Summary
Living related kidney transplantation must offer the recipient distinct advantages over cadaveric grafting in order to justify the health risk undertaken by the donor. At Steglitz Medical Center in Berlin from 1970 to 1987 30 such transplantations were performed (5% of all kidney transplantations) where the donor was a relative of the recipient. In cases of haploidentity and positive mixed lymphocyte culture, the recipients were pretreated with donor-specific transfusions. The posttransplantation graft function rate was higher in the group where the donated kidney came from a relative than where it did not (after 2 years under cyclosporin: 92% vs 73%,P=0.04), and corticosteroid treatment could be terminated more frequently under cyclosporin (95% vs 51%,P=0.001). Transplantations from living related donors were performed more often in foreigners (43% vs 20%,P=0.01) and children (19% vs 4%,P=0.0001). Perioperative complications in the donor nephrectomy occurred in 63% of the cases, severe ones in 13% (bleeding, pneumonia, and late abscess). Late sequelae were not observed. The short waiting time, the high graft function rate, and the low steroid requirement justify kidney transplantation from living related donors providing strict indicational criteria are observed.
Similar content being viewed by others
Literatur
Bennett AH, Harrison JH (1974) Experience with living familial renal donors. Surg Gynecol Obstet 139:894–898
Brenner BM, Meyer TW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 307:652–659
Brosig W, Nagel R (1965) Klinische Probleme der Nierentransplantation beim Nenschen. Urologie 4:1–8
Broyer M, Brunner FP, Brynger H, Fassbinder W, Gillou PJ, Oulès R, Rizzoni G, Selwood NH, Wing AJ (1986) Combined report on regular dialysis and transplantation in Europe, XVI, 1985. Europ Dial Transplant Assoc XXIII, June 29–July 3, 1986
Chavers BM, Michael AF, Weiland D, Najarian JS, Mauer SM (1985) Urinary albumin excretion in renal transplant donors. Am J Surg 149:343–346
Cochrum KC, Hanes D, Potter D, Vincenti F, Amend W, Feduska N, Perkins H, Salvatierra O (1979) Donor-specific blood transfusions in HLA-D-disparate one-haplotype-related allografts. Transplant Proc 11:1903–1907
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41
Cohen B, Persijn G (1988) Annual report 1987. Eurotransplant Foundation
Conrad M, Wahrman J, Williams S, Jorkasky D (1987) Living-related donation: a sibling controlled study. Transplantat Proc 19:1492–1493
Donnelly PK, Clayton DG, Simpson AR (1989) Transplants from living donors in the United Kingdom and Ireland: a centre survey. Br Med J 298:490–493
Dubernard JM (1984) Les techniques de prélèvement rénal et les risques à court terme chez le donneur vivant. 16ème cours international de transplantation et d'immunologie clinique, 28–30 mai, 1984
Dunn JF, Richie RE, MacDonell RC, Nylander WA, Johnson HK, Sawyers JL (1986) Living related kidney donors. Ann Surg 203:637–643
Fassbinder W, Frei U, Schoeppe W, Dathe G, Jonas D, Knöner M, Weber W (1982) Ergebnisse der Transplantation von Nieren verwandter Lebendspender. Urologe (A) 21:290–295
Flechner SM, Kerman RH, Van Buren CT, Epps L, Kahan BD (1984) The use of cyclosporine in living-related renal transplantation. Transplantation 38:685–691
Hakim RM, Goldszer RC, Brenner BM (1984) Hypertension and proteinuria: Long-term sequela of uninephrectomy in humans. Kidney Int 25:930–936
Leary FJ, Deweerd JH (1973) Living donor nephrectomy. J Urol 109:947–948
Merrill JP, Murray JE, Harrison JH (1956) Successful homotransplantation of the human kidney between identical twins. J Amer Med Ass 160:277–282
Miller IJ, Suthanthiran M, Riggio RR, Williams JJ, Riehle RA, Vaughan ED, Stubenbord WT, Mouradian J, Cheigh JS, Stenzel KH (1985) Impact of renal donation. Am J Med 79:201–208
Opelz G (1988) Collaborative transplant study. Newsletter 3:1988
Pabst W, Reinheimer-Grünenberg C (1988) Ein viertel Jahrhundert Organtransplantation in Deutschland. Der Nierenpatient — Journal für das Nephrologische Team. 1:30–34
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, Pherson KM, Peto J, Smith PG (1977) Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35:1–39
Sachs L (1974) Angewandte Statistik, IV. Auflage. Springer, Berlin
Salvatierra O, Vincenti F, Amend W, Garovoy M, Iwaki Y, Terasaki P, Potter D, Duca R, Hopper S, Slemmer T, Feduska N (1983) Four-year experience with donor-specific blood transfusions. Transplant Proc 15:924–931
Sanfilippo F, Kolbeck PC, Vaughn WK, Bollinger RR (1985) Renal allograft cell infiltrates associated with irreversible rejection. Transplantation 40:679–685
Sanfilippo F, Vaughn WK (1987) Results in live-donor renal transplantation: the SEOPF multicenter study. Transplant Proc 19:1489–1491
Statistisches Landesamt Berlin (1987) Berliner Statistik; melderechtlich registrierte Einwohner in Berlin (West) 31. Dezember 1986. Ausgabe April 1987
Streem SB, Novick AC, Steinmuller DR, Graneto D (1989) Flank donor nephrectomy: efficacy in the donor and recipient. J Urol 141:1099–1101
Talseth T, Fauchald P, Skrede S, Djoseland O, Berg KL, Stenstrom J, Heilo A, Brodwall EK, Flatmark A (1986) Long-term blood pressure and renal function in kidney donors. Kidney Int 29:1072–1076
Torres VE, Offord KP, Anderson CF, Velosa JA, Frohnert PP, Donadio JV, Wilson DM (1987) Blood pressure determinants in living-related renal allograft donors and their recipients. Kidney Int 31:1383–1390
Uehling DT, Malek GH, Wear JB (1974) Complications of donor nephrectomy. J Urol 111:745–746
Vincenti F, Amend WJC, Kaysen G, Feduska N, Birnbaum J, Duca R, Salvatierra O (1983) Long-term renal function in kidney donors. Transplantation 36:626–629
Weiland D, Sutherland DER, Chavers B, Simmons RL, Ascher NL, Najarian JS (1984) Information on 628 living-related kidney donors at a single institution, with long-term follow-up in 472 cases. Transplant Proc 16:5–7
Zucchelli P, Cagnoli L, Casanova S, Donini U, Pasquali S (1983) Focal glomerulosclerosis in patients with unilateral nephrectomy. Kidney Int 24:649–655
Author information
Authors and Affiliations
Additional information
In Erinnerung an die erste Verwandtentransplantation in Deutschland widmen wir diese Arbeit Frau Rosa Siegmund und Herrn Professor Dr. Wilhelm Brosig.
Rights and permissions
About this article
Cite this article
Schwarz, A., Offermann, G. Vorteile und Risiken der Nierentransplantation von verwandten spendern. Klin Wochenschr 67, 929–935 (1989). https://doi.org/10.1007/BF01721418
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01721418