CAN WE PREVENT CHRONIC GRAFT LOSS? STRATEGIES AND OUTCOME IN 1000 LIVE RELATED RENAL TRANSPLANTS FROM A DEVELOPING COUNTRY

Abstract

P266 Aims: This study describes strategies to prevent graft loss in a living related programme from a developing country. Methods: One thousand and forty five live related transplants were performed between 1985 and 2001. Analysis of survival was divided into three periods (1986 – 1993) 184 transplants, (1994 – 1997) 350 and (1998 – 2001) 511 transplants. Strategy included young donor selection, matching donor recipient body weight ratio, improvement in histocompatibility by DNA typing and flow cross match. Tailoring immunosuppression by ATG, IL2 induction, switch from Aza to MMF and CyA reduction, HLA match and donor age. Early diagnosis of dysfunction by imaging and frequent biopsy. Molecular diagnosis of TB, CMV and HCV, stringent control of hypertension, treatment of hyperlipidaemia and diet control. Maintenance immunosuppression was by triple drug regimen. Statistical methods used were Kaplan Meier, Log rank and Cox analysis. Results: Analysis of 1 and 5 year graft survival in the three eras showed that it was 80% and 51% in the first (1986-1993), 89% and 69% in second (1994-1997) and 92% and 81% in the third period (1998-2001). Age of donors was < 30 years in 34% in the first era and this increased to 40% in the third era while age > 50 years decreased from 13% to 8%. ATG and IL2 induction allowed use of poorly matched donors. In the first era there were 4% (1-2 antigen matched transplants) and 29% identical. This changed to 12% (1-2 antigen matched) and 18% identical in the third era. Graft loss due to chronic rejection reduced from 60.2% in the first era to 26% in second and 12.9% in the 3rd era. Of the total graft losses of 198, 46% were due to chronic rejection and 27% were due to death with graft function where the main reason was infection in 61%. Conclusions: In a living related programme graft loss equates with end of life. We feel that attempts can be to salvage a good proportion of grafts by early diagnosis and effective therapy of rejection, individualized immunosuppression, prevention of graft threatening infections, hypertension and hyperlipidaemia. Knowing limitations inherent in the available donor strategies can be developed to prolong graft survival.