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Deceased donor renal transplantation at army hospital research and referral: Our experience
CONTEXT: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was develo...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737664/ https://www.ncbi.nlm.nih.gov/pubmed/23956510 http://dx.doi.org/10.4103/0970-1591.114029 |
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author | Swami, Yogesh Kumar Singh, Dharam Vir Gupta, Sanjay K. Pradhan, Aditya A. Rana, Yajvender P. S. Harkar, Sandeep Wani, M. Shafi |
author_facet | Swami, Yogesh Kumar Singh, Dharam Vir Gupta, Sanjay K. Pradhan, Aditya A. Rana, Yajvender P. S. Harkar, Sandeep Wani, M. Shafi |
author_sort | Swami, Yogesh Kumar |
collection | PubMed |
description | CONTEXT: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation. AIMS: We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOT MATERIALS AND METHODS: Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function. RESULTS: We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%. CONCLUSION: Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool. |
format | Online Article Text |
id | pubmed-3737664 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-37376642013-08-16 Deceased donor renal transplantation at army hospital research and referral: Our experience Swami, Yogesh Kumar Singh, Dharam Vir Gupta, Sanjay K. Pradhan, Aditya A. Rana, Yajvender P. S. Harkar, Sandeep Wani, M. Shafi Indian J Urol Original Article CONTEXT: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation. AIMS: We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOT MATERIALS AND METHODS: Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function. RESULTS: We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%. CONCLUSION: Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3737664/ /pubmed/23956510 http://dx.doi.org/10.4103/0970-1591.114029 Text en Copyright: © Indian Journal of Urology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Swami, Yogesh Kumar Singh, Dharam Vir Gupta, Sanjay K. Pradhan, Aditya A. Rana, Yajvender P. S. Harkar, Sandeep Wani, M. Shafi Deceased donor renal transplantation at army hospital research and referral: Our experience |
title | Deceased donor renal transplantation at army hospital research and referral: Our experience |
title_full | Deceased donor renal transplantation at army hospital research and referral: Our experience |
title_fullStr | Deceased donor renal transplantation at army hospital research and referral: Our experience |
title_full_unstemmed | Deceased donor renal transplantation at army hospital research and referral: Our experience |
title_short | Deceased donor renal transplantation at army hospital research and referral: Our experience |
title_sort | deceased donor renal transplantation at army hospital research and referral: our experience |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737664/ https://www.ncbi.nlm.nih.gov/pubmed/23956510 http://dx.doi.org/10.4103/0970-1591.114029 |
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