The treatment of end-stage renal disease at the Johannesburg Hospital: a 17-year experience. Part II. the role of transplantation
Myburgh, J.A.; Botha, J.R.; Meyers, A.M.; Smit, J.A.; Milne, F.J.; Thomson, P.D.; Beale, P.; Seggie, J.
South African Medical Journal 64(14): 522-527
1983
ISSN/ISBN: 0256-9574 PMID: 6353617 Document Number: 216497
Experience with 525 kidney transplants performed at the Johannesburg Hospital from 1966 to 1982 is reviewed. The 1-year graft survival rates for HLA-identical related living donor (RLD) transplants, haplo-identical RLD transplants, and first and subsequent transplants from cadaver donors (CDs) are 95%, 72%, 59% and 52% respectively. One-year patient survival figures for all RLD and all CD transplants are 93% and 78% respectively. There is a slower but steady attrition in both graft and patient survival over the next 10-15 years which is the same for all patients irrespective of donor source. Infection and myocardial infarction remain the major causes of mortality and morbidity. Mortality in the 1st year after transplantation has been reduced dramatically in the last 5 years of the programme. This has coincided with the introduction of a policy of routine pretransplant blood transfusion and a less aggressive approach to the treatment of severe and recurrent rejection episodes. However, the incidence of irreversible graft rejection in the 1st year has remained the same. These results, although gratifying in a broad context, leave no room for complacency. The induction of a state of specific tolerance towards the grafted organ remains the ultimate goal in clinical transplantation.