Læknablaðið - 15.09.2000, Blaðsíða 31

FRÆÐIGREINAR /LIFFÆRAFLUTNINGAR
meðferð við lokastigsnýrnabilun hér á landi og af
þeim fengu 96 (46%) ígrætt nýra (9). Fjöldi
nýraígræðslna fór vaxandi með hverjum áratugi, úr
13 á þeim fyrsta í 50 á síðasta áratugi. Jafnframt
fjölgaði ígræðslum nýrna úr lifandi gjöfum og voru
þeir um 65% græðlinga á síðasta áratugi. I lok 1997
voru starfandi nýragræðlingar 59 og af þeim voru 45
úr lifandi gjöfum. Sjúklingar með ígrædd nýru voru
þá 70% allra í meðferð vegna lokastigsnýrnabilunar.
Meðalaldur sjúklinga við ígræðslu var 36 ár en aðeins
þrír voru yfir 60 ára aldri og var sá elsti 61 árs.
Eins og sést á mynd 1 eru gauklabólga og langvinn
millivefsnýrabólga algengustu orsakir
lokastigsnýrnabilunar hérlendis, en vakið hefur
athygli að hér á landi er sykursýkinýrnamein
tiltölulega sjaldgæf orsök nýrnabilunar á lokastigi.
Á áðurnefndu tímabili hefur eins árs lifun
græðlinga úr lifandi gjöfum verið 96% og fimm ára
lifun 89% sem telst góður árangur. Lifun græðlinga
úr látnum gjöfum reyndist fremur slök en eins árs
lifun var aðeins 61% og fimm ára lifun 48%. Engin
skýring liggur fyrir á þessari slöku lifun græðlinga frá
látnum gjöfum en rannsóknir standa nú yfir sem
beinast að því að finna orsök þess.
Niðurlag
Miklar framfarir hafa átt sér stað síðan fyrsta
nýraígræðslan var gerð fyrir rúmum 40 árum. í dag er
nýraígræðsla kjörmeðferð sjúklinga með nýrnabilun
á lokastigi. Skortur á nýrum til ígræðslu og tap
græðlinga vegna langvinnrar höfnunar eru þó enn
veruleg vandamál sem hafa leitt til myndunar langra
biðlista eftir nýrum til ígræðslu. Rannsóknir miða nú
að því að bæta langtímaárangur nýraígræðslu meðal
annars með þróun sértækari ónæmisbælandi lyfja.
Heimildir
1 Merrill JP, Harrison JH, Murray JE, Guild WR. Successful
homotransplantation of the kidney in an identical twin. Trans
Am Clin Climatol Assoc 1955; 67:167.
2. Murray JE, Merrill JP, Harrison JH. Prolonged survival of
human-kidney homografts by immunosuppressive drug
therapy. N Engl J Med 1963; 268:1315-23.
3. Beveridge T, Calne RY. Cyclosporine (Sandimmun) in
cadaveric renal transplantation. Ten-year follow-up of a
multicenter trial. European Multicentre Trial Group.
Transplantation 1995; 59:1568-70.
4. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE,
Agodoa LYC. Comparison of mortality in all patients on
dialysis, patients on dialysis awaiting transplantation, and
recipients of a first cadaveric transplant. N Engl J Med 1999;
341:1725-30.
5. Evans R, Mannien D, Garrison L, Hart L, Blagg C. The quality
of life of patients with end-stage renal failure. N Engl J Med
1985; 312: 553-9.
6. Eggers P. Comparison of treatment costs between dialysis and
transplantation. Semin Nephrol 1992; 12: 284-9.
7. Renal Data System. USRDS 1999 annual data report. Am J
Kidney Dis 1999; 34: Sl-176.
8. Organ donation, allocation and transplantation in the Nordic
countries: Scandiatransplant [Annual report] 1998. Scandia-
transplant; 1999.
9. Ásmundsson P, Pálsson R. Meöferð við lokastigsnýrnun-
bilunar á íslandi 1968-1997. Læknablaðið 1999; 85: 9-24.
10. Roodnat JI, Zietse R, Mulder PG, Rischen-Vos J, van Gelder
T, Ijzermans JN, et al. The vanishing importance of age in renal
transplantation. Transplantation 1999; 67: 576-80.
11. Kotanko P, Pusey C, Levy J. Recurrent glomerulonephritis fol-
lowing renal transplantation. Transplantation 1997; 63:1045-52.
12. Nelson HA, Gilfeather M, Holman JM, Nelson EW, Yoon HC.
Gadolinium-enhanced breathhold three-dimensional time-of-
flight renal MR angiography in the evaluation of potential
renal donors. J Vasc Intervent Radiol 1999; 10:175-81.
