Living-related Renal Transplantation Research Articles

Posttransplant renal allograft dysfunction – A retrospective observational study

Background: In India, a large number of end-stage renal disease patients are undergoing renal replacement therapy. A successful renal transplantation relives the burden of dialysis with improved quality of life and a productive life thereafter. This also reduces the cost of health care to the government and the society. Graft dysfunction is an important cause of graft loss.The objective of this retrospective study is to evaluate the graft dysfunction and its impact on patient and graft survival. Methods: We did a retrospective record-based analysis of 83 cases (including both deceased and live-related renal transplants) from 2014 to 2019 who were on triple immunosuppression (tacrolimus, mycophenolate mofetil, and steroids) as maintenance therapy. Patients who had graft dysfunction, underwent graft biopsy and were analyzed subsequently. Results: The most common causes for graft dysfunction on biopsy were acute rejection, acute tubular injury, and calcineurin inhibitor toxicity. About 39% of the patients had infections, predominantly bacterial and viral infections. The rejections were associated with poor patient survival (statistically significant). The overall patient survival at our center after 1 year and 3 years was 88% and 84%, respectively, while the death-censored graft survival was 86% and 81%, respectively. Conclusion: In our center, following renal transplantation, patients had a fairly successful outcome. However, early detection and prompt management of the graft dysfunction can improve the graft and the patient survival.

Live-related renal transplant with bench repair of saccular aneurysm of graft renal artery - A case report

Renal artery aneurysm is a rare entity with an incidence of about 1%. The preoperative evaluation of a voluntary kidney donor incidentally revealed a saccular aneurysm of the right renal artery on a computed tomography angiogram. Laparoscopic right donor nephrectomy was performed with Bench repair of the aneurysm and transplantation of this kidney to the recipient in the right iliac fossa. Transplant kidney had good perfusion on revascularization with normal postoperative graft function. Transplanting kidneys with renal artery aneurysm can be safely performed with a win-win situation for both donor and recipient.

Role of therapeutic plasma exchange in acute humoral rejection patients undergoing live-related renal transplantation: A single-center experience.

BACKGROUND AND AIM:Renal transplantation (RT) is the most successful and ideal renal replacement therapy for end-stage renal disease patients. Renal allograft rejection has always been one of the major barriers in successful RT. Our aim was to report the role of therapeutic plasma exchange (TPE) in acute humoral rejection (AHR) patients who underwent live-related RT (LRRT) and their renal allograft outcome at our center.MATERIALS AND METHODS:A prospective observational study was conducted from July 1, 2014, to December 31, 2016. Patients with biopsy-proven AHR and treated with TPE along with other lines of treatment after undergoing LRRT were included in the study. ABO-incompatible individuals, pediatric patients, and patients undergoing second transplants were excluded from the study. Clinical history, donor and graft details, management, and patient and graft survival were noted.RESULTS:Of the 1608 patients who underwent LRRT, 49 (37 males, 76%; 12 females, 24%; mean age 39.5 ± 13.3 years) had biopsy-proven AHR (3.04%) and were treated with TPE. A total of 281 TPEs were performed with an average of 5.7 TPE/patient (range 2–12). Of the 49 patients, 38 patients (78%) with favorable response underwent 213 (75.8%) TPEs (average of 5.6 TPE/patient; range: 2–12), whereas 11 patients (22%) with unfavorable response underwent 68 (24.2%) TPEs (average of 6.2 TPE/patient; range: 3–8). Blood urea (P = 0.012) and serum creatinine (P = 0.038) levels at the time of rejection were significant predictors of response to TPE therapy. The average length of stay in our study population was 33 ± 22 days. Six months posttransplant, the patient and graft survival were 93.3% and 89.5%, whereas at 12 months, they were 89.3% and 81.5%, respectively.CONCLUSION:TPE is a safe and effective adjunct therapy for treating AHR patients.

Outcomes of Kidney Transplantation in the Elderly Recipients.

