Renal transplantation in cyclosporine-treated recipients at the Singapore General Hospital.

Abstract

1. The 5-year patient and graft survival rates for live-donor renal transplants undergoing transplantation with CsA-based immunosuppression at the Singapore General Hospital from 1985-1999 were 97.0% and 91.6%, respectively. The 5-year patient and graft survival rates for cadaveric renal transplant recipients from the same institution were significantly lower at 91.6% and 79.4%, respectively. Long-term graft survival as described by half-lives (T1/2) were 28.6 years and 20.4 years for live-donor and cadaveric grafts, respectively. 2. Tissue matching had no impact on graft or patient survivals in either live-donor or cadaveric renal transplants. However, sensitisation was associated with significantly worse graft survival in cadaveric transplant recipients. 3. Primary cadaveric transplant recipients enjoyed significantly better graft survival rates than retransplanted recipients (5-year survival rates of 80.1% and 65.0%, respectively; p = 0.032). 4. Among cadaveric renal transplant recipients, a single acute rejection episode was associated with worse long-term graft survival (T1/2 of 14.6 years and 37.0 years for those with and without rejection, respectively, p = 0.001). Likewise, delayed graft function was associated with worse overall graft survival (5-year graft survival rates of 70.7% vs. 86.8% in patients with and without DGF, respectively, p < 0.001). 5. Among cadaveric transplant recipients with a functioning kidney at 5 years after transplantation, 61.4% had normal renal function with serum creatinine levels < 141 mumol/L while 33.9% had mild renal dysfunction with SCr of 141-250 mumol/L. 6. The high graft and patient survival rates in this Asian population as reported from this single centre study may be attributed to selection of younger patients without overt ischaemic heart disease for transplantation and to good patient compliance to CsA therapy. Thus, recipient selection and ensuring patient compliance to treatment are key strategies in optimizing the use of a scarce resource such as organ transplants.