Etiology of graft dysfunction in renal transplant recipients

Journal Title: International Archives of Integrated Medicine - Year 2019, Vol 6, Issue 3

Abstract

Background: Kidney transplantation is the preferred mode of renal replacement therapy for the end-stage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, 1-year patient survival is close to 98%, and 1-year allograft survival rates have improved to 90% for deceased donor kidney transplants and 95 % for living donor kidney transplants with some inter-center variability. The aim of the study: To elucidate the etiology of graft dysfunction among renal transplant recipients. Materials and methods: A retrospective study was conducted among 155 patients who underwent both cadavers and live donor transplant from October 2009 to March 2011 at a tertiary care center in Chennai, South India. All the transplant recipients were regularly followed with serum urea and creatinine, urine routine, calcineurin inhibitor drug levels in the serum, USG Abdomen, urine culture depending on the graft status. Graft dysfunction defined by a rise in the creatinine more than 25% or 0.3 to 0.5 mg per dl from the baseline. Those who developed graft dysfunction were presented for graft biopsy and managed based on the report accordingly. Results: Among the 155 transplant recipient patients, 66 (44%) patients developed graft dysfunction and underwent renal biopsy. The graft dysfunction was due to chronic allograft dysfunction (interstitial fibrosis and tubular atrophy) in 24 (15.4%) patients, acute cellular rejection in 13 (8.4%) patients, acute antibody-mediated rejection in 2 (1.3%) patients, acute tubular necrosis in 9 (5.8%) patients, calcineurin toxicity in 6 (3.9%) patients, thrombotic microangiopathy in 6 (3.9%) patients, IgA nephropathy in 3 (1.9%) patients and transplant renal artery stenosis in 1(0.6%) patient. Conclusion: Among the various causes, acute cellular, acute antibody rejection and chronic allograft nephropathy holds nearly 25% of the incidence of graft dysfunction. It indicates appropriate immunological evaluation, appropriate immunosuppression, use of induction agents in high-risk patients and protocol renal biopsy to identify early rejection in high-risk patient and appropriate early intervention is important to improve long-term term graft and patient survival.

Authors and Affiliations

S Thirumavalavan, Krishna Kumar, S. A. K. Noor Mohamed, R Vijaya Kumar

Keywords

Related Articles

A study of serum amylase levels in acute organophosphorous poisoning at Government Dharmapuri Medical College Hospital, Dharmapuri

Introduction: In India, OP compounds cause more self-poisoning deaths in southern and central India. In Northern India, aluminum phosphide causes most deaths with a fatality ratio. Poisoning due to occupational exposure,...

Management of severe sepsis and septic shock in pregnancy to improve the survival

Background: Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Early recognition and timely treatmen...

A comparative study of benign and malignant ovarian tumors in tertiary care center

In developing countries like India, patients seek medical help usually during advanced stage of ovarian tumors. Thus, patients with the tumors of ovaries need high index of suspicion. In early stage it present with very...

Spectrum of thyroid neoplasms: A one year study at tertiary referral center

Background: Thyroid cancer accounts for approximately 1% of total cancer cases. Thyroid neoplasms are most common malignant lesions in endocrine system. Their incidence is rapidly increasing in recent times, partially at...

Study of correlation between clinical profile, CD4 count and total lymphocyte count in HIV infected patients at rural tertiary care institute

Background: India is a country with low HIV prevalence, yet it has the third largest number of people living with HIV/AIDS. Availability of antiretroviral medications is improving, making it is important to develop feasi...

Download PDF file
  • EP ID EP675226
  • DOI -
  • Views 134
  • Downloads 0

How To Cite

S Thirumavalavan, Krishna Kumar, S. A. K. Noor Mohamed, R Vijaya Kumar (2019). Etiology of graft dysfunction in renal transplant recipients. International Archives of Integrated Medicine, 6(3), 313-318. https://europub.co.uk/articles/-A-675226