| Organ transplantation is one of the greatest progresses in medical development in the twenty century. Among the several transplant organs, kidney was the organ which developed the earliest and the most successfully. Owing to the mature of vascular anastomosis technique, the successful short-term hypothermic preservation of donor organ and successfully application of immunosuppressive agents, clinical renal transplantation has become to be a most effective and the most standard treatment of end stage of renal disease in the world. With the invention of Cyclosporine A (CsA), CsA have been widely successful using in the field of kidney transplantation and the kidney graft survival rate have been dramatically improved. The one year graft survive rate increased from 50% to 85%. Hundreds of thousands of uremia patients get a second new life. They have a normal quality life after renal transplantation. Many of them get marry and have their own descendants with a psychological fitness and healthy body. Now, there are many new potent immunosuppressive agents such as Tacrolimus (TAC), mycophenolate mofetil (MMF) and Zenapax appear. These drugs are commercially available right now. A lot of studies demonstrated that these drags composed regimen significantly improve the short-term outcome of kidney transplantation compared with traditional protocol. However, the long-term graft survival rate after one year or above remains unsatisfactory.Two thousand sixteen patients received kidney transplant in our center from Jun 1978 to Dec. 2000. This hospital transplant number is on the top of the whole country in the year of 2001. One year kidney graft survival or patient survival has steadily increased and now is always above ninety percent. The longest kidney allograft recipient has been surviving more than twenty years. In order to determine the factors which influence a graft survival and improve short-term and long-term graft survival furthermore, it is necessary to review and retrospective analysis on our large numberof renal transplantation. By this study, we wish we can make a feasible strategy to reduce the possibility of graft losses and improve the long term graft survival.PART One: A clinical review on 2016 cases of cadaveric renal transplantationand multivariate analysis for long-term grafts survivalObjective: The study was undertaken to analyze the risk factors affecting long-term allograft survival following the kidney transplants performed between 1978 and 2000 in our center. Methods: Thirty-two relative variables were analyzed by SAS statistical software. Using the Log-Rank method, we analyzed influence of these variables on short and long-term grafts survival. A Kaplan-Meier analysis was used to estimate the 1, 3, 5 and 10-year graft survival rates and half-life graft survival. Proportional hazards regression analysis (COX model) was used to assess and rank the relative risk of potential variables. Results: The one-year, three-year, five-year and ten-year grafts survival rate were 83%, 75%, 66% and 48%, respectively. After excluding the patients who died with functioning grafts, the one-year, three-year, five-year, ten-year grafts survival rate increased to 89%, 82%, 75%, and 69%, respectively. The mean half-life graft survival was 8.78 + 0.14 before the exclusion of death with functioning grafts and 14.09 + 0.20 years after the exclusion, respectively. By Log-Rank analysis, factors affecting short- and long-term grafts survival were identified as: duration of the kidney function recovery, cold-ischemia time, times of transplants, presence of acute rejection, serum creatinine levels at one month post transplant, immunosuppressive regimen, complications including infection. A COX model multivariate analysis showed that there were eighteen factors significantly affecting graft survival. Conclusion: Improvement of immunosuppression not only has significantly increased short-term graft survival, but also has resulted in better long-term outcome. Our data indicates that high quality donor organs and minimizing th...
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