Kidney transplant and its outcomes

Abstract

Background: Kidney transplantation has become the treatment of choice for most patients with end-stage kidney disease (ESKD). However, there is a remarkable disparity in the access and outcome of kidney transplant across the world. We present the clinical and survival data from the nephrology and kidney transplantation center for a period of 5 years in a cost-limited setting from Central India. Materials and Methods: This is a retrospective study of 66 kidney transplants performed in a single transplant center over a period of 5 years from 2016 to 2020. All data of recipients and donors were obtained from hospital records. Kaplan–Meier method was used for survival analysis. Results: Of 66 included patients, 86% were living donor and 14% were cadaveric kidney transplant. The mean age of the recipient was 30.64 ± 10.66 years. Fifty-five (83%) were male recipients and 11 (17%) were female recipients. The most common cause of ESKD in recipients was chronic glomerulonephritis (55%). The mean hemodialysis vintage was 11.04 ± 10.12 months. Seventy-four percent of donors were female and 24% of donors were male. Induction therapy with rabbit antithymocyte globulin was used in 20 (30%) and basiliximab in 21 (32%) recipients. Thirty (45%) recipients underwent graft kidney biopsy in view graft dysfunction. Acute cellular rejection was the most common cause of graft dysfunction seen in 8 (28%) of graft kidney biopsy. Graft survival and patient survival at 1, 3, and 5 years after transplant were 89%, 81%, and 77% and 90%, 84%, and 81%, respectively. Conclusions: Our observation showed that graft survival and patient survival after transplant were lower compared to other studies due to higher rejection rate and mortality due to infections. Hence, attention to immunological risk factors with proper immunologic testing pretransplant and early detection and adequate treatment of rejection episode even in cost-limited settings are suggested. Also after kidney transplant, prevention and prompt treatment of infection would offer the greatest potential to improve the chance of living longer with functioning graft.