Cadaveric Renal Transplantation: The Chennai Experience

Prabahar, Murugesan Ram; Soundararajan, P.

doi:10.1016/j.transproceed.2008.03.077

Cited by 19 publications

(12 citation statements)

References 3 publications

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“…[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]. …”

Section: Discussioncontrasting

confidence: 64%

Deceased donor renal transplantation: A single center experience

Gopalakrishnan¹,

Dineshkumar²,

Dhanapriya³

et al. 2017

Indian J Nephrol

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Deceased donor renal transplantation (DDRT) constitutes less than 5% of all kidney transplantats in India. A retrospective analysis of 173 deceased donor renal transplants performed in a public funded government hospital was done. Mean age of the recipients was 36 years (male:female ratio 2.4:1), and that of the donors was 32.3 years (male:female ratio 6:1). The cold ischemic time was 340 ± 170 minutes. Mean follow-up period was 36 months. Forty one patients died, 75% of them in the first post – transplant year. Sepsis and cardiovascular disease were the most common causes of death. Twenty two percent had acute rejection. There was no significant difference in the incidence in the rate of acute rejection, bacterial, fungal infections and death rate between the cohorts of induction and non induction immunosuppression. The patient and death censored graft survival at 1 year were 80 and 82.6% and at 5 years were 76 and 80% respectively.

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Section: Discussioncontrasting

confidence: 64%

Deceased donor renal transplantation: A single center experience

Gopalakrishnan¹,

Dineshkumar²,

Dhanapriya³

et al. 2017

Indian J Nephrol

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“…18 In a study by Mani, 1-year and 4-year graft survivals of 88 DDRT in Chennai were 72% and 63%, respectively, and patient survival was hardly different from graft survival. 19 Five-year patient and graft survivals of 68 DDRT in Chennai were 61.7% and 58.8%, respectively, with biopsy-proven acute rejection in 26.4%, DGF in 50%, and CIT of 5.6 ± 3.2 h. 20 Centers report remarkable differences in the quality of kidney they harvest which may contribute to differences in long-term results. ICU care and skill of the donor maintenance and recovering team may be a contributing factor.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…This has resulted in an acceptable rate of DGF (34%) in our cases. [5111221222324] DGF is an independent predictor of poor graft survival in cadaveric renal transplant recipients. [22]…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of renal allograft rejection was suggested by a decline in renal function confirmed by ultrasound-guided percutaneous allograft biopsy as per the modified Banff classification. [1011] Cellular rejections were treated with methyl prednisone (MP) 500 mg × 3-5 doses ± r-ATG 1.5 mg/kg single dose. Humoral rejections were treated with plasmapheresis (50 ml/kg per session × 4-8 sessions) + intravenous immunoglobulins (IVIG) 0.4 g/kg × 5-10 doses ± rituximab 375 mg/m 2 Body surface area BSA single dose or bortezomib (1.3 mg/m 2 BSA × 4 dosages).…”

Section: Methodsmentioning

confidence: 99%

Deceased donor renal transplantation at army hospital research and referral: Our experience

et al. 2013

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Context:In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation.Aims:We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOTMaterials and Methods:Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function.Results:We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%.Conclusion:Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool.

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Cadaveric Renal Transplantation: The Chennai Experience

Cited by 19 publications

References 3 publications

Deceased donor renal transplantation: A single center experience

Deceased donor renal transplantation: A single center experience

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

Deceased donor renal transplantation at army hospital research and referral: Our experience

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