Deceased Donor Kidney Transplantation Outcomes at a Sri Lankan Center: A Comprehensive Single-Center Analysis

Abstract

Background Chronic kidney disease (CKD) causes significant morbidity and mortality in patients and incurs a huge burden on healthcare expenses globally. Renal replacement therapy becomes imperative when patients reach end-stage renal disease. Kidney transplant is the best modality of choice for the majority of patients, and deceased donor kidney transplantation is the major contributor in the majority of countries. We present an outcome study in Sri Lanka for deceased donor kidney transplantation. Methodology This is an observational study conducted at the Nephrology Unit 1 at the National Hospital of Sri Lanka, Colombo, in patients who had undergone deceased donor kidney transplantation from July 2018 to mid-2020. We studied the outcomes of these patients for one year, including delayed graft function, acute rejection, infection, and mortality. Ethical clearance was obtained from the ethical review committee of the National Hospital of Sri Lanka, Colombo, and the University of Colombo. Results The study included 27 participants with a mean age of 55 ± 9.519 years. Diabetes mellitus (69.2%), hypertension (11.5%), chronic glomerulonephritis (7.7%), chronic pyelonephritis (7.7%), and obstructive uropathy (3.8%) were the etiological factors of CKD. Basiliximab was used as an induction agent, and a tacrolimus-based triple-drug regimen was used for maintenance in all patients. The mean cold ischemic time was 9 ± 3.861 hours. The majority (44%) of recipients had an O-positive blood group. At one year, the mean serum creatinine was 1.40 ± 0.686 mg/dL, and the mean estimated glomerular filtration rate was 62 ± 21.281 mL/minute/1.73 m 2 . Delayed graft function occurred in 25.9% of the recipients, and 22.2% had acute transplant rejection. Postoperative infection was observed in 44.4% of recipients. One year after transplantation, 22% of the recipients died. Infection was the cause of death in 83% of recipients (five of six patients). The causes of death in the study sample were pneumonia (50%), including pneumocystis pneumonia (17%), myocardial infarction (17%), mucormycosis (16%), and other infections (17%). There was no significant association between outcomes at one year with age, gender, causes of CKD, or postoperative complications. Conclusions Our study found that the one-year survival rate following deceased donor kidney transplantation in Sri Lanka is relatively low, with infections being the leading cause of mortality. The high infection rate during the early post-transplant period underscores the need for enhanced infection prevention and control measures. Although we did not observe any significant association between the outcomes and the variables studied, it is important to note that the small sample size of our study may have influenced this finding. Future research with larger sample sizes may provide more insights into the factors influencing post-transplant outcomes in Sri Lanka.

Deceased donor kidney transplant policies in Asia – implications on practice and recommendations for the future

“…In 2019, 15 Asian countries contributed data on their DDKT programs to the USRDS 2 and/or ONT-WHO Global Observatory on Donation and Transplantation. 9 ( Table 1 ) Additionally, there are case series of DDKT from Sri Lanka, 10 Vietnam, 11 Bahrain 12 and Mongolia 13 reported in the literature in the last 5 years. International Registry of Organ Donation and Transplant (IRODAT) also reported sporadic DDKT activities in the Philippines, Lebanon and Jordan in the last five years.…”