Nepalese kidney transplant recipient in a follow up clinic: related and unrelated living donor.

A cohort retrospective study was conducted on all follow up kidney transplant recipients at Transplant Follow up Clinic from June 16, 2003 to July 15, 2008. The main objective of this study was to find out the demographic pattern of the kidney transplant recipients and type of donors. Among 452 recipients, the transplantation were done in India (449), Germany (2) and in the USA (1) with male to female ratio of 3:1. Kidney donors were unrelated 315 (69.69%), related 134 (29.43%) and some did not disclose 4 (0.88%). Most of the kidney transplantation (93.75%) were done in 45 different hospitals in India and about three quarters (71.7%) of them were operated in the private hospitals in various states of India; only 2 (4.16%) in Germany and 1 (2.08%) in USA. Newar was the largest population 142 (31.4%) and second largest group was Mangol 124 (27.4.4%) that comprised of Gurung, Rai, Magar, Tamang etc. Brahmins were the third largest population 91 (20.1%). In this study the youngest recipients was 14 years and the oldest was of 75 years. The mean age was 41 (SD 13.84). This study showed that 35 (7.7%) died, 8 (1.7%) reported rejection and underwent re-transplantation and 238 patient have lost follow up till early 2008. Kidney transplantation should be promoted as it is cheaper compared to dialysis in the long run. This study found that unrelated kidney donors have outnumbered the related donors in Nepalese kidney transplant recipients which emphasize the importance of unambiguous documentation and also a provision of lawful action against the middle-men if found involved in an illegal kidney related activities in Nepal. Organ transplantation is an important integral part of human health and should be regularize and promote lawfully to protect humans from trafficking for kidney, possible kidnapping, killing and stealing.

Frecuencia de insulinorresistencia y/o déficit secretor de insulina y su relación con factores de riesgo para la hiperglucemia en pacientes con trasplantes renales / Frequency of insulin resistance and/or insulin secretory deficit and its connection with risk factors for hyperglycaemia in patients with kidney transplants

La resistencia a la insulina y el déficit en la secreción pancreática de esta hormona son los factores patogénicos de la hiperglucemia asociada al trasplante renal, proceso frecuente y multifactorial que complica la evolución de estos enfermos. Se le realizó a 83 pacientes a los que se les había efectuado trasplantes renales, durante su seguimiento en consulta externa, una PTGO de 2 h con dosificación de insulina, determinando mediante los índices HOMA S y B por ciento, la presencia de resistencia insulínica (48 por ciento) y la disminución de la secreción hormonal (23,1 por ciento) para conocer la frecuencia de estos trastornos, el papel de la deficiencia en la secreción y/o acción de la insulina y su asociación con factores de riesgo, excluyendo el tratamiento inmunosupresor. Se constató una elevada frecuencia de trastornos en el metabolismo de la glucosa (50 por ciento) y evidente asociación con los factores considerados de riesgo para la hiperglucemia postrasplante. Se halló que la mayor edad del receptor, el mayor tiempo en diálisis, así como un índice de masa corporal elevado, más ganancia de peso al tercer mes del trasplante, la historia familiar de diabetes, la infección por el virus de la hepatitis C y la cifras elevadas de triglicéridos pretrasplante, resultaron estadísticamente significativos en los enfermos con índices insulínicos patológicos.

Insulin resistance and the deficit in the pancreatic secretion of this hormone are the pathogenic factors of hyperglycaemia associated with kidney transplant, a frequent and multifactorial process that complicates the evolution of these patients. A PTGO of 2 h with dosage of insulin was performed among 83 patients who had undergone renal transplants during their follow-up at the outpatient department. Insulin resistance (48 percent) and the decrease of hormonal secretion (23.1 percent) were determined by using the indexes HOMA S and B percent in order to know the frequency of these disorders, the role of the deficiency in the secretion and/or action of insulin and its association with risk factors, excluding the immunosuppressive treatment. A high frequency of disorders in the glucose metabolism (50 percent) and an evident association with factors considered as risk for posttransplant hyperglycaemia were confirmed. It was found that the oldest age, the longest time under dialysis, as well as an elevated body mass index, plus weight gain at the third month of the transplant, the family history of diabetes, the hepatitis C virus infection and the high figures of pretransplant triglycerides, were statistically significant in patients with pathological insulin indexes.