13. Flowers JF Jacobs S, Cho E. Comparison of open and laparo-
scopic live donor nephrectomy. Ann Surg 1997; 226:438.
14. Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or
more of follow-up of living kidney donors. Lancet 1992; 340:
807-10.
15. Melchor JL, Gracida C, Lopez A. Living donors in kidney
transplantation: five-year follow-up. Transplant Proc 1998; 30:
2869-70.
16. Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth
CG. Kidney donors live longer. Transplantation 1997; 64:976-8.
17. Saran R, Marshall SM, Madsen R, Keavey P, Tapson JS. Long-
term follow-up of kidney donors: a longitudinal study. Nephrol
Dial Transplant 1997; 12:1615-21.
18. Johnson E, Anderson J, Jacobs C, Suh G, Humar A. Long-term
follow-up of living kidney donors; quality of life after
donation. Transplantation 1999; 67: 717-21.
19. Pirsch JD, Miller J, Deierhoi MH, Vincenti F, Filo RS. A com-
parison of tacrolimus (FK506) and cyclosporine for
immunosuppression after cadaveric renal transplantation.
FK506 Kidney Transplant Study Group. Transplantation 1997;
63: 977-83.
20. Sollinger H. Mycophenolate mofetil for the prevention of
acute rejection in primary cadaveric renal allograft recipients.
Transplantation 1995; 60: 225-32.
21. Norman DJ, Kahana L, Stuart FP Jr, Thistlewaite JR Jr, Shield
CF, Monaco A, et al. A randomized clinical trial of induction
therapy with OKT3 in kidney transplantation. Transplantation
1993; 55:44-50.
22. Suthanthiran M, Strom TB. Renal transplantation. N Eng J
Med 1994; 331:365-76.
23. Peters T, Shaver T, Ames JI, Santiago-Delpin E, Jones K,
Blanton J. Cold ischemia and outcome in 17,937 cadaveric
kidney transplants. Transplantation 1995; 59:191-6.
24. Lechvallier E, Dussol B, Luccioni A, Thirion X, Vacher-
Copomat H, Jaber K, et al. Posttransplantation acute tubular
necrosis: risk factors and implications for graft survival. Am J
Kidney Dis 1999; 32: 984-91.
25. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE,
Mclntosh MJ, Stablein D. Improved graft survival after renal
transplantation in the United States, 1988 to 1996. N Engl J
Med 2000; 342: 605-12.
26. Ortho Multicenter Transplant Study Group. A randomized
clinical trial of OKT3 monoclonal antibody for acute rejection
of cadaveric renal transplants. N Engl J Med 1985; 313:337-42.
27. Pirsch JD, Ploeg RJ, Gange S, D'Alessandro AM, Knechtle SJ,
Sollinger HW, et al. Determinants of graft survival after renal
transplantation. Transplantation 1996; 61:1581-6.
28. Ishikawa A, Flechner SM, Goldfarb DA, Myles JL, Modlin CS,
Boparai N, et al. Quantitative assessment of the first acute
rejection as a predictor of renal transplant outcome.
Transplantation 1999; 68:1318-24.
29. Fellström B. Transplant atherosclerosis. J Intern Med 1996;
240:253-7.
30. Cosio FG, Pelletier RP, Falkenhain ME, Henry ML, Elkhamas
EA, Davies EA, et al. Impact of acute rejection and early
allograft function on renal allograft survival. Transplantation
1997;63:1611-5.
31. Humar A, Kerr S, Gillingham KJ, Matas AJ. Features of acute
rejection that increase risk for chronic rejection. Trans-
plantation 1999; 68:1200-3.
32. Carpenter CB. Long-term failure of renal transplants: Adding
insult to injury. Kidney Int 1995; 48/Suppl. 50: S40-S44.
33. Opelz G, Wujciak T, Ritz E. Association of chronic kidney
graft failure with recipient blood pressure. Collaborative
Transplant Study. Kidney Int 1998; 53: 217-22.
34. Michielsen P. Recurrence of the original disease. Does this
influence renal graft failure? Kidney Int 1995; 48/Suppl. 52: S-
79-S-84.
35. Andresdottir MB, Assmann KJM, Hoitsma AJ, Koene RAP,
Wetzels JFM. Recurrence of type I membranoproliferative
glomerulonephritis after renal transplantation. Transplan-
tation 1997; 63:1-5.
36. Andresdottir MB, Hoitsma AJ, Assman KJM, Koene RAP,
Wetzels JFM. The impact of recurrent glomerulonephritis on
graft survival in recipients of HLA-identical living related
donor grafts. Transplantation 1999; 68:623-7.
Læknablaðið 2000/86 575