Deceased donor transplantation – Our experience in the last 4 years
Background: Kidney transplant is the best treatment option for end stage kidney disease. Deceased donor transplantation has helped in increasing the donor pool for waitlisted dialysis patients. We received seventy deceased donor kidneys through the Kerala Network of Organ Sharing (KNOS) over the pas...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2019-01-01
|
| Series: | Indian Journal of Transplantation |
| Subjects: | |
| Online Access: | http://www.ijtonline.in/article.asp?issn=2212-0017;year=2019;volume=13;issue=3;spage=188;epage=193;aulast=Kalthoonical |
| _version_ | 1819035050065264640 |
|---|---|
| author | Vilesh Valsalan Kalthoonical Georgy K Nainan George P Abraham Mohan Mathew Datson George Renu Paul Y S Sooraj Philip G Thomas Vijay Radhakrishnan Francis C Manavalan |
| author_facet | Vilesh Valsalan Kalthoonical Georgy K Nainan George P Abraham Mohan Mathew Datson George Renu Paul Y S Sooraj Philip G Thomas Vijay Radhakrishnan Francis C Manavalan |
| author_sort | Vilesh Valsalan Kalthoonical |
| collection | DOAJ |
| description | Background: Kidney transplant is the best treatment option for end stage kidney disease. Deceased donor transplantation has helped in increasing the donor pool for waitlisted dialysis patients. We received seventy deceased donor kidneys through the Kerala Network of Organ Sharing (KNOS) over the past 4 years from August 2013 to August 2017 and transplanted sixty six with good outcome. Pre-implantation biopsy performed in marginal donors helped in decision making to take the kidney and increase the donor pool. Aims and Objectives: 1)To evaluate outcome of renal transplant recipients in deceased donor transplantation. 2)To evaluate the role of pre-implantation biopsy to improve donor selection for better long term outcome. Materials and Methods: Sixty-six deceased donor kidneys were transplanted into the recipients from our pool of 253 patients registered with the KNOS. Four cadaver kidneys were rejected based on pre-implantation biopsy. Fifty-nine transplants were done at VPS Lakeshore and seven were done at PVS Memorial Hospital, Kochi. Donors of age less than 65 years were considered. Pre-tranpslant evaluation of recipients on waiting list including lab and cardiac evaluation with PRA status was done. Cross match was done prior to transplant. Triple immunosuppression including cyclosporine, mychophenolate mofetil and prednisolone with basiliximab as induction agent was used in all cases. Low dose tacrolimus was introduced after the third month in some cases. Pre-implantation biopsy was done in marginal donors for better donor selection. Results: Of the 66 recipients, 52 (78.8%) were males and 14 (21.2%) were females. PRA status was negative in all recipients. Deceased donors <65 years of age were considered. Twenty deceased donor kidneys were biopsied before implantation, of which 16 were implanted. Four kidneys were rejected as one showed glomerulocystic changes . One had extensive thrombus in all glomeruli, one had >56% IFTA changes, and other had 30%–40% IFTA changes. Results at 4 years post-transplant showed graft survival in 55/66 (83.34%) and patient survival in 60/66 (90.91%) cases. Six patients died: two with pneumocystis carinii pneumonia (PCP) (at 9 months/3.3 years post-transplant), one with mucormycosis (at 16 months post-transplant), one with acute coronary syndrome (immediate post-transplant), and two patients with sepsis. The average serum creatinine was < 1.4 mg/dl in 48 (87.2%) cases, 1.4–2.4 mg/dl in 7 (12.7%) cases, and > 2.4 mg/dl in 1 (1.8%) case. The surgical outcome was good in all (100%) patients with no intraoperative surgical complications. Delayed graft function was noted in 18% of patients. Prolonged cold ischemia time was noted in patients with acute tubular necrosis. Six patients had acute rejection, of which two were antibody mediated, and four had acute cellular rejection. One patient had tacrolimus toxicity on biopsy and was shifted to everolimus. Infections included one patient with surgical wound infection, 12 patients with urinary tract infections, one patient with invasive fungal infection, and two patients with PCP. At 4 years, deceased donor transplantation has good graft and patient outcomes. Conclusion: Deceased donor transplantation has good graft outcome which is comparable to live non related donors. It has minimal paper work and less costly than routine live transplant. Pre-implantation biopsy should be considered in marginal donors for appropriate donor selection and avoid organ wastage in doubtful cases. In our study we noted that transplant outcome was better in recipients receiving kidney from with in the city limits because of less cold ischemia time. Hence facilities for early transportation of organs with minimal procedural hurdles to minimize cold ischemia time should be carried out by the concerned authorities. Proactivity from the Government at state, zonal and national level is needed to improve deceased donor pool and cadaver transplantation in India. |
| first_indexed | 2024-12-21T07:43:27Z |
| format | Article |
| id | doaj.art-e97900b341004d5e94d4aa2a42c9720c |
| institution | Directory Open Access Journal |
| issn | 2212-0017 2212-0025 |
| language | English |
| last_indexed | 2024-12-21T07:43:27Z |
| publishDate | 2019-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Transplantation |
