/- 9.8 years. 95.6% of the recipients were on hemodialysis prior to transplantation. The current standard regimen includes calcineurin inhibitor, Mycophenolic acid and prednisolone. Interleukin-2 receptor monoclonal antibody has been used in the high immunological risk or high risk for DGF recipients that were 50% of the recipients. There was no statistically significant difference in the biopsy-proven acute rejection (BPAR) free survival between deceased and living donor transplantation. Proportion of cases with the diagnosis of acute rejection according to Banff 2007 classification is as follows: 32.4% acute cellular rejection (ACR), 39.4% antibody-mediated rejection (AMR) and 21.1% mixed cellular and antibody-mediated rejection. Seventy two patients, 35 deceased donor and 37 living donor kidney transplant recipients, had biopsy-proven glomerular disease after transplantation which IgA nephropathy is the most common form of glomerulonephritis. Median graft survival was 7.6 and 13.2 years and median patient survival was 12.1 and 15.5 years for recipient of deceased and living donor transplant respectively. The follow up program of living donors was introduced in 2003 and there were not any donors who required renal replacement therapy.
据报道，诗里拉吉医院进行了37年的肾脏移植手术，共801例（59.4%为 deceased donors，40.6%为 living donors）。采用了与OPTN/UNOS平行的等待名单积分系统。 deceased donor肾脏移植的大多数受者有3个HLA错配。由于积分分配系统，他们中没有一个有6个HLA错配。扩展标准供体占所有 deceased donors的7.8%。 deceased donor移植前的平均透析时间为53±34个月。54%的 deceased donor肾脏移植出现延迟移植功能（DGF），与具有即时移植功能的受者相比，1年活检证实的急性排斥反应发生率显著更高，肾脏移植住院时间更长，住院费用更高，患者生存率更低。大多数 living donor肾脏移植受者有1个单倍型匹配。供体平均年龄为35.9±9.8岁。95.6%的受者在移植前接受血液透析。目前的标准方案包括钙调神经磷酸酶抑制剂、霉酚酸和泼尼松龙。白细胞介素-2受体单克隆抗体已用于高免疫风险或高DGF风险的受者，占受者的50%。 deceased donor和 living donor移植之间活检证实的无急性排斥反应（BPAR）生存率无统计学显著差异。根据2007年班夫分类法诊断为急性排斥反应的病例比例如下：32.4%为急性细胞排斥反应（ACR），39.4%为抗体介导的排斥反应（AMR），21.1%为细胞和抗体介导的混合排斥反应。72例患者，35例 deceased donor和37例 living donor肾脏移植受者，移植后经活检证实患有肾小球疾病，其中IgA肾病是最常见的肾小球肾炎形式。 deceased donor和 living donor移植受者的移植中位数生存期分别为7.6年和13.2年，患者中位数生存期分别为12.1年和15.5年。2003年引入了 living donors的随访计划，没有任何供体需要肾脏替代治疗。
