[Evaluation of factors affecting early and late outcome of 225 kidney transplantations].
The aim of this study was to evaluate some chosen factors affecting early and late outcome of 225 renal transplantations performed in the Department of General and Transplantation Surgery of the Pomeranian Medical Academy in Szczecin from 1985 to 1995. Analysed groups were elected from this number in a way as to be comparable and their demographic data were discussed. Factors taken into consideration were: the impact of transplantation team experience, operator, graft perfusion method, preservation solution, multiple renal arteries, uretheral stent, multiorgan harvesting and donor sex. The early outcome was estimated as: immediate function, delayed function and nonfunction. The late outcome was: 3 months, 1 year and 3 years graft and patient survival. Analysed groups were compared as far as an incidence of following surgical postoperative complications: urological, vascular, septic, graft rupture, bleeding, fluid collections and other surgical complications, is concerned. The data base was statistically elaborated using t-Student and Chi 2 test taking as statistically significant p less than 0.05. Results show that the impact of transplantation team experience was an important factor (Tab. 1, 2, 3). The comparison of three following groups of transplantations (75 cases each) elucidates that after learning period came a stabilisation period, in which the outcome is close to that achieved in other Polish transplantation centers. While investigating the factor of operator two groups of transplantations performed by seniors and one "learning group" were compared and no statistically significant difference was found. This is probably because each transplantation done by learning surgeon was assisted by one of above seniors. The perfusion method impact was investigated comparing two small groups (in situ and ex situ perfusion) and no benefit of any was proved. The difference between outcomes of groups in which UW or Eurocollins was used, was statistically significant as far as three years graft survival is concerned. In UW group it was 55.9%, whereas in Eurocollins group it was 29.4%. The probable explanation is that the possibility of longer cold ischemia time, given by UW solution, implicates more time to find better suited recipient for particular graft. The impact of multiple renal arteries on the outcome of transplantation was analysed by comparing group of 105 grafts with one artery and 25 multiple arterias grafts. The immediate function occurred in 92% of group with multiple and 62.9% of group with one artery. The difference was statistically significant. The factor of indwelling uretheral stent was investigated comparing the group of 94 transplantations where it was used and the group of 35 transplantations without it. There was no difference as far as urological complications are concerned. Multiorgan harvesting plays a very important role facing serious organ shortage in all developed countries. The comparison of 37 multiorgan and 95 kidney harvestings showed no negative implications of the first one for the outcome of renal transplantations. Evaluation of donor sex factor did not show any essential differences while comparing group of 162 grafts taken from male and the group of 63 grafts taken from female donors. Following conclusions were established after discussion of above results: the most important factor was the impact of transplantation team experience; preservation by UW solution caused better late outcome of treatment; there was no negative influence of transplanting grafts with multiple arteries; the impact of operator, donor sex, perfusion method, multiorgan donation and use of uretheral stent was not proved.
Długosz
R
R
Kliniki Chirurgii Ogólnej i Transplantacyjnej, Pomorskiej Akademii Medycznej w Szczecinie.
D005069:Evaluation Studies as Topic; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D010348:Patient Care Team / Q000592:standards; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods; D016896:Treatment Outcome