| spelling | doaj.art-e97900b341004d5e94d4aa2a42c9720c2022-12-21T19:11:16ZengWolters Kluwer Medknow PublicationsIndian Journal of Transplantation2212-00172212-00252019-01-0113318819310.4103/ijot.ijot_80_18Deceased donor transplantation – Our experience in the last 4 yearsVilesh Valsalan KalthoonicalGeorgy K NainanGeorge P AbrahamMohan MathewDatson GeorgeRenu PaulY S SoorajPhilip G ThomasVijay RadhakrishnanFrancis C ManavalanBackground: Kidney transplant is the best treatment option for end stage kidney disease. Deceased donor transplantation has helped in increasing the donor pool for waitlisted dialysis patients. We received seventy deceased donor kidneys through the Kerala Network of Organ Sharing (KNOS) over the past 4 years from August 2013 to August 2017 and transplanted sixty six with good outcome. Pre-implantation biopsy performed in marginal donors helped in decision making to take the kidney and increase the donor pool. Aims and Objectives: 1)To evaluate outcome of renal transplant recipients in deceased donor transplantation. 2)To evaluate the role of pre-implantation biopsy to improve donor selection for better long term outcome. Materials and Methods: Sixty-six deceased donor kidneys were transplanted into the recipients from our pool of 253 patients registered with the KNOS. Four cadaver kidneys were rejected based on pre-implantation biopsy. Fifty-nine transplants were done at VPS Lakeshore and seven were done at PVS Memorial Hospital, Kochi. Donors of age less than 65 years were considered. Pre-tranpslant evaluation of recipients on waiting list including lab and cardiac evaluation with PRA status was done. Cross match was done prior to transplant. Triple immunosuppression including cyclosporine, mychophenolate mofetil and prednisolone with basiliximab as induction agent was used in all cases. Low dose tacrolimus was introduced after the third month in some cases. Pre-implantation biopsy was done in marginal donors for better donor selection. Results: Of the 66 recipients, 52 (78.8%) were males and 14 (21.2%) were females. PRA status was negative in all recipients. Deceased donors <65 years of age were considered. Twenty deceased donor kidneys were biopsied before implantation, of which 16 were implanted. Four kidneys were rejected as one showed glomerulocystic changes . One had extensive thrombus in all glomeruli, one had >56% IFTA changes, and other had 30%–40% IFTA changes. Results at 4 years post-transplant showed graft survival in 55/66 (83.34%) and patient survival in 60/66 (90.91%) cases. Six patients died: two with pneumocystis carinii pneumonia (PCP) (at 9 months/3.3 years post-transplant), one with mucormycosis (at 16 months post-transplant), one with acute coronary syndrome (immediate post-transplant), and two patients with sepsis. The average serum creatinine was < 1.4 mg/dl in 48 (87.2%) cases, 1.4–2.4 mg/dl in 7 (12.7%) cases, and > 2.4 mg/dl in 1 (1.8%) case. The surgical outcome was good in all (100%) patients with no intraoperative surgical complications. Delayed graft function was noted in 18% of patients. Prolonged cold ischemia time was noted in patients with acute tubular necrosis. Six patients had acute rejection, of which two were antibody mediated, and four had acute cellular rejection. One patient had tacrolimus toxicity on biopsy and was shifted to everolimus. Infections included one patient with surgical wound infection, 12 patients with urinary tract infections, one patient with invasive fungal infection, and two patients with PCP. At 4 years, deceased donor transplantation has good graft and patient outcomes. Conclusion: Deceased donor transplantation has good graft outcome which is comparable to live non related donors. It has minimal paper work and less costly than routine live transplant. Pre-implantation biopsy should be considered in marginal donors for appropriate donor selection and avoid organ wastage in doubtful cases. In our study we noted that transplant outcome was better in recipients receiving kidney from with in the city limits because of less cold ischemia time. Hence facilities for early transportation of organs with minimal procedural hurdles to minimize cold ischemia time should be carried out by the concerned authorities. Proactivity from the Government at state, zonal and national level is needed to improve deceased donor pool and cadaver transplantation in India.http://www.ijtonline.in/article.asp?issn=2212-0017;year=2019;volume=13;issue=3;spage=188;epage=193;aulast=KalthoonicalDeceased donorgraft survivalpatient survivalpreimplantation biopsyrejection |
| spellingShingle | Vilesh Valsalan Kalthoonical Georgy K Nainan George P Abraham Mohan Mathew Datson George Renu Paul Y S Sooraj Philip G Thomas Vijay Radhakrishnan Francis C Manavalan Deceased donor transplantation – Our experience in the last 4 years Indian Journal of Transplantation Deceased donor graft survival patient survival preimplantation biopsy rejection |
| title | Deceased donor transplantation – Our experience in the last 4 years |
| title_full | Deceased donor transplantation – Our experience in the last 4 years |
| title_fullStr | Deceased donor transplantation – Our experience in the last 4 years |
| title_full_unstemmed | Deceased donor transplantation – Our experience in the last 4 years |
| title_short | Deceased donor transplantation – Our experience in the last 4 years |
| title_sort | deceased donor transplantation our experience in the last 4 years |
| topic | Deceased donor graft survival patient survival preimplantation biopsy rejection |
| url | http://www.ijtonline.in/article.asp?issn=2212-0017;year=2019;volume=13;issue=3;spage=188;epage=193;aulast=Kalthoonical |
| work_keys_str_mv | AT vileshvalsalankalthoonical deceaseddonortransplantationourexperienceinthelast4years AT georgyknainan deceaseddonortransplantationourexperienceinthelast4years AT georgepabraham deceaseddonortransplantationourexperienceinthelast4years AT mohanmathew deceaseddonortransplantationourexperienceinthelast4years AT datsongeorge deceaseddonortransplantationourexperienceinthelast4years AT renupaul deceaseddonortransplantationourexperienceinthelast4years AT yssooraj deceaseddonortransplantationourexperienceinthelast4years AT philipgthomas deceaseddonortransplantationourexperienceinthelast4years AT vijayradhakrishnan deceaseddonortransplantationourexperienceinthelast4years AT franciscmanavalan deceaseddonortransplantationourexperienceinthelast4years |