Kidney transplantation at the University of Illinois at Chicago from 1988-2004

Abstract

The Division of Transplantation at the University of Illinois at Chicago (UIC) was established in 1968 by Dr. Olga M. Jonasson, who performed the first living related kidney transplant in Illinois. The UIC Hospital is a typical inner city hospital serving primarily minorities and under-privileged populations with significant challenge for issues such as compliance, insurance coverage, low income, and degree of education. We analyzed the outcomes of 67 pediatric and 801 adult consecutive renal allotransplantations performed at the University of Illinois at Chicago (UIC) from January 1988-December 2002 and more recent information in relation to newly developed programs (robotic living donation, transplantation in sensitized patients, early steroid discontinuation, ethnicity tailored immunosuppression) until November 2004 (21 pediatric and 172 adults). The one-year graft survival has improved comparing the cases performed between 1988-1998 versus cases after 1998 from 82-88%, with similar patient survival. However, the overall 5-year patient and graft survival has not changed significantly in the 2 different eras and is currently 85% and 65%, respectively. With the use of minimally invasive, robotic-assisted living donor nephrectomy, the use of living donors has increased and these now represent 75% of the kidney donors at UIC. Transplantation in highly sensitized recipients has become more successful with the use of plasmapheresis resulting in 100% patient and graft survival and a 10% acute rejection rate in the first series of 20 patients. Early steroid discontinuation (steroid discontinued at day 6 after transplantation) has allowed for significant improvement of results in pediatric recipients. We have 100% one-year patient and graft survival and no acute rejections in a series of 13 children, compared with a 25% rejection rate in 13 children with steroid-containing immunosuppession. Tailored immunosuppression with early steroid discontinuation now achieves equal early results in African American as in any other ethnic group with 98-99% patient and graft survival and acute rejection rates below 10%. Of interest will be the future evolution of long-term patient and graft survival under the new immunosuppressive protocols with early steroid discontinuation achieving very low acute rejection rates and impressive one-year survival rates. There is reason for optimism that the improved early results will translate into better long-term outcomes.