Graft function and outcomes of deceased donor kidney transplant patients in a tertiary care center

Background: With the rising incidence of diabetes and hypertension, the prevalence of end-stage renal disease has increased greatly so as the need for renal replacement therapy. Availability of suitable living-related donors is a major problem which increases the demand for deceased donor renal transplantation (DDRT), making it a lifeline for the patients on dialysis without any living donors. Methodology: This is a retrospective analysis of 118 DDRT done between 2012 and 2020, in a private quaternary care hospital in a south Indian state. All patients received basiliximab induction, with maintenance immunosuppression using steroids, mycophenolate mofetil (MMF) or mycophenolate sodium, and tacrolimus. Results: In our study, we report unadjusted graft survival of 93.2% and 81.3%, patient survival of 94.9% and 83.1% at the end of 1 and 5 years, respectively. The recipients with age < 60 years had 5 years graft survival of 87%. The study group consisted of 15.25% of the patients with panel reactive antibody (PRA) positive and 10.16% of them with donor-specific antibody (DSA) during renal transplantation, and there was only one allograft loss in this subset of the patients. Conclusion: This study confirms that human leukocyte antigen matching is not very important with the current immunosuppressive protocol using tacrolimus and MMF. Early initiations of tacrolimus do not increase the incidence of delayed graft function. We report 91.6% graft survival in the DSA-positive group, with basiliximab induction and desensitization protocol.

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Deceased Donor Renal Transplant Outcome in a South Indian Tertiary Care Hospital With Zonal Allocation Model - An Observational Study

Kandasamy

Madhavan²,

Murugesan³

et al. 2022

Indian Journal of Transplantation

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Posttransplant Renal Allograft Dysfunction – A Retrospective Observational Study

Kunthara

Sahay

Hussain

et al. 2021

Indian Journal of Transplantation

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Background: In India, a large number of end-stage renal disease patients are undergoing renal replacement therapy. A successful renal transplantation relives the burden of dialysis with improved quality of life and a productive life thereafter. This also reduces the cost of health care to the government and the society. Graft dysfunction is an important cause of graft loss. The objective of this retrospective study is to evaluate the graft dysfunction and its impact on patient and graft survival. Methods: We did a retrospective record-based analysis of 83 cases (including both deceased and live-related renal transplants) from 2014 to 2019 who were on triple immunosuppression (tacrolimus, mycophenolate mofetil, and steroids) as maintenance therapy. Patients who had graft dysfunction, underwent graft biopsy and were analyzed subsequently. Results: The most common causes for graft dysfunction on biopsy were acute rejection, acute tubular injury, and calcineurin inhibitor toxicity. About 39% of the patients had infections, predominantly bacterial and viral infections. The rejections were associated with poor patient survival (statistically significant). The overall patient survival at our center after 1 year and 3 years was 88% and 84%, respectively, while the death-censored graft survival was 86% and 81%, respectively. Conclusion: In our center, following renal transplantation, patients had a fairly successful outcome. However, early detection and prompt management of the graft dysfunction can improve the graft and the patient survival.

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Deceased-Donor Renal Transplantation: A Single-Center Experience from a Tertiary Care Hospital in North India

Chadha

Choudhury

Goel

et al. 2023

Indian Journal of Transplantation

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Introduction: Deceased-donor renal transplants can help cope up with the increasing demand of renal allografts in India. We evaluated the outcomes of deceased-donor renal transplantation at our center. Methods: This retrospective study analyzed the donor and recipient characteristics along with graft and patient survival in deceased-donor renal transplant recipients at our center between April 2011 and October 2021. Results: The mean age of recipients (n = 21) and deceased donors was 48 ± 9.4 and 39.3 ± 8.7 years, respectively. Male:female ratio among recipients was 1.6:1 while that in donors was 2:1. Chronic glomerulonephritis (71.4%) was the most common native kidney disease. Most patients received antithymocyte globulin (80.9%) as induction and tacrolimus-based triple-drug regimen (80.4%) as maintenance therapy. The median follow-up duration was 32.8 months. Graft dysfunction was reported in 57.1% (n = 12/21) patients; acute tubular necrosis was the most common reason (n = 5). Six patients died, and sepsis was the most common reason for death (n = 3/6; 50%); 66.7% (n = 4/6) deaths occurred within the first 6 months. The mean graft survival time was 106.2 months (95% confidence interval: 95.4–116.6). The cumulative proportion of graft survival was 95.2% (n = 20/21) at 3 and 5 years. The cumulative proportion of patient survival was 80.9% at 3 years and 76.2% at 5 years. Conclusion: Patient outcomes over 5 years follow-up were good and suggest that deceased-donor transplants should be encouraged along with living-donor transplants to cover the huge demand–supply mismatch in renal replacement therapy.

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Graft function and outcomes of deceased donor kidney transplant patients in a tertiary care center

Cited by 5 publications

References 15 publications

Deceased Donor Renal Transplant Outcome in a South Indian Tertiary Care Hospital With Zonal Allocation Model - An Observational Study

Deceased Donor Renal Transplant Outcome in a South Indian Tertiary Care Hospital With Zonal Allocation Model - An Observational Study

Posttransplant Renal Allograft Dysfunction – A Retrospective Observational Study

Deceased-Donor Renal Transplantation: A Single-Center Experience from a Tertiary Care Hospital in North India

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