Renal transplantation at Oregon Health and Science University: recent results and protocols.

Renal transplants have been performed at the University Hospital, Portland, OR since 1959. In the 5-year period between January 1997 and December 2001, 736 kidney-only transplants were performed at our institution. Living donor transplants comprise an increasing proportion of the transplants performed. Our patient and graft survival rates, both short- and long-term reflect the close collaboration between the transplantation medicine and transplantation surgery faculties, and the excellent support from nurse-coordinators, histocompatibility laboratory specialists and the organ procurement organization. Since September 2001, we have used a risk-based immunosuppression algorithm. The incidence of acute rejection within the first 3 months following transplantation ranged from 7-18% in the different risk groups. We have incorporated surveillance renal allograft biopsies into our standard of care and biopsies are performed at 3 months and one year after transplantation. The incidence of subclinical rejection was 15% on the 3-month surveillance biopsies and 4% on the one-year biopsies. The majority of these rejection episodes were CCTT type I acute rejection, which responded to treatment with pulse steroids. Since 1991, we have been transplanting kidneys from blood group A2 donors into blood group B or O recipients. Graft survival is similar to that in patients receiving an ABO compatible transplant. We have recently adopted the use of intravenous immune globulin to abrogate a positive crossmatch and allow transplantation of a kidney from a living donor. Six patients have been successfully transplanted using this protocol. In an effort to speed up the work-up of recipients waiting for a deceased donor kidney transplant, we have implemented a computer-driven algorithm. By generating a list of patients who should be crossmatched, and by automating generation of work sheets and reports, this computer-driven program has expedited deceased donor workups.