Kidney transplantation at the Charité: long tradition, elderly patients and the duration of hospitalization.
Since the sixties kidneys have been transplanted successfully at the 2 predecessors of today's transplant center at the Charité. So far, 1,290 kidneys were transplanted resulting in 89.8% overall graft survival at one year and 78.6% at 5 years. Several factors were associated with these results. Ischemia times were very short (11.9 +/- 7.3 hours). Patients with diabetic nephropathy were rarely transplanted without combined pancreas transplantation. Combined with a pancreas transplantation, kidney grafts fared even better than those of non-diabetic patients. The share of living donation is still rising and is associated with a better outcome than cadaveric grafts. In contrast, the effect of HLA mismatches was not very pronounced. Zero- and one-mismatch transplantations had a clear benefit over those with 2-3 mismatches, but higher numbers of mismatches did not lead to worse results. To expand the donor pool with kidneys from old donors (> 64 years) we participate in the Eurotransplant Senior Program (ESP) where these kidneys are allocated locally to recipients aged 65 years and older without HLA matching. The ischemia times for ESP kidneys were shorter (7.3 +/- 3.0 hours) but transplants were less well matched (4.2 +/- 2.1 mismatches). Graft survival was not different from controls aged 60 years and older who received a kidney from a donor under age 65. The ESP patients do not require prolonged hospitalization for transplantation (30.6 +/- 14.6 days versus 35.3 +/- 26.0 days in patients below 60 years). With the introduction of the ESP the number of transplantations in recipients aged 60 years and above have risen considerably.
Fritsche
Lutz
L
Charité Hospital, Humbolt University, Berlin, Germany.
Hoerstrup
Jan
J
Budde
Klemens
K
Frei
Ulrich
U
Kahl
Andreas
A
Loening
Stefan
S
May
Gottfried
G
Neuhaus
Peter
P
Neumayer
Hans-Hellmut
HH
Reinke
Petra
P
Schoenberger
Bernd
B
Schoenemann
Constanze
C
D000328:Adult; D000368:Aged; D003928:Diabetic Nephropathies / Q000401:mortality / Q000601:surgery; D005060:Europe; D005260:Female; D005858:Germany; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000401:mortality; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology* / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome