25 Years of Kidney Transplantation - A Period of Change.
Dirk L. Stippel, Tülay Cingöz, Roger Wahba, Roman-Ulrich
Müller, Ursula Bauerfeind, and Georg Dieplinger
Clinical Transplants 2014, Chapter 8
Abstract
At the University of Cologne Hospital, 1062 kidney
transplants in adults and 136 pediatric transplants were performed between 1990
and 2014. Immunosuppressive therapy was changed during this time period from a
therapy with anti-lymphocyte globulin induction followed by a triple therapy to
a period using induction (IL2 receptor antagonists) followed by low dose
tacrolimus, mycophenolate mofetil and steroids. Antiviral therapy has been
constant during the 25 years, consisting of ganciclovir or valganciclovir.
Major change occurred in the age of donors and recipients, with more than a
third of both now being older than 65 years. Living donation has increased in
number and proportion, at the same time the number of deceased donors rapidly
declined. Longer time periods on dialysis resulted not only in an increased
risk profile of the recipients, but were also accompanied by a significantly
higher number of mismatches for the allocated kidney, since the relative
importance of waiting time in the allocation process increased. Multivariate
analysis showed that immunological factors such as HLA-match and panel reactive
antibody are relevant factors, even in a single center analysis.
25 Years of Kidney Transplantation - A Period of Change
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