338 Ch 337. Renal Transplantation

Renal transplant 是 ESKD 最佳 treatment (vs dialysis) — better survival + QOL + cost-effective；台灣 2023 ~ 250 例/年 (vs ~ 85,000 dialysis patients；嚴重器官短缺)；donor types：(1) deceased donor (DD): brain-dead (DBD) or DCD (donation after circulatory death) — expanding pool；(2) living donor (LD): related or unrelated；ABO compatibility + HLA matching + crossmatch；immunosuppression：(1) induction — basiliximab (IL-2R) or rATG for higher-risk；(2) maintenance triple — tacrolimus (CNI) + mycophenolate mofetil (MMF) + prednisone；(3) mTOR inhibitors (sirolimus, everolimus) alternative；2010s-2024 belatacept (CTLA-4 Ig, CNI-sparing) for select；complications：early (DGF — delayed graft function, surgical), acute rejection (ACR + AMR), chronic allograft nephropathy / IFTA, infections (CMV, BK virus, PCP, fungal), malignancy (PTLD, skin), CV, recurrence of original disease；outcomes：1-yr 95%+, 5-yr 80-85%, 10-yr 60-70%；FORWARD + future：xenotransplantation (pig kidney 2023-2024 first human transplants), iPS-derived nephron, organoid)。