Introduction:In a developing country with a predominantly young population, the valid assumption is directed toward medical care toward the young. However, as medical technology has advanced, quality care has ensured better survival for the elderly population also. The aim of this study was to determine the clinical outcomes in elderly patients undergoing kidney transplantation.Materials and Methods:A retrospective analysis of 1150 patients who had undergone live related renal transplantation was done from January 2006 to December 2014. These patients were divided into two groups; Group 1: age >60 years (N = 150), Group 2: age 18–60 years (N = 1000). The clinical outcomes were compared.Results:The mean age in Group 1 was 69 ± 7.5 years (SD ± 7.5), and group 2 was 41 ± 8 years. In groups 1 and 2, males were 80% and 82%; death censored graft survival at 5 years was 82% and 87%; patient survival at 5 years was 86% and 94%, respectively. The incidence of biopsy-proven acute rejection was similar in both groups (11.3 vs. 10.2%, P = 0.12). Urinary tract infection was the most common infectious complication. Sepsis was the primary cause of death in both groups.Conclusion:In the elderly patients who underwent kidney transplantation, satisfactory graft function, and patient survival were maintained over a period of 60 months. Urinary tract infections were common, and sepsis was the most common cause of death with a surviving allograft. The acute rejection and mortality rates were comparable to the literature published from India so far.

Comparative analysis of complement-dependent lymphocytotoxicity crossmatch and flow cytometry crossmatch results versus Luminex single-antigen bead-based donor-specific IgG class I antibody MFI values in live related renal transplant cases; a retrospective observation in 102 cases

ABSTRACT The aim of this study was to compare the results of solid phase assay and cell-based assay, and explore the near-accurate DSA-MFI-cutoff value detected on solid phase assay above which the cell-based assay would show a positive result. In this retrospective study, 102 prospective renal transplant recipients were tested for the presence of donor-specific antibodies (DSAs) by cell-based assay (T-cell-CDC-AHG-XM and T-cell-IgG-FC-XM) and solid phase assay (class-I-IgG-L-SAB) with their corresponding donor. Among the 40 patients in the group first (L-SAB-DSA-MFI<1000), one case was positive in IgG-T-cell-FC-XM while T-cell-CDC-AHG-XM was negative in all the cases. In the second group having L-SAB-DSA-MFI values between 1000 and 3000, 19 cases were positive and the remaining 11 cases were negative in IgG-T-cell-FC-XM. T-cell-CDC-AHG-XM showed a negative reaction in all 30 cases. In the third group having L-SAB-DSA-MFI values between 3000 and 5000, IgG-T-cell-FC-XM was positive in 18 cases while, two were negative. T-cell-CDC-AHG-XM demonstrated a negative result in 14 cases while reaming six cases demonstrated a positive result. In the fourth group having L-SAB-DSA-MFI values >5000, all 12 cases showed a positive result in both IgG-T-cell FC-XM and T-cell-CDC-AHG-XM. Our results indicated that the L-SAB-DSA-MFI values >2215 were significantly (P < .001) correlated with positive IgG-T-cell-FC-XM while L-SAB-DSA-MFI values >4689 were significantly (P < .001) correlated with positive CDC-XM.

Potential applicability of perioperative thromboelastography to access the coagulopathies in live related renal transplantation: a prospective observational pilot study

Potential applicability of perioperative thromboelastography to access the coagulopathies in live related renal transplantation: a prospective observational pilot study

