POS-808 "Renal allograft cortical necrosis" - Disappearing entity in live renal transplant over two decades - A Single centre experience

Abstract

Renal graft cortical necrosis (GCN) is a catastrophic cause of graft failure. The literature is very scarce on this entity. We evaluated the incidence, causes, management, and outcome of allograft cortical necrosis in two decades from our center. This is a retrospective analysis of transplant patients who had biopsy-proven allograft cortical necrosis, transplanted between 2000 and 2020. Demographic details, immunological workup, induction, and maintenance regimen, cause of cortical necrosis, the outcome was analyzed. Data were analyzed using SPSS version 20. Continuous data were presented in mean ± standard deviation, for non-normal data, the median (interquartile range) was used. Among 1975 transplant recipients, 37 (1.87%) patients had GCN. Of which 35 patients (2.87/100 transplant/year) were between 2000-2010; 2 patients (0.086/100 live transplants/year) between 2011-2020. All had CDC crossmatch XM negative. None had flow crossmatch testing before 2011 whereas all were tested with FXM after 2012. Mean days to GCN was 8. 28 had early rejection (19 had vascular rejection); 7 had graft vessel thrombosis,1 had mucormycosis. 60% had diffuse; 40% had partial GCN. 60% received ATG; 11% received combined plasmapheresis and ATG as anti-rejection therapy. 25 patients had no recovery, 9 had partial recovery and 3 had a complete recovery.15 patients underwent nephrectomy within 24 days (median); 11 patients died of sepsis; median days to death from transplant was 56 days. 4 underwent a second renal transplant. The dramatic decrease in the incidence of graft cortical necrosis after 2011 could be attributed to use of improved DSA detection methods, crossmatching techniques, adoption of better desensitization protocols in our institute.