Kidney transplantation success rate

Opelz, G. HLA matching should be utilized for improving kidney transplant success rates. Transplant. Proc. 23, 46-50 (1991). 

Perhaps the main reason for the tacit acceptance of the hemodialyzer stems from the fact that the human body contains two kidneys and can, usually, function satisfactorily with only one. This makes kidney donation and transplantation a more realistic operation than heart and other transplantations thus, kidney transplantations have been performed on a fairly common basis since the initial transplant in 1954. With the aid of careful tissue matching, preferably with a relative, and some immunosuppressant drugs, this transplantation operation has a high (85+%) success rate. In practice, however, the donor organs are not nearly as available as the demand, and 100,000+ people use the hemodialyzer routinely until a transplant becomes possible. In many cases, the hemodialyzer is used for decades, and secondary disorders, such as anemia, hemolysis, hypertension, and psychiatric problems, sometimes develop. 

The first successful kidney transplant was performed in 1954 between monozygotic twins, followed by the first attempted liver transplant in 1963 (Starzl et al. 1963). However, significant intraoperative and early postoperative mortality, combined with ineffective and often toxic immunosuppressive regimes, resulted in 1-year survival rates in the 1970s of only 30%. The introduction of effective immunosuppression with cyclosporin in 1981 and subsequently tacrolimus in 1989, led to significant improvement in survival following liver transplantation, and a dramatic increase in the number of transplants being performed. 

The glomerular filtration rate (GFR) of a successfully transplanted kidney may be near normal almost immediately after transplantation. In some patients, however, the concentration of standard biochemical indicators of renal function, such as serum creatinine and blood nrea nitrogen (BUN), may remain elevated for several days. Standard formulas used to predict drug dosing rely on a stable semm creatinine and may be inaccurate immediately following transplantation (see Chap. 41). 

Technical success of embolization for intrarenal vascular injury is quite high, around 95-100% [42-44]. Typically the recurrence rate is nearly 0% however, in one series a second embolization session was needed in 2 (15%) of 13 patients to fully occlude arteriovenous fistulas and achieve true technical success [44]. An analysis of the effect on renal function of selective embolization for traumatic renal lesions revealed that the mean volume of infarcted kidney was only 6% (range 0-15%) and 1 week postembolization the serum creatinine was normal in all their patients [42]. A series of renal transplants estimated that the maximal volume of infarcted kidney after embolization for biopsy-related injuries was always less than 30% [44]. Also, while renal function dete-... 

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