Vascular Complications in Live Related Renal Transplant – BSMMU Experience

Introduction: Renal Transplantation is the optimal treatment for end-stage renal disease.Among the surgical complication in Renal Transplant vascular complication is most dreadedand many lead to sudden allograft loss and increase patient morbidity and even mortality.&#x0D; Objective: To share our experience and analysis of outcome of vascular complicationsof Live related Renal Transplant in our Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka.&#x0D; Materials &amp; Methods: One hundred eighty two (182) live related Renal Transplantwere performed from July 2011 to March 2020. During this period we evaluated thiscases retrospectively to find out vascular complications and analyzed them for frequency,clinical presentation and their management and outcome.&#x0D; Result: The age of recipients range from 6-65 years, male 129, female 53 vascularcomplications are found in 8 cases — 1 Renal Artery Thrombosis, 2 venous thrombosis,1 Renal Artery aneurysm, 1 hematocele, 3 lymphocele. 4 patients needed graftnephrectomy, 2 lymphocele cases need lympho-peritoneal shunt and 1 improve bysclerotherapy with povidone-iodine, hematoma needs surgical evacuation. One patientdied after graft Nephrectomy due to sepsis.&#x0D; Conclusion: Major vascular complications are relatively uncommon after live relatedRenal Transplantation but still contributes a major factor of graft loss and patientmorbidity. According to these data we can conclude Renal Transplantation is safeprocedure for end stage renal disease.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.72-75

Comparative Study of Short-Term Outcome of Live Related Renal Transplantation From Grafts Having Single vs Multiple Arteries

Objective: To compare the outcome of live related renal transplantation between the Grafts having single vs multiple arteries.&#x0D; Materials and Methods: The data of 94 renal transplants with single and multiple arteries performed between January 2011 and December 2012 were collected from Bangabandhu Sheikh Mujib Medical University and National Kidney Foundation. Sixty three renal transplants with single renal artery were compared to 31 transplants with multiple arteries. The aspects analyzed were number of arteries of the graft, donor type, ischemia time, time spent for arterial anastomosis, time spent for total vascular anastomosis and time for whole operation, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 6 month after transplantation, graft loss and mortality.&#x0D; Results: The incidence of surgical complications in grafts with single artery and multiple renal artery was respectively: vascular 6.4% and 3.2%; urological 13.2% and 9.6%, other surgical complications was 3,2% and 3.2%, and the difference were not significant among the two groups. Symptomatic lymphocele was 3.2% observed in single artery group but the incidence of lymphoceles was 6.4% in grafts with multiple arteries (p &lt; 0.005). The incidence of delayed graft function in grafts with a single artery and multiple arteries was respectively 6.4% and 6.4% (p =&lt;0.005). Mean serum creatinine at the end of 6th months of postoperative period was 1.33mg/dl and 1.67 mg/dl in grafts with single and multiple arteries respectively (p&lt;0.005). Cold ischemia time, preparation time duration of in vivo arterial anastomosis and the total length of operation time was significantly longer in the multiple artery group(p&lt;0.005). Six months grafts survival in single and multiple artery was 88.9% and 87.1% respectively.&#x0D; Conclusions: Kidney transplantation using grafts having single and multiple arteries present similar indeces of surgical complications and short-term outcome. Though, lymphoceles was more frequent among grafts with multiple arteries but the difference were not significant among the two groups. In other words. Live related renal transplantation from grafts having multiple arteries is safe and has a good outcome.&#x0D; Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.9-16

ERYTHROCYTOSIS POST RENAL TRANSPLANTATION: A SINGLE CENTRE STUDY

Background: Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin (Hb) and or hematocrit levels that occur following renal transplantation in the absence of thrombocytosis, leukocytosis, or another potential cause of erythrocytosis. PTE occurs in 8 to 15 percent of renal transplant recipients and usually affects patients with well-preserved graft function. Materials and Methods: To evaluate the prevalence and risk factors of PTE, we retrospectively analyzed the records of renal transplant recipients undergoing regular follow-up at our center for at least 6 months. Patients with a history of chronic obstructive pulmonary disease or malignancy were excluded. PTE was defined as Hb >17 g/dl. A total of 215 living-related renal transplant recipients were included. The clinical and laboratory parameters were noted. Results and Discussion: Thirty-eight (17.7%) out of 215 renal transplant recipients developed PTE. The mean age of the PTE group was 38.1± 9.4 years. The median time to onset of PTE was 9.5 (range 4-24) months post-transplant. The mean Hb at the time of diagnosis of PTE was 17.84± 0.54g/dl. There was a significant correlation of PTE with male sex, history of smoking before transplantation, history of ≥1 episode of acute rejection and cyclosporine (versus tacrolimus) containing triple-drug immunosuppression (p<0.05). There was not any significant correlation of PTE with age, blood pressure, renal function, HLA matching, induction immunosuppression regime, transplant renal artery stenosis or new-onset diabetes after transplantation (NODAT). Other pre-transplant factors including history of hypertension, diabetes mellitus, underlying renal disease, hemoglobin levels, blood transfusions, erythropoietin dose and duration of dialysis were not significantly correlated to PTE. Conclusion: PTE was observed in 17.7% of renal transplant recipients. PTE developed more frequently within the first year of transplantation. In addition to male sex and history of smoking, episodes of acute rejection and cyclosporine containing immunosuppression were associated with PTE.

