Renal transplantation in Macedonia

During the last 10 years we performed 92 renal transplantations in our Skop je hospital (Macedonia), using 22 cadaver donors and 70 living donors. We a lso performed 15 explantations from cadavers and seven kidneys were allocat ed to former Yugoslavia. Standard surgical procedures were used for both li ving and cadaver donor explantations and transplantations. For living expla ntations, donors were matching in 66 cases (94.28%) and in four cases (5.7% ) non-matching donors who however were relatives of the patient Explantatio ns and transplantations took place only after all ethical and legal-related problems had been solved. The minimum acceptable HLA mismatch was 50% with negative present or historical cross-match. A quadruple sequential immunos uppressive treatment was used, including either poly- or monoclonal globuli ns (thymoglobulin [ATG], lymphoglobulin [ALG], daclizumab, OKT-3) as an ind uction therapy and prednisolone, azathriopin and cyclosporin A as maintenan ce therapy. Rejection episodes were treated by pulse MP therapy or OKT-3 an d increased doses of MMF if the patients were steroid-resistant. Kaplan-Mei er survival curves showed that survival at 12, 36 and 60 month reached 90%, 75% and 60%, respectively. Survival was better after transplantation using a graft from a living donor than after transplantation using a graft from a cadaver donor (survival rates: 92%, 82% and 68% at 12, 36 and 60 months a fter surgery). Delayed graft functioning (DGF) was observed in 16 patients (17.3%), reaching 46.6% after transplantation of a graft from a cadaver don or and 10% after transplantation of a graft from a living donor. The relati vely high percentage of DGF in the living donor program was due to the use of grafts from elderly donors (over 65 years of age). We registered 26 (29% ) episodes of acute rejection that were predominantly histologically confir med and further classified according to the BANFF criteria. Treatment of fi ve steroid-resistant rejections proved to be successful. Neither early nor late surgical and medical complications were different from those reported in the literature. Despite the modest number of kidney transplantations, ch ronic renal failure has decreased in our region. The authors expect further improvement in this powerful therapeutic procedure thanks to links with re gional and European transplant centers allowing better cooperation and orga n sharing. (C) 2000 Editions scientifiques et medicales Elsevier SAS.