Kidney Transplantation: Charles Nicolle Hospital Experience R. Bardi, M. Cherif, R. Goucha, M. Ounissi, E. Abderrahim, F. Ben Hamida, M. Makhlouf, S. Jendoubi-Ayed, Th. Ben Romdhane, S. Ben Boujemaa, F. El Younsi, K. Ayed, H. Ben Maiz, A. Kheder, Y. Gorgi, and T. Ben Abdallah ABSTRACT The aim of our retrospective study was to analyze the short- and long-term follow-up of 298 renal transplantations performed between June 1986 and May 2005. All were first transplantations except 4 cases, with 54 from cadaveric and 244 from living donors. The recipients included 196 males and 102 females of overall mean age of 31.21  8.9 years (range, 16 – 61 years). A combination of prednisolone and azathioprine was presented for 212 patients or mycophenolate mofetil for 86 patients. Polyclonal or monoclonal antibod- ies were used as induction therapy in 183 cases. Cyclosporine was administered to 188 cases and tacrolimus only to 16. HLA matching was 0 mismatches (MM) in 65 cases; 1 or 2 MM in 113; 3 MM in 99; and 4 MM in 21. Acute tubular necrosis occurred in 45 cases. One hundred eighteen patients experienced at least 1 acute rejection episode: 102 cases (41.8%) among living and 16 (29.6%) among cadaveric kidneys donor (P = .0007). The actuarial patient and graft survival rates at 1, 5, 10, 15, and 20 years were 95.9%, 87.4%, 77.5%, 65.6%, and 60.8%, and 94.9%, 84.5%, 75.4%, 65.4%, and 53%, respectively. Sixty-three patients died and 72 patients returned to dialysis. Our results were comparable to experienced centers. However, the member of kidney transplantations does not match the increased number of patients on renal replacement therapy. It is advisable to promote obtaining organs from brain-dead donors. T HE TUNISIAN renal transplant program began in June 1986. Until May 2005, 550 kidneys had been transplanted in Tunisia. Herein we have reported the short- and long-term follow-up of 298 adult kidney transplanta- tions performed at Charles Nicolle Hospital in Tunis. PATIENTS AND METHODS During this 19-year period, 298 adults underwent first transplanta- tions except in 4 cases: 54 (18.1%) from cadaveric (CAD) and 244 (81.9%) from living donors (LD), including 231 (77.6%) related (LRD), 3 (1%) nonrelated (NLRD), and 10 (3.3%) spousal donors. The recipients included 196 males (65.8%) and 102 females (34.2%) of overall mean age of 31.21  8.9 years (range, 16 – 61 years). The age distributions were 16 to 29 years (48%); 30 to 49 years (48%); and 50 years (4%). The primary renal disease was unknown in 82 subjects (27.52%), chronic glomerulonephritis in 114 (38.26%), chronic pyelonephritis in 62 (20.8%), nephroangiosclerosis in 26 (8.73%), and hereditary nephropathy in 14 (4.69%). Initial renal replacement therapy (RRT) was hemodialysis (HD) in 251 cases (84.2%), chronic peritoneal dialysis (CPD) in 45 (15.1%), and the 2 techniques combined in 2 subjects (0.7%). All patients received ABO- compatible, cross-match-negative kidneys. HLA antigens were detected by complement-dependent lympho- cytotoxicity (LCT) assay for class I and class II antigens until 1997. Thereafter, we used the PCR-SSP technique, particularly for HLA class II, in 116 patients (38.9%). Cross-match tests have been performed since July 1997 by LCT sensitized with washes, by antihuman globulin (AHG) and dithiothreitol (DTT) in 124 pa- tients (41.61%). LCT was used to detect the presence of anti-HLA antibodies before transplantation among all patients; since January 2000 we have employed enzyme-linked immunosorbent assay From the Nephrology Department (R.B., M.M., S.J.-A., Th.B.R., S.B.B., K.A., Y.G., T.B.) and Immunology Laboratory (M.C., R.G., M.O., E.A., F.B.H., F.E.Y., H.B.M., A.K.), Charles Nicolle Hospi- tal, Tunis, Tunisia. Address reprint requests to Prof Taieb Ben Abdallah, Labora- toire de Recherche d’Immunologie de la Transplantation Rénale et d’Immunopathologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006 BS Tunis, Tunisia. E-mail: taieb.babdallah@rns.tn © 2009 Published by Elsevier Inc. 0041-1345/09/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.12.030 Transplantation Proceedings, 41, 651– 653 (2009) 651