Objectives: To discuss the organizational and surgical aspects, results, remarkable events and some ethical considerations of the renal transplantation program with grafts from living donors at our institution over a 25-year period.
Methods: The renal transplant program of the Jiménez Diaz Foundation began in 1964 and the first kidney graft from a living donor was transplanted in 1968. Since then and until December 1993, 157 renal grafts from living donors have been transplanted. The donors were parents in 94, siblings in 55 and the spouse in 4 occasions. Moreover, two free kidneys and two grafts from nonrelated donors were transplanted. The surgical procedure was also similar; i.e., right nephrectomy through a supracostal lumbotomy to remove the kidney and transplantation in the right iliac fosa with anatomosis to cava and common iliac or hypogastric artery. Changes in the surgical technique warranted by the intraoperative findings were infrequent. The ureter was anastomosed to the bladder using an extra- or transvesical technique depending on the surgeon's experience. Harvesting and transplantation of the kidney graft were performed simultaneously by two surgical teams.
Results: There were no major complications in the donors or technical difficulties or errors during harvesting that might have compromised graft viability, although complications such as hemorrhage, urinary fistula, thrombosis and prolonged anuria were observed early postoperatively. The incidence of grafts lost specifically related with the technique was less than 3%. Nineteen recipients had died early postoperatively from acute rejection and sepsis. Recipient and graft survival were basically related with the degree of histocompatibility and the changing therapeutic strategy over the 25-year period. The best results were found in 33 transplants involving HLA identical siblings, with a five-year actuarial survival rate of 89%, a 10- and 15-year survival of 70% and a 22-year survival of 22%, followed by those who were haploidentical who had donor-specific transfusions and the haploidentical cases treated with cyclosporine. The poorest results were seen in the historical group of 52 transplant procedures performed between 1968 and 1981 who were treated with the classical medication.
Conclusions: The good results achieved and the minimal risk to donors demonstrated by our experience over a period of 25 years support continuation of the renal transplantation program with grafts from living donors, as well as our approach of having two surgical teams working simultaneously.