Background: High bioethical and surgical technology, which is realized during organ transplantation, does not have secondary issues. Everything from the induction of immunosuppression to the patient's last breath is a team work that collects the hopes of the patient, his relatives, doctors, and society.
Materials and methods: For 20 years, we have been monitoring the long-term results of transplantations in patients of different age and social groups. We collected a full follow-up and now we can evaluate reliable signs of a better quality of life, depending on the immunosuppression (IS) scheme used. According to historical era, 1104 patients were assigned to following IS: steroid based maintenance consisted of CNI+MMF following either no induction or anti-CD25r or anti-CD3 induction (614 patients), and steroid free lowCNI+MMF following alemtuzumab induction in combination or not with anti-C5b-C9 (500 patients). Besides survival rates, quality of live (QOL) related to social rehabilitation were assessed. We investigated return to pre disease occupation or acquisition of a new profession as a result of continuing education in adult patients, public education as kindergarten/school attendance in children, active mode of life, hobby, sport, marriage, childbearing, quantity of active friends in environment (not in social networks).
Results: Seven years graft survival was higher in alemtuzumab patients (75% vs 71%, p=0.0291). Better QOL was associated with age of transplant and dialysis duration prior to transplantation. The longer children were on dialysis, the lower the QOL. The best QOL demonstrated children with preemptive transplantation. In adults, on the contrary, the longer the waiting time for a transplant was, the higher the index of social activity and personal perception of the QOL.
Conclusions: 1. Induction IS followed by less maintenance IS both in amount and dosages of the drugs, not accompanied by visible metabolic disorders, with less oncological complications, significantly improves the QOL.
2. The best QOL we observed in children who received their kidney graft at the 1.5-2 years of age preemptively, or after short dialysis.