Outcome of renal transplantation from deceased donors: experience from developing country

Abstract

Background: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplantation (RT). Organ retrieval from brain dead deceased donor (DD) is getting increased attention as the waiting list for organ recipients far exceeds the organ donor pool. In our country, despite a large population, the number of brain dead donors undergoing organ donation is very less. DDRT is the possible solution to bridge the disparity between organ supply and demand. In India, the potential for DDRT is huge due to the high number of fatal road traffic accidents and this pool is yet to be tapped. Patients and methods: We report DDRT outcome in 294 patients (age: 36.5 ± 14.1 years; male:female, 200:94) between 2005 and 2012. All patients received single-dose rabbit-anti-thymocyte globulin for induction and steroids, calcineurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Results: Our retrospective study in 294 DDRT shows a fairly successful outcome. Over a mean follow-up of 3.93 years, patient and graft survival rates were 81.7% and 92.6%, respectively, with a median serum creatinine of 1.5 mg/dL. 20.7% had biopsy-proven acute rejection. Conclusion: Given the widespread organ shortage, DDRT has a potential to expand the donor pool and shorten the waiting list for RT, encouraging the use of this approach even in low-income countries. Aggressive donor management, increasing public awareness about the concept of organ donation, good communication between clinician and the family members, and a well-trained team of transplant coordinators can help in improving the number of organ donations.

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

“…Thirty patients (10%) died of infectious complications in the first 3 years, and this is an acceptable number of patients to die in the first 3 years after KT in a developing country, similar to other Indian studies . Graft failure is almost always a death sentence, and there is no graft failure with patient survival in developing countries.…”

“…Overall, there were more male than female recipients, but there were more female donors. This gender imbalance is common to the overall transplant programme in India, including directed group and DDKT, and not limited to KPD .…”

“…Overall, there were more male than female recipients, but there were more female donors. This gender imbalance is common to the overall transplant programme in India, including directed group and DDKT, and not limited to KPD [25][26][27][28][29]33,34]. combining KPD with desensitization [3,9] or ABOiKT; expanding the number of acceptable mismatches; national [15], international [10] and global kidney exchange [32]; the use of A2 donor to O patient such as in the Methodist KPD programme [24]; and computer allocations will improve the quality and quantity of match and transplant rates for difficult-to-match Our report showed that different KPD forms (Table 2) can be successfully applied in any country with limited resources [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Deceased donor renal transplantation: A single center experience

“…[12] In our study, 48.5% had DGF, 21.8% had acute rejection, mean CIT was 5.66 h, 1 and 5 years patient survival 80.2% and 76.3% and graft survival 82.6% and 80%, respectively. When compared to other Indian studies,[131415] the incidence of DGF was higher in our study despite having shorter mean cold ischemic time [Table 5].…”

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

“…Compared with European data; one-and five-year patient SR (97.4% and 91.8%) were similar, but graft SR (91.3%, 80.5%) was better in our DDKTx recipients (4). In India, Kute et al have found that one-and five-year patient and graft SR are 81.7%, 77.5% and 92.6%, 88.3%, respectively (8). In a study from Argentina, one and five year patient SR were 87.5% and 74.5%; graft SR were 91.6% and 64.7% respectively (9).…”