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Kidney Transplantation, the Halifax Experience
Clinical Transplants (1996)
  • P. Belitsky
  • A. S. MacDonald
  • J. Lawen
  • Vivian McAlister
  • H. Bitter-Suermann
  • B. Kiberd
  • K. West
  • I. Sketris

In the absence of a national kidney sharing system in Canada, virtually all the cadaver kidneys we transplant come from donors within the 4 provinces we serve. Currently the only criteria we use for recipient selection of cadaver kidneys, apart from ABO blood group matching and a negative anti-T-cell crossmatch, are good HLA match and transplant wait-list seniority. All transplant recipients receive CsA-based immunosuppression. Antibody induction is used only for repeat transplants and pediatric transplants. Recipients of first cadaver kidney transplants with zero HLA-DR mismatches have significantly better graft survival than those with mismatches. Graft and patient survival rates for first cadaver transplants continue to improve within the CsA era, and are comparable to those seen in centers routinely using antibody induction and routine sequential quadruple immunosuppression. Chronic graft nephropathy continues to be the most important cause of graft loss after the first year, unchanged over the past 2 decades, followed closely by death with a functioning kidney. The latter is a more important cause of loss in recipients older than age 60, and in recipients of HLA-identical live donor transplants. Repeat cadaver transplant recipients have a 5-year graft survival rate today equivalent to that seen with first cadaver transplants. Graft loss from acute rejection is modest, but kidneys requiring rescue therapy for steroid-resistant rejection have significantly poorer one- and 5-year graft survival and ultimately are lost from rejection. Patients with HLA-identical live-related donor transplants have better long-term survival with CsA than with azathioprine due to a decrease in graft loss from chronic rejection. Pre-transplant sensitization has an adverse effect on graft survival for haploidentical but not HLA identical live-related transplants. Patients over age 60 have equivalent graft survival to younger recipients for at least 7 years, and should not be precluded from receiving transplants by age alone. Prolonged CIT > 24 hours is associated with a significantly increased incidence and duration of ATN and need for dialysis, significantly increased early and late graft loss from acute and chronic rejection respectively, significantly reduced QALY's, and significantly higher early and late costs of transplantation.

  • Cadaver,
  • Graft Survival,
  • Histocompatibility Testing,
  • Immunosuppression,
  • Kidney Transplantation,
  • Living Donors,
  • Multivariate Analysis,
  • Postoperative Complications,
  • Reoperation,
  • Risk Factors,
  • Survival Rate,
  • Tissue Donors,
  • Tissue and Organ Procurement
Publication Date
Publisher Statement
This article is not available online here. If you are affiliated with The University of Western Ontario, please use the Shared Library Catalogue's Classic Search to check whether the journal in which this article was published is available in Western Libraries.
If you are not affiliated with The University of Western Ontario, search WorldCat to find out where you can get access to the journal.
Dr. Vivian McAlister is currently a faculty member at The University of Western Ontario.
Citation Information
P. Belitsky, A. S. MacDonald, J. Lawen, Vivian McAlister, et al.. "Kidney Transplantation, the Halifax Experience" Clinical Transplants (1996)
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