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• W2006896551 abstract "A106 Purpose: The purpose of this study is to investigate the effect of long waiting time on dialysis on the outcome for both living and cadaveric renal transplantation in Japan. Background: A severe organ shortage and prolonged waiting time for transplantation has been a problem in Japan. Since the release of basiliximab (BSLIX) in Japan two years ago, it has been reported to reduce the incidence of acute rejection and the possibility of decreasing the dose of calcineurin inhibitors and/or steroids. Methods: In association with four transplantation centers in Kyushu and Okinawa islands, we analyzed 34 patients who underwent renal transplantation from June 2002 to March 2004. They were all used the same immunosuppressive protocol including BSLIX, either cyclosporine A or tacrolimus, mycophenolate mofetil (MMF) and steroids. BSLIX was administered 20mg at day 0 and day 4. The dosages of calcineurin inhibitors were controlled with targeting average or trough level of 150-200 ng/ml for cyclosporine A and 10-15 ng/ml in tacrolimus. MMF was administered 30 mg/kg pre-operatively followed by a reduced dose. As for steroids, methyl-predonisolone 500 mg was given just before reperfusion and quickly decreased thereafter. The patients were classified into three groups according to the period of hemodialysis, group-A (<5 years, mean 2.2 years, n=15), group-B (? 5 years and <20 years, mean 9.3 years, n=12) and group-C (? 20 years, mean 23.8 years, n=7). The parameters compared were age, pre-operative complications, donor situation, ischemic time, rejection and infection rates, graft function and hospital stay. Results: The over all analysis of 34 patients were as follows; an average age of 40.9 years old (3 to 63 y.o.), 21 male and 12 female, average dialysis duration of 10.8 years (8m to 26y7m), 22 from living donors and 12 from non-heart-beating donors, and average donor age of 55.2 y.o. (17 to 77 y.o.). The recipient age was significantly old in group-B and -C compared to that in group-A (44.6 y.o. and 50.9 y.o. vs 29.5 y.o., p=0.043). The rates of hypertension in each group were 26%, 41% and 28%, respectively. The patients in group-C had more history of parathyroidectomy (43%), cardiac diseases (29%), amyloidosis (14%) and arteriosclerosis (57%). In group-C, 85.7% of the patients happened to receive the organs from non-heart beating donors in contrast to 8.3% in group-A, and 40% in group-B. A donor age was significantly old in group-C compared to that in groups-A and -B (67.9 y.o. vs 49.5 y.o. and 49.3 y.o., respectively, p<0.05). Warm ischemic time and total ischemic time in each group were 5.6, 13.4 and 10.4 minutes, and 2.3, 12.2 and 12.5 hours, respectively. Acute rejection within 30 days in occurred 0%, 33.3% and 42.8%, and infection within 60 days 13.3%, 25.0% and 85.7%, respectively. Serum creatinine levels at 4weeks in each group were 1.01, 3.70 and 2.29 mg/dl, and the best creatinine levels were 0.87, 1.80 and 1.72 mg/dl, respectively. The length of hospitalization was 53.0, 61.5 and 91days. Thirty-one grafts (97.1%) functioned for follow up periods (range from 1 month to 19 month). One patient in the group C died of sepsis at day 41. Conclusions: Renal transplant recipients on long term dialysis in Japan are old and complicated preoperatively, and tend to receive organs from marginal donors. Although the incidence of acute rejection/infection was high and the recovery of graft function was slow, graft survival and patient survival in short term were both acceptable. Our immunosuppressive protocol included BSILIX would be useful for these high risk patients." @default.
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• W2006896551 date "2004-07-01" @default.
• W2006896551 modified "2023-10-16" @default.
• W2006896551 title "RENAL TRANSPLANTATION ON LONG-TERM DIALYSIS PATIENTS AT BASILIXIMAB ERA –JAPANESE SOUTHERN ISLAND MULTI-CENTER TRIAL -" @default.
• W2006896551 doi "https://doi.org/10.1097/00007890-200407271-01833" @default.
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