A Retrospective Analysis of 1000 Renal Transplantations Performed at One Center M. Haberal, R. Emirog ˘ lu, G. Arslan, H. Karakayali, G. Moray, and N. Bilgin O RGAN TRANSPLANTATION in Turkey saw little progress prior to 1969. Only two heart transplanta- tions had been performed by that time, one in Istanbul and the other in Ankara. Experimental studies that were done after this, namely the liver transplantations first performed on pigs and dogs, by our team in the 1970s, are worthy of mention. 1 In those years, the absence of laws pertaining to organ procurement was the main obstacle to progress with transplantation activities in Turkey. Still, despite many financial and legal obstacles, the first living-related renal transplantation, from a mother to her 12-year-old child, was performed in our center at Hacettepe University Hospital on November 3, 1975. 2 This was followed by another landmark achievement, the first cadaveric renal transplan- tation, which was carried out at our center on October 10, 1978 using a kidney supplied by Eurotransplant. 3 Although there was no law governing organ transplanta- tion in Turkey during the 1970s, we were able to obtain kidneys from Eurotransplant and SEOPF (South Eastern Organ Procurement Foundation, Richmond, Va) in that period. 3 Because our sources were limited, we were only able to perform transplantations between first-degree rela- tives with certified consent based on our national laws. Various members of Parliament, the publishing and broad- cast media, and the Board of Religious Affairs have all made considerable contributions to our activities. We al- ways worked closely with our transplant recipients, and care was taken to discuss and present these patients to the Turkish public as important case studies. In this way we were able to widely promote the transplantation concept. As a result of these efforts, Law No. 2238 regarding the storing, grafting, and transplantation of tissue and organs was enacted in Turkey on June 3, 1979. One month later, on July 27, 1979, our team performed the first domestic cadaver kidney transplantation. 3 The problems we faced in trying to properly follow up transplant recipients at a large center motivated us to establish a specialized transplanta- tion facility. In September 1985, the Turkish Transplanta- tion and Burn Foundation, which was founded in 1980, built the Ankara Organ Transplantation Hospital. After com- pleting 321 successful kidney transplantations at Hacettepe University, our team began to perform kidney transplanta- tions at this new center on October 16, 1985. Later, in November 1992, the Ministry of Health ap- proved the Ankara Hospital as a training facility to offer licensing in various medical specialties. Finally, Bas ¸kent University was founded in 1993, and this center became the Bas ¸kent University Ankara Hospital. Our transplantation team performed 1012 kidney transplantations between Oc- tober 16, 1985 and January 1, 2001. In this study, we retrospectively evaluated the first 1000 kidney transplanta- tions that were performed at our new center. MATERIALS AND METHODS From October 16, 1985 to November 15, 2000, we performed 1000 kidney transplantations at Bas ¸kent University Ankara Hospital, formerly known as the Turkish Transplantation and Burn Founda- tion Hospital. All patients’ charts were evaluated retrospectively, and the clinical and demographic data were analyzed. The great majority of these transplantations (n = 830) were live-donor procedures. In the selection process, potential donors were as- sessed with a standardized routine. Adults who volunteered to donate kidneys to their relatives were evaluated for possible donor nephrectomy after they signed consent forms. We did not consider donor candidates younger than 18 years of age. Individuals with systolic blood pressure 140 mmHg and diastolic pressure 90 mmHg or those who required antihypertensive drugs to normalize blood pressure were also excluded. Normotensive and nondiabetic adults with no urological abnormalities or systemic illness, and those who had acceptable human leukocyte antigen (HLA) match- ing, ABO blood group compatibility, and a negative crossmatch with the recipient were accepted as appropriate candidates for donor nephrectomy. Normal renal function, blood chemistry, and complete blood all count were also prerequisites. Subjects with 24-hour urine creatinine clearance of 100 mL/min were not considered as potential donors. As a final step, renal angiography was performed to identify kidneys with a single and longer arterial pedicle as the preferred organs for nephrectomy. A formal psychi- atric evaluation was also done on all donors prior to the surgery. The donor nephrectomies were performed extraperitoneally through a standard flank incision and without rib excision. General anesthesia was used in all but the most recent 19 individuals, who From the Department of General Surgery and Transplantation and Department of Anesthesiology, Bas ¸ kent University Faculty of Medicine, Ankara, Turkey. Address reprint requests to M. Haberal, Bas ¸ kent University Faculty of Medicine, Department of General Surgery, Fevzi Cakmah Cad 10 Soh, Bahcelevler, Ankara, Turkey. E-mail: melekk@baskent-ank.edu.tr © 2002 by Elsevier Science Inc. 0041-1345/02/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(02)03154-8 Transplantation Proceedings, 34, 2405–2407 (2002) 2405