P1819PEDIATRIC KIDNEY TRANSPLANTATION IN INDIA :IMPROVING OUTCOMES

Abstract

Abstract Background and Aims Renal transplantation is the modality of the choice for the management of children with end stage renal disease. It offers better quality of life, though associated with risk of rejection and infection. This study was conducted Method This is a retrospective review of patients <= 18 years of age who underwent renal transplant at Fortis hospitals, India from 2006 to 2019.The choice of induction agent was based on the discretion of the treating team and the socioeconomic tests of the patient, All these children were treated with Tacrolimus, MMF and prednisone, At each visit they were subjected to standard haematological and biochemical tests Data on age, sex, use of immunosuppression, incidence of infection and rejection was collected. Percentage, range and median were used to represent the data. Results The study group comprised of a total 120 pediatric patients underwent renal transplant between 2006-2018 at Fortis hospitals. Median age was 14 years (3-18 years) and 85 were boys and 35 were girls. The immunosuppression protocol consisted of induction by either basiliximab or ATG, followed by maintenance immunosuppression with tacrolimus, mycophenolate and steroids. 17 patients received no induction. Median creatinine at the time of discharge was 0.74 mg/dl (0.3-1.6 mg/dl). The median duration of follow up was 60 months (1-156 months). In our cohort, patient survival rate was 97.9 % and graft survival rate was 94.6 %. 18 patients had infections - UTI (8), CMV infections (7), BK virus infection (2), tuberculosis (1), varicella (1), cryptosporidium diarrhea (1) and fungal infection (1). Rate of rejection was 13.3%. Two patients had graft loss in the early post operative period, one secondary to renal vein thrombosis and other due to BK virus infection/acute tubular necrosis. Five patients lost the graft over the next 12 years due to non compliance with medications (4) and recurrence of FSGS (1). 2 patients died with functioning graft, one due to severe pancreatitis and other due to severe sepsis. One died after return to dialysis. Conclusion With advances in immunosuppression, rejection rate and graft survival have improved dramatically over the last decade. Compliance with medications and regular follow up are the major contributors for satisfactory long-term outcome.