Repair with Gonadal Vein Patch in the Unexpected Left Renal Vein Injury During Donor Nephrectomy

Objective: The objective of this presentation is to share our experiences with an unusual repair of a defective graft renal vein using an own gonadal vein, which occurred iatrogenically during a laparoscopic donor nephrectomy. Case Report: A 35-year-old man with situs inversus totalis was referred to our clinic for a living-related renal transplant with a diagnosis of end-stage renal disease. The donor was 66-year-old mother of the patient. Laparoscopic left donor nephrectomy was planned for his mother . At the end of laparascopic disection renal vein tear occurred during the renal extraction. Without any intervention renal extraction was performed to maintain the patency of renal allograft and to stabilize the donor. Partial hemorrhage from renal vein was brought under control. Donor nephrectomy was completed with a defective remaining segment of renal vein. We decided to repair with gonadal vein patch ın the unexpected renal vein injury. Patch from tearing part of renal vein with short gonadal vein repairment was performed. After repairment of graft renal vein, anastomosis to external iliac vein was performed. The trans-plant procedure was completed successfully. The kidney functioned immediately. Doppler ultrasound revealed that perfusion of the kidney was normal. The postoperative creatinine levels of recipient were in the normal ranges. Daily urine output was normal. Conclusion: Repairment of a defective graft renal vein by using own gonadal vein seems to be a simple, safe, and reliable method. This technique provides an alternative approach for the reconstruction of vessels in living-donor kidney transplants.

P1797ACUTE RENAL GRAFT FAILURE ASSOCIATED WITH AT1 RECEPTOR ANTIBODIES : 2 CASES IN SKMC

Abstract Background and Aims Some kidney transplantation recipients with negative donor specific antibodies can develop acute rejection episodes which are difficult to treat, associated with non-HLA antibodies like angiotensin 2 type 1 receptor antibodies (AT1R Ab). The mechanism of rejection by AT1R ab involves vascular injury. Our cases are unique as the first patient got mineralocorticoid deficiency like picture unexpectedly. For the second case, hyperacute rejection cause in the first allograft was not identified and but hyperacute rejection episodes involving antibodies against endothelial cells are reported in literature. Method 2 patients received renal transplantation from life related donors in out institute developed acute rejection episodes. As part of investigations, we did non -HLA antibodies testing which came positive . Results Case 1 30 years old male, with end stage renal disease on hemodialysis . The patient had a live related renal transplant with Mismatch 1-1-1 and negative DSA. Induction with Basiliximab was initiated but changed to ATG due to delayed graft function. Kidney biopsy on day 6 post operatively showed diffuse moderate to severe acute tubular injury (up to necrosis) with glomerular intracapillary fibrin microthrombi, focal minimal peritubular capillaritis and mild glomerulitis and focal weak C4d positivity, highly suspicious for active antibody mediated rejection. The patient was treated with pulse steroids, ATG total of 7.5mg/kg, 3 sessions of Plasma exchange and IVIG 2 g/kg and 2 doses of Rituximab for his hyperacute rejection. AT1R antibodies titer was 11U/ml. MICA was negative. Losartan was initiated as a maintenance therapy.

Immunosuppression and Graft Rejection in Living-related HLA-identical Renal Transplantation: The RADOVFULL Study.

