ABSTRACT
To determine the incidence and determinants of delayed graft function due to post-transplant acute tubular necrosis in live related donor renal transplantation. This is a retrospective study of 337 recipients of live related donor renal graft performed between 1986 and 2006. Of these recipients, 24 (7.1%) subjects developed delayed graft function with no evidence of acute rejection, cyclosporin toxicity, vascular catastrophe or obstructive cause and had evidence of acute tubular necrosis (ATN Group). These subjects were compared with recipients (n= 313, 92.9%) who had no clinical or biochemical evidence of ATN. Mean age, and gender distribution of recipients was similar in the two groups (ATN group 35.7 +/- 8.3, non-ATN group 34.3 +/- 7.5, P= 0.43). Gender distribution of the recipients (men 279, 89.1% vs. 21, 87.5%, P= 0.80) as well as donors (women 221, 70.6% vs. 18, 75.0%, P= 0.75) was also similar. In ATN group as compared with non-ATN group the donor age was significantly greater (56.6 +/- 8.3 vs. 46.6 +/- 11.2 years, P< 0.0001). There was marginal difference in pre-operative systolic BP (154.5 +/- 18.3 vs. 147.4 +/- 20.2 mm Hg, P= 0.077) and significant difference in diastolic BP (87.8 +/- 9.5 vs. 83.4 +/- 11.4 mmHg, P= 0.041). Incidence of multiple renal arteries was similar (16.7% vs. 7.3%, P= 0.22). The warm ischemia time was significantly greater in ATN group (33.3 +/- 6.2 min) as compared to non-ATN group (30.4 +/- 5.7 min, P= 0.042). Duration of hospital stay was more in ATN group (19.9 +/- 6.7 vs. 16.8 +/- 8.4 days, P= 0.04) but there was no difference in 1 year survival (284 subjects, 90.7% vs. 21 subjects, 87.5%, P= 0.873). This study shows that greater donor age, higher baseline diastolic BP and greater warm ischemia time are major determinants of delayed graft function due to acute tubular necrosis after related donor renal transplantation.
Subject(s)
Delayed Graft Function/etiology , Family , Kidney Transplantation/adverse effects , Kidney Tubular Necrosis, Acute/etiology , Living Donors , Adult , Age Factors , Blood Pressure , Delayed Graft Function/mortality , Delayed Graft Function/physiopathology , Female , Humans , Incidence , Kidney Transplantation/mortality , Kidney Tubular Necrosis, Acute/mortality , Kidney Tubular Necrosis, Acute/physiopathology , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Treatment Outcome , Warm Ischemia/adverse effectsSubject(s)
Kidney Transplantation/psychology , Patient Compliance , Socioeconomic Factors , Treatment Refusal , Adult , Educational Status , Family , Female , Follow-Up Studies , Graft Rejection/epidemiology , Humans , Immunosuppressive Agents/therapeutic use , India , Interviews as Topic , Kidney Transplantation/immunology , Kidney Transplantation/mortality , Male , Retrospective Studies , Time FactorsSubject(s)
Antitubercular Agents/therapeutic use , Kidney Transplantation , Tuberculosis/epidemiology , Adult , Drug Therapy, Combination , Ethambutol/therapeutic use , Female , Follow-Up Studies , Humans , Incidence , India , Isoniazid/therapeutic use , Living Donors , Male , Postoperative Complications/epidemiology , Postoperative Complications/microbiology , Pyrazinamide/therapeutic use , Pyridoxine/therapeutic use , Retrospective Studies , Rifampin/therapeutic use , Time Factors , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/mortality , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiologyABSTRACT
To determine th usefulness of various immunosuppressive regimens in renal transplantation and to study various complications at a new centre, we analysed 41 patients of end stage renal disease who underwent renal transplantation in our hospital over a period of three years. The first 11 patients (Group I) received azathioprine-prednisolone, the next 30 patients (Group II) received cyclosporin-prednisolone-azathioprine combination therapy. Over a mean followup of 33.36 +/- 8.19 months in group I, the survival rate was 63.6%; in group II over a followup of 14.86 +/- 2.9 months, survival was 86.66%. Kaplan-Meier survival analysis showed a trend to improved survival in group II but results did not reach statistical significance (Log rank test statistic = 2.77, p < 0.1). The incidence of infection was significantly lower in group II (p < 0.05). The major causes of death were infections, rejection, cyclosporin toxicity, acute pancreatitis, and ruptured mycotic aneurysm in one case.
