Long-term (>10 years) Result of Kidney Transplantation between HLA Identical Siblings

Cho, Nam Sun; Moon, Jang Il; Kim, Yu Seun; Kim, Soon Il; Kim, Myoung Soo; Chung, Ku Yong; Jeon, Kyung Ock; Lee, Eun Mi; Park, Kiil

Abstract

Degree of HLA matching between donor and recipient is a well-known risk factor affecting the renal allograft function and survival. This study presents long-term clinical outcomes of kidney transplantation between HLA identical siblings from a single center. A total of 60 patients (pts), who has been followed up more than 10 years were identified and constituted the cohort of this study. The graft and patient survival were estimated with Kaplan-Meier's analysis method. Causes of graft loss and pts' death, episode of acute and chronic rejection, allograft function, and long-term complications were reviewed from medical records. Before 1984, azathioprine (AZA) and steroids were used for immunosuppression, but cyclosporine (regular oral solution, regular capsules or microemulsion preparation) and a low dose steroid has been the mainstay of immunosuppression since 1984. Earlier 37 pts were treated with AZA/steroids protocol (AZA group) and later 23 pts were immunosuppressed with cyclosporine (CsA)/steroids protocol (CsA group). Mean duration of follow-up months was 151 in AZA and 114 in CsA group respectively. Mean age of recipients at the time of transplantation was 34.1 years in AZA and 34.7 years in CsA group. Ten year graft survival in each group were 67.6% and 65.2% (p=0.672) and patient survival were 82.7% and 80.0% (p=0.833) respectively. Adoption of CsA/steroids protocol since 1984 did not significantly improve the graft and patient survival comparing AZA/steroids protocol. During the period, 12 patients died of various causes. The leading causes of patient death were cerebrovascular disease (3) and infection (3). Twenty-two grafts were lost: 13 in AZA and 9 in CsA group. The common causes of graft loss were pts' death with functioning graft (12), chronic rejection (5), and poor compliance (4). We could not find any differences in the causes of mortality and graft loss between the AZA and CsA groups. Mean serum creatinine in the chronic rejection-free pts at post-transplant 10 year were 1.4 and 1.3 mg/dl in or CsA group. CsA/steroids protocol did not improve the long-term outcome in HLA matched pairs. Long surviving transplant recipients continue to experience a variety of medical and surgical complications. For this reason, continued follow-up by experienced medical personnel is essential. Measures need to be taken to prevent and manage these late complications. Continued investigation into new and better immunosuppressive modalities is essential in an attempt to prevent the long-term consequences of maintenance immunosuppression.