We aimed to describe the immunosuppressive regimens and graft rejection rates in living-related HLA-identical (LR HLAid) renal transplantation. We performed a retrospective multicenter analysis of the French national database for LR HLAid renal transplantations performed between 2002 and 2012. Univariate and multivariate analysis were performed to determine risk factors for graft rejection in LR HLAid recipients. A total of 27 218 renal transplantations were performed, of whom 163 had a LR HLAid donor. About immunosuppressive treatment, <60% of the cohort had induction therapy with polyclonal or monoclonal antibodies, 28% did not receive calcineurin inhibitors, and 36% did not receive steroids in maintenance. Biopsy-proven acute rejection was diagnosed in 21 patients (12.9%). Rejection occurred on an average of 24 months after transplantation, in 28.5% of the cases after minimization of immunosuppression. Factors associated with rejection were age of recipient (OR, 0.91 [0.84-0.96]; P = 0.003), the body mass index of donors (odds ratio [OR], 1.22 [1.04-1.46]; P = 0.01), and minimization of immunosuppression (OR, 26.2 [5.48-166.6]; P < 0.001). Overall and graft survival rates were not statistically different according to rejection at 1, 5, and 10 years posttransplantation. Minimization of immunosuppression should be done with caution in LR HLAid renal transplantations.

P1613INFLUENCE OF GENETIC POLYMORPHISM IN MMPS AND TIMPS ON ALLOGRAFT OUTCOME IN RENAL TRANSPLANT RECIPIENTS

Abstract Background and Aims Renal transplantation (RT) is currently the most effective replacement therapy and believed as a boon for patients with end-stage renal disease (ESRD). Allograft rejection remains to be one of the crucial impediments in successful renal transplantation. Matrix metalloproteinases (MMPs) and their natural inhibitors (tissue inhibitors of matrix metalloproteinases; TIMPs) play an important role in immune-mediated tissue destruction of the allograft by allowing influx of leucocytes and mononuclear cells into the graft. The study of MMPs and TIMPs in transplant rejection may also lead to novel approaches in the therapy of rejection processes. To investigate the association of functional polymorphisms in MMP-1 (-1607 1G/2G), (-519 A/G); MMP-3(5356 A/G), (1161 A/G); MMP-9 (1721G/C), (Q279R A/G), (R668Q G/A); TIMP1(+536 C/T) and TIMP3(-1298 C/T gene with risk of allograft rejection in renal transplant recipients of North India. Method A total of two hundred live related renal transplant donors and recipients pairs blood sample was collected and were genotyped for MMP-1 (-1607 1G/2G), (-519 A/G); MMP-3(5356 A/G), (1161 A/G); MMP-9 (1721G/C), (Q279R A/G), (R668Q G/A); TIMP1(+536 C/T) and TIMP3(-1298 C/T) gene polymorphisms by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) methodology. All two hundred renal transplant recipients were categorized into 162 non-rejecters and 32 rejecters and were analyzed further. All the statistical analysis was done using SPSS software. Results The genotype frequencies of MMP1 (-1607 1G/2G) [2G/2G; odds ratio (OR) = 2.97, 95% confidence intervals (95% CI) = 1.69-5.20, P ≤ 0.05]; MMP9 (Q279R) [RQ; odds ratio (OR) = 0.47, 95% confidence intervals (95% CI) = 0.25-0.99, P = 0.02 &amp; QQ; odds ratio (OR) = 0.49, 95% confidence intervals (95% CI) = 0.25-0.94, P = 0.03]; MMP9 (P574R) [PR; odds ratio (OR) = 2.70, 95% confidence intervals (95% CI) = 1.77-4.13, P ≤ 0.05 &amp; RR; odds ratio (OR) = 2.70, 95% confidence intervals (95% CI) = 1.09-6.71, P = 0.03]; TIMP1(+536 C/T) [CT; odds ratio (OR) = 15.41, 95% confidence intervals (95% CI) = 9.12-26.05, P ≤ 0.05 &amp; TT; odds ratio (OR) = 7.01, 95% confidence intervals (95% CI) = 3.39-14.49, P ≤ 0.05] and TIMP3(-1298 C/T) [CT; odds ratio (OR) = 0.31, 95% confidence intervals (95% CI) = 0.19-0.50, P ≤ 0.05] was significantly associated with allograft rejection. On comparison of genotypic frequencies for MMP-1, MMP-3, MMP-9, TIMP1 and TIMP3 gene polymorphisms between rejecters and non-rejecters no significant difference was found while comparing genotypic frequencies of non-rejecters with donors a significant association was observed in MMP1 (-1607 1G/2G) [P ≤ 0.05]; MMP9 (Q279R) [P = 0.02]; MMP9 (P574R) [P ≤ 0.05]; TIMP1 [P ≤ 0.05] and TIMP 3 [P ≤ 0.05] respectively. Therefore, MMP1 (-1607 1G/2G), MMP9 (Q279R), MMP9 (P574R), TIMP1 and TIMP3 demonstrated significantly reduced risk for allograft rejection. MMP1 (-1607 1G/2G) [P ≤ 0.02]; MMP9 (P574R) [P ≤ 0.05]; TIMP1 [P ≤ 0.05] and TIMP3 [P =0.01] was also found significantly associated on comparison between rejecters and donors. Conclusion Mutant genotypes/ alleles for MMP1 (-1607 1G/2G); MMP9 (Q279R); MMP9 (P574R); TIMP1 (+536 C/T) and TIMP3 (-1298 C/T) are associated with reduced risk for allograft rejection and improved allograft survival in North Indian transplant recipients and could serve as an ideal marker to predict pre-transplant allograft outcome.

