Evaluation of Factors Causing Delayed Graft Function in Live Related Donor Renal Transplantation
Journal Title: IJSR-International Journal Of Scientific Research - Year 2017, Vol 6, Issue 1
Abstract
Aims and Objectives: To know the incidence and various factors responsible for delayed graft function due to post-transplant acute tubular necrosis in live related donor renal transplantation. MATERIALS AND METHOD: retrospective study done in 99 patients who underwent live related renal transplantation in NIMS between october 2014 and feb 2016, all the recipients irrespective of the etiology of end stage renal disease. And patients with delayed graft function due to other complications like rejection,vascular catastrophes and urological complications are not taken into the study. All the recipients received kidney from ABO compatible donors with negative tissue cross match and followed the same selection criteria and practically same surgical and medical staff were involved .All the recipients were given intravenous methyl prednisolone intraoperatively. Other immunosuppressive drugs used were tacrolimus,mycophenolate mofetil and basiliximab induction if the donor is spouse. Recipient and donor surgeries were performed simultaneously following standard procedures Donor nephrectomy was done by open method.In the recepient donor renal vein anastamosed to extenal iliac vein and renal artery to internal iliac artery or external iliac Artery. Ureteroneocystostomy was done by Lich Gregoir technique .Total ischemia time, i.e., the time between clamping of renal artery in the donor and the time of release of clamps in recipient was recorded in all the patients. All the recipients requiring dialysis in the first week post-transplant were subjected to ultrasonography, renal doppler studies, renogram and renal biopsy .Acute tubular necrosis (ATN)was diagnosed using standard clinical, biochemical and histopathological criteria. Statistical analysis done by using t-test for numerical variables and chi square test for ordinal variables.P values < 0.05 were considered significant. RESULTS: Total live transplantations done during study period was99 cases. Causes of ESRD are CGN-28,CIN-16,IgA Nephropathy-10, Diabetic Nephropathy-4,VUR-2,Others-39cases. Delayed graft function seen in 12cases, in that ATN-8, AMR-2, ACR-2 cases. ATN group patient characteristics were compared with non ATN group. Mean age of recipients was similar in the two groups (ATN group 40.7 ± 8.3, non-ATN group 39.3 ± 7.5, P= 0.43). No significant difference in the the base line systolic BP of two groups 146(ATN) vs142(non ATN) p value-0.077, But there is significant difference in baseline diastolic BP 90(ATN) vs 86 (non ATN)) p value- 0.041. Baseline diastolic BP is significantly greater in ATN group than in non ATN group. In ATN group as compared with non-ATN group the donor age was significantly greater (58 ± 5.5 vs 42 ± 6.5 years, P< 0.001). e Total ischemia time was significantly greater in ATN group (63.3 ± 6.2 min) as compared to non-ATN group(45.5 ± 5.7 min, P= 0.042). Duration of hospital stay was significantly more in ATN group When compared with non ATN group (16.9 ± 6.7 ATN vs. 10.8 ± 8.4days, non ATN P= 0.01). CONCLUSION:is study shows that greater donor age,high baseline diastolic BP and greater ischemia time are major determinants of delayed graft function due to acute tubular necrosis after live related donor renal transplantation.Prevention of DGF will shorten the hospital stay and reduces the overall cost.
Authors and Affiliations
Ch ramreddy, Rahul devraj, D abzal basha, Abbas SJ, Ramchandraiah G, S Vidyasagar
Keywords
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