MON-183 EXPERIENCE IN KIDNEY TRANSPLANTATION IN NEPHROLOGY & TRANSPLANT UNIT, TEACHING HOSPITAL, KANDY, SRI LANKA -A SINGLE CENTER EXPERIENCE

Abstract

Kidney transplantation using organs from deceased or live donors, has been well established as the optimal management for patients with End Stage Renal Disease (ESRD). Along with the global data, Sri Lanka is also having a huge disparity between the need and the availability of kidneys. Nephrology & Transplant units in Sri Lanka, Teaching Hospital, Kandy commenced kidney transplantation on November, 2010 starting with live donor (LD) transplant. Deceased donor (DD) coordination programme was started in May, 2014. Retrospective data collection was done using registries from the theater and the deceased donor coordination center. Data with regard to the numbers of living and deceased donor transplants were collected from year 2001-2018. Sex and the age distribution of recipients and donors of 2017 and 2018 were analyzed. Year 2011 had the maximum number of LD transplants (n=93) while the numbers have decreased to 42 in 2018. Mean number of LD kidney transplant during the past decade is 78 per year. The DD transplants have increased from 8 in 2014 to 28 in 2018. The maximum number of total kidney transplants were done in 2016 (n=102) and it had dropped to 70 by 2018. The mean number of total kidney transplants done during the past decade is 92 per year. 2. Age and sex distribution of recipients Out of 168 recipients, 122 were males (72.61%) and the rest were females (n= 46, 27.38%). There were 59 (35.11%) DDs and 109 (64.88%) LDs. Among them there were only 5 of age <20 years (3.01%, 4 LD, 1 DD) , 56 in 20-40 years (33.73%, 45 LD, 11 DD), 103 in 40-60 years (62.04%, 58 LD, 45 DD) and only 4 with age >60 years(2.4%, 2 LD, 2 DD) . 3. Age and sex distribution of donors Out of 146 donors, 108 (73.97%) were LDs while the rest were DDs (n= 38, 26.02%). There were 78 (53.42%) males and 68 (46.57%) females. Three donors were of age <20 years (all male, DDs) and 43 were of age 20-39 years (29 LD, 14 DD) . Out of them 26 were males and the rest (n= 17) were females. Ninety one donors were within 40-59 years and consisted of 47 males and 44 females (73 LDs,18 DDs). Nine donors were of age >60 years (2 males, 7 females). Among them 6 were LDs and the rest (n=3) were DDs. Out of all there were 6 laparoscopic live donor nephrectomies done in 2018. Three DD kidneys were discarded due to unsuitability for transplantation following transfer. Liver retrieval started in 2018 and there were 12. Two liver transplants were done at our unit and the rest (n=10) were transferred to National Hospital, Sri Lanka. Although there is a dip in total annual kidney transplantations, the dialysis burden increases. The reasons are difficulty in finding a donor within a nuclear family, more stringent donor criteria, de motivation to find a LD due to availability of deceased donor programme etc. Two other major hospitals in the North Central province of Sri Lanka, at Anuradhapura and Polonnaruwa have also commenced kidney transplantations there by reducing our burden. However, it is very important to increase the supply of more kidneys. Education regarding organ donation, improvement of infrastructure for organ management, Donor card with consent for organ donation, consideration of expanded donor criteria, Laparoscopic donor nephrectomy, initiation of paired donor exchange programme needs attention.