| Theme |
Renal Transplantation under New Organ Sharing System in Japan |
| Title |
Clinical evaluation of cadaveric renal transplants in Japan |
| Author |
Kunio Morozumi |
Department of Internal Medicin III, Division of Nephrology, Nagoya City University, Medical School |
| Author |
Kazuharu Uchida |
Department of Transplant Surgery, Nagoya Second Red Cross Hospital |
| Author |
Chikao Yamazaki |
Masuko Institute for Medical Research |
| [ Summary ] |
We considered important risk factors for the outcome of cadaveric renal transplants in a new Japanese network system for organ sharing. It was essential for the safe transplantation to develop systems of rapid diagnosis for serious transmitted infections in cadaveric donors in Japan. Rapid pathologic diagnosis before the transplant operation was also important for avoiding the risk of primary no function in donors suffering severe hypotension and/or mild disseminated in travascular coagulation before harvest. Graft biopsy performed one-hour after reperfusion of blood into the graft was useful for estimating both immediate and late outcome of the grafts especially with older donors. The new topic of nephron dosing mismatch between donor and recipient will soon be an important problem in Japan as well as the United States and European countries. The international classification of kidney transplant pathology (Banff classification) was widely accepted and several validation studies confirmed the significant clinicopathologic usefulness. An attempt to revise the Banff scheme will be continued to complete the details of classification, especially in chronic rejection. The most important risk factor for chronic graft loss seemed to be chronic rejection. The pathogenesis of chronic rejection, however, is still unclear, and pathologic characteristics of chronic rejection have been less specific in the cyclosporin eracompared with conventional immunosuppression. New and reliable diagnostic indices for chronic rejection are necessary to improve the long term outcome of the graft.Electron microscopic findings of the peritubularcapillary basement membrane were useful for making a diagnos is even in interstitial type chronic rejection. It is very important to keep in mind that the key to success in careful evaluation through out the course of renal transplantation. |