P1830HEMODIALYSIS IN CHILDREN:NINE YEARS OF EXPERIENCE OF ALBANIAN CHILDREN HEMODIALYSIS CENTER

Abstract Background and Aims Hemodialysis is one of the modalities of renal replacement therapies, which is required for patients with serious acute or chronic renal dysfunction, in consequence, with uremic toxicity and derangement of electrolytes and acid-base balance. We started provided an hemodyalisis treatment for children in Albania, for the first time about nine years ago. We want to show you our modest experience and some statistical data about the only centre of the hemodialysis for children in Albania. Method All patients who received hemodyalisis treatment between September 2010 and September 2019, were enrolled in the study. Results 55 children with acute or chronic injury received hemodyalisis treatment over 9 years; 28 females and 27 males, aged from 6 months to 17 years old. 29 cases had acute kidney injury (14 of them due to HUS). 23 of AKI cases are completely recovered. 5 cases had fatal outcome, one left with renal sequelae. Of 26 children with chronic kidney disease, 13 of them underwent live-related renal transplantation, 3 children are left to continue their treatments abroad, one child actually is in CAPD, 2children died, the others continue the dialysis treatments. 14 children came from Kosovo. Conclusion Despite the limited experience, our hemodialysis center has successfully handled cases not only from Albania, but also from Kosovo.

Safety and Efficacy of Right Retroperitoneal Laparoscopic Live Donor Nephrectomy: A Retrospective Single-Center Study.

BackgroundThe aim of this study was to investigate the efficacy and safety of right retroperitoneal laparoscopic live donor nephrectomy (LDN) in 81 cases of living-related renal transplant.Material/MethodsWe retrospectively reviewed all living-related donors who underwent right retroperitoneoscopic living donor nephrectomy between June 2010 and December 2017 at the First Hospital of Jilin University and their corresponding recipients. Demographic and clinical data were collected from the hospital’s electronic clinical data system. Data on preoperative renal retention parameters, operative time, and donor kidney warm ischemia time, the trimmed length of the renal artery and vein of donor kidney, and the time to extubation were recorded. Complications in both donors and recipients were recorded.ResultsWe included 81 donors who underwent successful right-sided retroperitoneoscopic LDN, with 31 males and 50 females and a mean age of 47.1 years (range 21–63 years). There was no intraoperative conversion to open donor nephrectomy. The mean operative time was 120.68±29.8 min. The mean warm ischemic time was 49.26±3.86 s. The estimate blood loss was 54.32 mL (range 50–400 mL). The median length of hospital stay was 7 days (range 4–13 days). There was neither intraoperative complication such as hemorrhage or lymph fistula nor kidney graft injury. There was no graft renal vein thrombosis and ureteral stricture or other complications. No graft rejection occurred.ConclusionsRight retroperitoneal laparoscopic live donor nephrectomy is safe and effective for renal transplant in living-related renal transplant by laparoscopic excision and extraction of the right kidney with vena cava flap.

