Half a century of renal transplantation activity in the busiest unit of our country - How far have we gone

Background: Kidney transplantation (KTx) is the gold standard therapy of renal failure

affecting the quality and longevity of life. Our country has introduced KTx early in the 70’s

and the first one performed in our unit was in 1971. Since then, a lot has changed and in

1984 the transplant unit started running in the current legal status.

Methods: We performed a retrospective analysis of the transplant activity in our unit

Results: Since 1971, 3249 KTx procedures were performed through the end of 2024, 1558

from deceased donors and 1691 from living donors. 6 patients were treated with

autotransplantation, 4 simultaneous pancreas and kidney and 2 combined liver and kidney

transplants. 66.7% of patients were male. Since 2005, the incompatible programme of KTx

started, initially ABOi and consequently HLAi. To overcome the incompatibility issues, the

paired pool donation was added, with the first one performed intercontinentally in 2011. 4

pairs were transplanted and 12 live donors donated to the cadaveric waiting list for their

incompatible potential recipient. 10 year survival rate of the iKTx was 91.9%, with graft

survival 75.6% compared to the survival rate of comp KTx of 93.7% and graft survival 79.4%.

The surgical challenge for the unit was the introduction of the laparoscopic donor

nephrectomy in 2018. Since then, only 3 donors had an open procedure. The paediatric KTx

are also part of the program initially sporadically but since 2019 as an organised program in

collaboration with the paediatric hospital and the support of the anaesthetic department 34

kids were transplanted (23 live donor and 8 deceased) with a mean age of 13.6 years.

Our unit is the 2nd in Europe that started using Imlifidase as part of desensitisation protocol in

potential recipients with preformed antibodies to the donor and positive cross match. So far 4

patients were transplanted with only one experiencing acute rejection on the table and

subsequent nephrectomy.

Conclusions: We are optimistic that new horizons will open in transplantation, as with the

support of the government the deceased donation rate has increased from 4.4 donors per

million population in 2019 to 10 in 2024. Improving the transplant candidate work-up,

optimising maintenance on the waiting list, and providing outstanding post-transplant care

will be vital to the continued success of KTx.