Organ transplantation in Bulgaria.
The transplantation program in Bulgaria started in 1968 with renal transplantations to a child and adult woman. In 1986 the first heart transplantation was performed. To date a total of 10 heart transplants have been performed, including one combined heart/lung. A liver transplantation program was launched in 2005 with a total number of 16 transplantations-7 from living donors and 9 from deceased donors. The highest transplantation activity is registered in the field of renal transplantation. During the period 1980-2006, 462 Bulgarian recipients of kidney were transplanted in Bulgaria. The ratio between transplantations from deceased and living related donors is approximately 1:0.9. Annual transplantation activity varies among the years from 1 to 12 renal transplantations p.m.p./per year. The 1- (80.7% vs. 63.1%), 5- (57.86% vs. 39.0%) and 10-year (42.65% vs. 23.62%) graft survival rates are higher for recipients of living donor kidneys compared to those of deceased donor. In 1983 a National kidney waiting list was established. Currently the number of the registered patients eligible for renal transplantation is 885. The proportion of sensitized patients in the waiting list is 20.45% and 4.34% of them are hyperimmunized. Recently HLAMatchmaker program has been implemented not only for sensitized patients but also for those with rare alleles and haplotypes. Post-transplant immunological monitoring showed a strong association between alloantibody presence and delayed graft function (Chi-square=10.73, P<0.001), acute rejection (Chi-square=14.504, P<0.001), chronic rejection (Chi-square=12.84, P<0.001) and graft loss (Chi-square=20.283, P<0.001). Based on the experience in our transplant center a strategy for improvement of long-term renal graft survival was developed and implemented.
Naumova
Elissaveta
E
Central Laboratory of Clinical Immunology, University Hospital Alexandrovska, 1 Georgy Sofiisky Street, Sofia, 1431, Bulgaria. immun@alexandrovska-hospital.bg
Panchev
Petar
P
Simeonov
Pencho J
PJ
Mihaylova
Anastassia
A
Penkova
Kalina
K
Boneva
Petia
P
Marinova
Daniela
D
Paskalev
Emil
E
Simeonov
Petar L
PL
Zlatev
Assen
A
D002031:Bulgaria; D002648:Child; D003602:Cytotoxicity, Immunologic; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D014180:Transplantation / Q000706:statistics & numerical data*; D014850:Waiting Lists