SAT-346 POST-TRANSPLANT MALIGNANCY - OUR CENTRE

Cancer is now increasingly recognized as a major cause of death among patients especially after kidney transplantation. Malignancy represent a major burden in transplantation medicine. The Incidence is about 12 fold higher for PTLD and 3.5 fold higher for non-cutaneous malignancy compare to age-matched population. The increased risk is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. Aim: We attempted to assess the incidence of post-transplant malignancies in patients who underwent renal transplantation at our centre, along with studying the presentation, type and other factors affecting their development. Materials and methods We analysed data retrospectively from 626 patients who underwent renal transplantation at our centre from January 2003 to September 2018. Pre transplant history, post transplant course including duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. Details regarding type of malignancy, histopathology, staging and treatment given and outcome were collected. Number of transplant recipient-626. The total number of patients with malignancy is 12. Incidence of malignancy posttransplant is 1.9%. Male-7 and female-6. One patient was detected with 2 malignancies during her post transplant period. The types of malignancies encountered were Type of Malignancy•Squamous cell Ca of tongue – 3•Post transplant lymphoproliferative disease – 6•Squamous cell carcinoma of lung -1•Adenocarcinoma of pancreas – 1•Carcinoma of colon -1•Atypical papillary neoplasm of breast – 1 ( second malignancy)The mean duration of patient on dialysis before transplantation in the study population was 413 days. The mean duration of interval between diagnosis of malignancy and transplantation was 1560 days. None of these patients had any other risk factors for development of malignancies like exposure to radiation, smoking or family history of malignancies. None of the patients had any past history of malignancies. 3 (30%) out of 10 patients had under-gone deceased related donor transplantation, while the rest had live related renal transplant Conclusion The incidence of malignancy – 1.9%. Probable reason for decreased incidence of malignancy is the decreased immunosuppression needed by South Asian people. The most common malignancy was solid organ tumour; tongue being the most common organ. Most common histological variant is squamous cell carcinoma. Non-Hodgkin is more common than Hodgkin. Incidence of malignancy is low. Decision regarding cancer screening should be made on individual basis.

Options of Renal Replacement Therapy in CKDu.

Patients with advanced Chronic Kidney Disease of Unknown origin (CKDu) need to plan for renal replacement therapy. The patients usually affected are probably best served with living-related renal transplantation. Potential donors from the same area are possibly at risk for developing CKDu and need close monitoring post kidney donation. Peritoneal dialysis (PD) is probably a better option as hemodialysis (HD) centers are located in urban areas only and patients have the convenience of receiving therapy at home. The “PD first” pilot project of Sri Lanka is a unique initiative that trains community physicians to offer PD to patients with advanced CKDu. In Telengana and Andhra Pradesh, the Aarogyasri insurance scheme provides for poor patients to avail of free HD and transplantation in government and private hospitals. Much more needs to be done to care for all those who are affected. A public–private partnership model for providing comprehensive care to patients with advanced CKDu can be undertaken in all areas affected by CKDu that makes renal replacement therapy (RRT) available and accessible, irrespective of financial and social limitations.

Impact of One-Year Serum Creatinine on Long-term Renal Graft Survival in a Living-Related Renal Transplant Program.

