It is now more than 40 years since the first successful renal transplant oc- Kidneys from a donor can be maintained for transplantation by a machine that passes a cooling saline solution through them.
Many are cured, and since then, thousands have been carried out all around the world. The rate is increasing. Whereas in 1970, 274 were done in the United Kingdom, the figure is now closer to 600 annually. In Australia, where the figures are equal to or better than in most other countries, between 200 and 250 are performed annually, and Melbourne is the unquestioned centre for this activity. Here, their survival rates are excellent, and after one year the figure is 88 per cent, and almost 80 per cent after four years.
In the past, most failures occurred because there was poor matching of the donor and recipient. Besides having compatible blood, tissue matching is also vital. It has been recognized only relatively recently that just as the blood has its A, B and 0 groups, so the tissues have their own system of tissue types, referred to as the HLA system. Matching the tissue types as closely as possible is the ideal and the way in which best results will be achieved.
The most probable person to be a kidney donor would be a living twin or close relative. However, surgeons are reluctant to remove a kidney from a healthy person, and the trend is to use cadaver kidneys – those from a person who has just died. In America, the trend is to use living donors if possible. However, although complete compatibility with tissue typing is often not possible, good results can still occur when they are matched as nearly as possible.