Preemptive Cadaveric Renal Transplantation-Clinical Study

Dialysis(hemodialysis and peritoneal dialysis) and renal transplantation are the effective therapy for end stage renal disease(ESRD).However,chronic dialysis causes many kinds of complications and it's cost is very expensive.Meanwhile,patients mortality is very high and quality of life is worse.Renal transplantation has been accepted widespreadly and become decisive therapy because it makes the uremic patients get rid of the pain of frequent dialysis and makes patients quality of life return to well-being state.Preemptive renal transplantation is defined that patiens with ESRD receive transplantation before the need of dialysis. Some organ transplantation centers clinic studies have demonstrated that preemptive living renal transplantation recipients maintain better health status,less severe anemia and high serum albumin level,besides excluding the dialysis complications and hepatitis infection,which makes the transplantation results very good.Through the retrospective analysis for the ChangZheng Hospital Organ Transplantation Center cases to assess whether the preemptive cadaveric renal transplantation(PCRT) has feasibility for the clinic.Materials and methods: In 2001,there were 32 preemptive renal transplantation recipients(14.95%),correspondently, control group consists of 156 recipients postdialysis in ChangZheng Hospital Organ Transplantation Center.There were PRA negative cases in both groups.The PCRT and control groups had no diferrence with primary disease,gender,age,blood group and so on.Donors of both groups were cadaver and grafts function was normal.Donors hepatitis immunologic test was negative.Donors and recipients were well matched with ABO blood group.The immunosuppressive protocol were identical,so were the antirejection drugs.Statistic and analyse the blood pressure,ferrohemoglobin and serum albumin levels,grafts function,liver function,leucocyte counting 1 year after renal transplantation including acute rejection and infection incidence within 3 months postoperation.Results:There was no patient who received pretransplant blood transfusion in PCRT group,one patient was infected by hepatitis B in this group.There were 53patients(33.97%) who received pretransplant blood transfusion in control group.11 patients were infected by hepatitis B ,12 patients were infected by hepatitis C ,1 patient was infected by both hepatitis B and hepatitis C respectively among 23 patients who had hepatitis.Hepatitis incidence did not appear significant diferrence between the PCRT and control groups,liver function had not diferrence correspondly.The blood pressure,nutritional status(ferrohemoglobin and serum albumin level) and renal function(plasma creatinine level) were same in PCRT group compared with control group pretransplantation.Both groups blood pressure surpassed normal level 1 week posttransplantation,not only there were 17(53.13%) and 95(60.90%) patients who had hypertention in each group but also the diferrence was very significant(P=0.000) and average blood pressure each time 1 year without diferrence.The ferrohemoglobin and serum albumin levels had no significant difference at each time posttransplantation and both groups nutritional status improved gradually.Posttransplant erythrocytosis was noted only in the control group.In terms of grafts function,the plasma creatinine levels and urine volumes each period had no significant differences in PCRT group compared with control group.Every group recovery of graft function coincided posttransplantation.Both groups had no differences each period in terms of livers function(total bilirubin and ALT levels),but ALT levels in control group fluctuated significantly.The incidence of rejection episodes in PCRT and control groups was highest within 1 week and was no comparable within 3 months posttransplantation.PCRT group had no infective cases within 1 week posttransplantation,control group existed urological system infection mainly.The incidence of infection episodes in both groups increased significantly 1 week later.Most of the infections in renal...