Posted by John One other thing that you might factor in is the fact that often a lower HLA antigen match might be given much higher doses of immunosuppressant drugs at the start (and for the first few months), and higher doses can equal lower function. So if he is on big doses of drugs, the dose will almost surely come down eventually. I still personally would prefer a higher HLA match over a lower one, but my donor as cadaveric not live; still, while a live donor theoretically has a lower cold ischemic time, the two mechanisms of graft damage (HLA mismatch and ischemic time) really have nothing to do with one another so expecting one to offset the other is really not realistic. Statistics do not do much good if you are the one who is off the center line, but statistically the difference between living donor kidney graft survival for 0 HLA match versus 6 HLA match is less than 2.6% difference. At five years this grows a bit to 18.3%. Of course that it just the average for 1000+ patients. (http://www.ustransplant.org/annual_reports/ar02/refTables500/ar02_table_508b_mismatch_ki.htm) . I cannot comment on the infection, but unless the infection is so faint that it cannot be detected at the time surgery, then infection is usually an absolute contraindication to go ahead (especially confusing to me when the donor was living and could be rescheduled.) Hang on: all the big drug doses (immunosuppressants, antibiotics for infection, thymoglobulin, etc) all affect kidney function and until they clear the system and the kidney gets a bit of adjustment time in the new environment, this may not run perfectly. I have known pole with delayed graft function who took a three months get going fully. Keep us posted.
on 4/30/2003, 10:31 pm, in reply to "Transplant Problems"
Acute tubular necrosis is fairly common, although usually less so in live donors because of shorter cold storage times. But the renal tubular cells naturally have a very high rate of cell turnover, and they will, given time, replace themselves if blood supply is good, and there is not significant rejection.
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