This study was carried out to determine the impact of one-year posttransplant serum creatinine (SCr) levels on the long-term outcomes of living-related donor kidney transplants. A retrospective cohort study included 773 adult living-related renal transplant recipients from 2010 to 2012, with a minimum follow-up period of five years. Demographics and posttransplantation follow-up data including immunosuppression regimens, rejection episodes, and survival rates were evaluated. Patients were divided into four cohorts (G1, G2, G3, and G4 based on SCr at the end of the 1st year: G1, SCr <88.4 μ mol/L; G2, 88.5≤ SCr ≤ 132.6 μmol/L; G3, 132.7≤ SCr ≤176.8 mol/L; and G4, SCr ≥176.9 μ mol/L). Comparisons between the groups used the Chi-square test for qualitative parameters and analysis of variance for continuous variables. Five-year graft survival for G1 was 98% as compared to 76% in G4 (P <0.001). Recipients of G4 encountered more acute rejection episodes in 21% of the cases as compared to 7.3% in G1 (P = 0.001). Donors were older in G4 (42.07 ± 10.4 years) as compared to G1 (30.1 ± 8.5 years) (P = 0.001). A third of the donors in G1 were HLA identical as compared to 7% in G4. Prediction of long-term graft survival is possible by the SCr level at one year post transplant. This can be of great importance, especially to identify those patients who require close monitoring in follow-up. Donor age, HLA, and acute rejection impact SCr at one year and hence graft outcome.

Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study.

Introduction:Side-to-side pantaloon anastomosis for renal grafts with double renal arteries (RA) with significant luminal discrepancy between graft arteries has not been reported. We hypothesized that the pantaloon technique is feasible and safe in these cases.Materials and Methods:A retrospective review of all consecutive, open, live-related renal transplants with double RA with significant luminal discrepancy performed at our center from January 2014 to September 2018 was undertaken. Significant luminal discrepancy was defined as smaller RA constituting 30% ± 5% of total RA diameter on preoperative computed tomography angiogram. Three groups were defined: Group A - pantaloon anastomosis, Group B - end-to-side anastomosis of smaller to main RA, and Group C - separate implantation of each artery. The primary objective was to study feasibility and safety of pantaloon anastomosis measured by recipient serum creatinine levels, Doppler ultrasound, and vascular complications (vascular thrombosis and anastomotic bleed). Secondary objectives included measurement of cold ischemia time, warm ischemia time in recipient (WIR), and nonvascular recipient complications.Results:Fifty-eight recipients had donors with double RA with significant luminal discrepancy. Group A - included 40, Group B – 5, and Group C - 13 patients. Recipient creatinine at day-7, - 30, and - 90 were similar among the groups. The 30-day perioperative complication rate was also similar. Group A and B had significantly lower WIR and higher cold ischemia time compared to Group C.Conclusion:Pantaloon anastomosis is feasible in renal grafts with double RA with significant luminal discrepancy and offers advantage of lower WIR compared to separate implantation technique.

Role of early povidone iodine instillation in post-renal transplant lymphorrhea: A prospective randomized study.

The aim of the present study was to prospectively evaluate the role of early povidone iodine instillation in the management of post-renal transplant lymphorrhea. Live-related renal transplant recipients operated between January 2002 and December 2015 were included in the study. Significant lymphorrhea was defined as >50 mL lymph from drain beyond postoperative day 5. Such patients were randomized into two groups by simple randomization using a computer-generated random list: group A (received 0.5% povidone iodine instillation) and group B (no instillation). Absolute risk reduction and numbers needed to treat were calculated to estimate the effect of povidone iodine instillation for the treatment of lymphorrhea and decrease in the incidence of lymphocoele. A total of 1766 patients underwent renal transplant during this period. One hundred seventeen patients with lymphorrhea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58 patients had successful resolution within 2 weeks, whereas in group B, 34 patients had successful resolution within 2 weeks. Overall, 9 (14.75%) patients in group A and 29 (51.78%) patients in group B had lymphatic collections (both symptomatic and asymptomatic). Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow-up. Absolute risk reduction was 10.8%, and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. Povidone iodine instillation after 5 days of transplantation aids in the early resolution of post-renal transplantation lymphorrhea, as well as reduces the incidence of future lymphocoele.