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Deceased donor transplants in CMC Vellore: A ten year experience.
Indian Journal of Transplantation
50 4.
To improve transplant outcome, it is necessary to minimize acute rejection episodes.
Deceased donor transplants in CMC Vellore : A ten year experience. Ajit J Thomas, Chandrasingh J, Santosh Kumar, Antony Devasia, Lionel Gnanaraj, Nitin Kekre, Ninan Chacko, and Ganesh Gopalakrishnan. Aim : To analyze all deceased-donor renal transplants done in Christian Medical College Vellore from 1996. Methods : The authors retrospectively studied all 57 cases of deceased donor renal transplants done in this institution from 1996 to May 2007. Donor parameters analyzed included the demographics, Cold Ischemia time (CIT), perfusion solution, and place of harvest. The recipient parameters included native kidney disease, delay in graft function, rejection episodes and graft survival. Of the 57 transplants, 5 were repeat transplants due to allograft failure. One patient had bilateral transplants. 14 kidneys were sourced from other institutions that were part of our organ sharing network. Fifty patients were on cyclosporine based immunosuppression, whereas the rest (n=7) were on Tacrolimus and Mycophenolate. Ringer Lactate has traditionally been the Perfusion fluid of choice although the last 19 transplants have seen Eurocollins and HTK emerging as the preferred choice. The most common cause of ESRD was diabetes (n= 12). The native kidney remained unknown in 28 patients. For the parameters available for analysis we divided recipients into three groups. Group 1 had Cold ischemia Time (CIT) < 6 hours (n=7), Group 2 with CIT between 6-12hrs (n=22), and group 3 with CIT (n=19) > 12 hours. The donor age was also divided into 3 groups for the purpose of analysis. One group had < 20 years (n=14). The group with donor ages between 21 and 45 years were the commonest (n=28). The rest comprised donors > 45 years.
Conclusions : While young donor, newer perfusion fluids and decreased CIT all significantly improved immediate graft function, a
Copyright © 2008 by The Indian Society of Organ Transplantation
Indian J Transplant 2008; 2: 32-50
lesser Cold Ischemia Time appeared to have the maximum impact on graft performance.
Do we have a answer for patients with High PRA or Positive cross match ? Varma PP, Hooda AK Dept of Nephrology, Army Hospital (R&R), Delhi Cantt
Introduction : Patient with high PRA or positive cross match have preformed humoral antibodies to HLA class I antigens. A logical approach would be to stop antibody formation and to remove preformed antibodies. Aim: To test our hypothesis of successful transplantation by using mycophenolate mofetil and plasmapheresis in patients with high PRA/positive cross match.
Methods : Prospective renal transplant recipients with persistently high PRA or positive cross match were the subjects. They were started on mycophenolate mofetil and later were given 5 sittings of plasmapheresis. After a month PRA and Cross match was tested. If negative the patient was taken up for transplantation and given conventional triple drug immunosuppression along with induction therapy. Results: 11 patients with mean age 39. 55 years (range 23-58 years), with male: female ratio 8:3 were the subjects. Their mean waiting period to transplantation due to high PRA/ Cross match was 5 months (range 1-18 m). Mean PRA and cross match before therapy was 75. 5 (range 40-100%) and 32% (range 10-100%) respectively. After one month of treatment, cross match and PRA dropped to <10% in 10/11 patients (90. 9%). Following transplantation one patient developed graft venous thrombosis and required graft nephrectomy. None of the remaining 9 patients have developed any rejection episode over a follow up period of 4. 6 m (range 2-8 m). After 3 months mean creatinine in them was 1. 38 mg/dl (range 0. 8-2. 3 mg/dl).
Conclusion : Our study shows that in patients with high PRA or positive cross match, with plasmapheresis and MMF excellent results in antibody reduction can be obtained (This simple regimen has been devised by us and used for the first time in the world by us).
50 4.
To improve transplant outcome, it is necessary to minimize acute rejection episodes.
Deceased donor transplants in CMC Vellore : A ten year experience. Ajit J Thomas, Chandrasingh J, Santosh Kumar, Antony Devasia, Lionel Gnanaraj, Nitin Kekre, Ninan Chacko, and Ganesh Gopalakrishnan. Aim : To analyze all deceased-donor renal transplants done in Christian Medical College Vellore from 1996. Methods : The authors retrospectively studied all 57 cases of deceased donor renal transplants done in this institution from 1996 to May 2007. Donor parameters analyzed included the demographics, Cold Ischemia time (CIT), perfusion solution, and place of harvest. The recipient parameters included native kidney disease, delay in graft function, rejection episodes and graft survival. Of the 57 transplants, 5 were repeat transplants due to allograft failure. One patient had bilateral transplants. 14 kidneys were sourced from other institutions that were part of our organ sharing network. Fifty patients were on cyclosporine based immunosuppression, whereas the rest (n=7) were on Tacrolimus and Mycophenolate. Ringer Lactate has traditionally been the Perfusion fluid of choice although the last 19 transplants have seen Eurocollins and HTK emerging as the preferred choice. The most common cause of ESRD was diabetes (n= 12). The native kidney remained unknown in 28 patients. For the parameters available for analysis we divided recipients into three groups. Group 1 had Cold ischemia Time (CIT) < 6 hours (n=7), Group 2 with CIT between 6-12hrs (n=22), and group 3 with CIT (n=19) > 12 hours. The donor age was also divided into 3 groups for the purpose of analysis. One group had < 20 years (n=14). The group with donor ages between 21 and 45 years were the commonest (n=28). The rest comprised donors > 45 years.
Conclusions : While young donor, newer perfusion fluids and decreased CIT all significantly improved immediate graft function, a
Copyright © 2008 by The Indian Society of Organ Transplantation
Indian J Transplant 2008; 2: 32-50
lesser Cold Ischemia Time appeared to have the maximum impact on graft performance.
Do we have a answer for patients with High PRA or Positive cross match ? Varma PP, Hooda AK Dept of Nephrology, Army Hospital (R&R), Delhi Cantt
Introduction : Patient with high PRA or positive cross match have preformed humoral antibodies to HLA class I antigens. A logical approach would be to stop antibody formation and to remove preformed antibodies. Aim: To test our hypothesis of successful transplantation by using mycophenolate mofetil and plasmapheresis in patients with high PRA/positive cross match.
Methods : Prospective renal transplant recipients with persistently high PRA or positive cross match were the subjects. They were started on mycophenolate mofetil and later were given 5 sittings of plasmapheresis. After a month PRA and Cross match was tested. If negative the patient was taken up for transplantation and given conventional triple drug immunosuppression along with induction therapy. Results: 11 patients with mean age 39. 55 years (range 23-58 years), with male: female ratio 8:3 were the subjects. Their mean waiting period to transplantation due to high PRA/ Cross match was 5 months (range 1-18 m). Mean PRA and cross match before therapy was 75. 5 (range 40-100%) and 32% (range 10-100%) respectively. After one month of treatment, cross match and PRA dropped to <10% in 10/11 patients (90. 9%). Following transplantation one patient developed graft venous thrombosis and required graft nephrectomy. None of the remaining 9 patients have developed any rejection episode over a follow up period of 4. 6 m (range 2-8 m). After 3 months mean creatinine in them was 1. 38 mg/dl (range 0. 8-2. 3 mg/dl).
Conclusion : Our study shows that in patients with high PRA or positive cross match, with plasmapheresis and MMF excellent results in antibody reduction can be obtained (This simple regimen has been devised by us and used for the first time in the world by us).