SUN-353 A comprehensive review of 50 cases of kidney transplants performed over 10 months a single centre experience from an African country

Abstract

Access to kidney transplantation has always been a problem in the African countries with many patients having to travel to other medically advanced countries in Asia, Europe and America. This involves unnecessary excessive expenditure and the travails of journey and stay in an unknown foreign land. To ease this situation and provide affordable Renal transplant services in their home land, we have made an effort to start the transplant services at our medical facility and have successfully carried out about 50 transplants in a period of 10 months from December 2018 till September 2019. A comprehensive overview of the cases has been presented forthwith. All the Kidney transplants done between the period Nov 2018- Sept 2019 ( 50 cases) were included in the analysis. All the transplants were performed at a single center and the data were collected progressively during their Pre transplant evaluation, perioperative course and post op follow up. All the laboratory and radiological tests were done locally at the center except the HLA cross matches and typing which were outsourced to Transplant immunology labs outside the country. All the patients underwent laparoscopic donor nephrectomy except in patients with technical difficulties. A series of 50 kidney transplants were performed over a period of 10 months [ DEC 2018- september 2019] at a private hospital successfully. All the cases were live donor kidney transplants with majority of the donors being 1st or 2nd degree relatives or spousal donors. There were no cases of mortality and all the patients had good immediate graft function except in 6 patients, who had delayed graft function; 5 of them improving over 2 – 6 weeks and one patient not in follow-up at the time of submission of this abstract]. Renal allograft biopsy was done in 5 patients. In 4 patients biopsy findings were suggestive of ATN, and the other, report awaited at the time of submission of this abstract. Of all patients, 2 were HBsAg +ve, and 2 were HIV +Ve. Two patients required simultaneous nephrectomy at the time of transplant, one for ADPKD and the other for VUR. Other postoperative problems included; one patient had sub-acute intestinal obstruction due to adhesions requiring laparoscopic intervention and the other segmental consolidation with cough and fever. All the patients received induction with rabbit Thymoglobulin, and IV methyl prednisolone. 12 patients required plasma exchange and IVIG for positive X match { 11 pre op’ and 1 post op’}. Overall patient survival was 100% and graft survival over 98% {49/50}. Our experience shows that kidney transplantation is a viable and practical option for the treatment of End stage kidney disease and can be performed even in resource constrained centers in third world countries.