Vorteile und Risiken der Nierentransplantation von verwandten spendern

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Abstract
Living related kidney transplantation must offer the recipient distinct advantages over cadaveric grafting in order to justify the health risk undertaken by the donor. At Steglitz Medical Center in Berlin from 1970 to 1987 30 such transplantations were performed (5% of all kidney transplantations) where the donor was a relative of the recipient. In cases of haploidentity and positive mixed lymphocyte culture, the recipients were pretreated with donor-specific transfusions. The posttransplantation graft function rate was higher in the group where the donated kidney came from a relative than where it did not (after 2 years under cyclosporin: 92% vs 73%,P=0.04), and corticosteroid treatment could be terminated more frequently under cyclosporin (95% vs 51%,P=0.001). Transplantations from living related donors were performed more often in foreigners (43% vs 20%,P=0.01) and children (19% vs 4%,P=0.0001). Perioperative complications in the donor nephrectomy occurred in 63% of the cases, severe ones in 13% (bleeding, pneumonia, and late abscess). Late sequelae were not observed. The short waiting time, the high graft function rate, and the low steroid requirement justify kidney transplantation from living related donors providing strict indicational criteria are observed.