- Email: [email protected]
Predicting the future! – Role of “zero hour” – Post revascularisation graft biopsy in predicting graft outcome in renal allograft recipients
52
indian journal of transplantation 9 (2015) 47–60
Abstract #: ISOT2015-78 Spectrum of infections post renal transplant – A retrospective study G. Ranjith Menon, Zachariah Paul, Anil Mathew, Rajesh Nair, George Kurian Amrita Institute of Medical Sciences, Kochi, India Background: Infections are a major cause of morbidity and mortality in kidney transplant recipients. To some extent, these may be preventable. Careful pretransplant screening, immunization, and post-transplant prophylactic antimicrobials may all reduce the risk for post-transplant infection. Aims: The primary objective was to determine the spectrum of infections that occurs in renal transplant recipients. Methodology: This retrospective study included 150 renal transplant recipients over a period of three years at Amrita Institute of Medical Sciences. Results: There were 66 documented infectious events in the recipients. The majority of the infections were urinary tract infections (36%) followed by respiratory infections (25.5%). The majority of the infections occurred after 6 months post transplant followed by those occurring between one and six months. Conclusions: The most common infection was urinary tract infection and the most common pathogen was E. coli, majority occurred in the first month post transplant. Most infections occurred in the age group of 20–39 years. Most infections were bacterial in origin. Several other infections like superficial mycoses. http://dx.doi.org/10.1016/j.ijt.2015.09.014 Abstract #: ISOT2015-83 Predicting the future! – Role of ‘‘zero hour’’ – Post revascularisation graft biopsy in predicting graft outcome in renal allograft recipients Garima Aggarwal, Anil Mathew, Seethalekshmy, Rajesh Nair, George Kurian Amrita Institute of Medical Sciences, Kochi, Kerala, India Background: Several attempts have been made to predict the early graft out come by assessing the histologic changes in zero-hour graft biopsy. The post-revascularisation ‘‘zero hour’’ biopsy (within half an hour after revascularisation in the recipient) of renal allograft may provide useful information on subclinical renal lesions like global glomerular sclerosis, IF/ TA, hyalinization of arterioles, ATN and rarely crescents, glomerulonephritis, tubulitis, and other immunological changes, present in the healthy donors and the pathological changes which are being transmitted from the donor to recipient via grafted kidney. Aims: To assess the influence of implantation chronic abnormalities on kidney allograft function at the 3rd and 12th month and rejection episodes in renal allograft recipients. Methodology: In 126 renal allograft recipients, ‘‘zero hour’’ post-revascularization (within half an hour after revascularisation of the graft in the recipient) wedge biopsies were histologically evaluated for global glomerulosclerosis, interstitial fibrosis/tubular atrophy, hyalinosis in vessels, acute tubular injury and Banff 2009 grading. Findings were correlated with graft function at 3 months and 12 months and rejection episodes occurring within 12 months of follow-up.
Results: We found no association between implantation chronic abnormalities and kidney allograft function measured by eGRF at 3 months and 1 year after renal transplantation or with the number of rejection episodes. Biopsies from 57 donors had unremarkable morphology and from 69 donors had associated changes; however, there was no difference in graft outcome among this group as well. Acute tubular injury was the most common injury reported. No case of hyperacute rejection was seen. Conclusions: Zero biopsies provide no significant prognostic information. The morphology of several chronic changes that evolve in kidney transplant is unspecific. Zero biopsies constitute a reference point for future graft histological assessments. http://dx.doi.org/10.1016/j.ijt.2015.09.015 Abstract #: ISOT2015-84 Outcome of pediatric renal transplants in a tertiary care centre in South India Kartik Ganesh, Zachariah Paul, Anil Matthew, Rajesh Nair, George Kurian Amrita Institute of Medical Science and Research, Kochi, India Background: Renal transplantation is the treatment of choice for children with end stage renal disease (ESRD) (1). Although adult renal transplant programs are in existence in India for more than three decades, pediatric programs have lagged behind. Registry data systems for dialysis and transplantation do not exist in the country. The exact incidence and prevalence of chronic renal failure in children is not known. Aims: To analyse the profile of pediatric renal transplant recipients at Amrita Institute of Medical Sciences and to calculate the patient and graft survival. Methodology: A retrospective analysis of data of all pediatric patients who underwent transplant at AIMS was done. Clinical and demographic data of donors and recipients were collected and analysed. A comparison of characteristics with the adult transplant programme was also made. Results: 29 patients underwent live related transplant, one underwent cadaveric transplantation. Median age & weight of the recipients at transplantation were 183 months and 35.7 kg respectively; M:F ratio was 11:19. Sixteen children had glomerular disease and 11 had tubulointerstitial disease. Preemptive transplantation was done in 2 patients, 90% received hemodialysis and 3% received peritoneal dialysis prior to transplantation. The mean duration of dialysis was 3 months. The most common donor was the mother. Immunosuppression medications included cyclosporine, azathioprine, tacrolimus, mycophenolate mofetil and corticosteroids. Graft survival at 1 year for 26 out of 30 recipients was 96%. At 5 years, for 15 patients, graft survival was 80%. 2 patients (6%) developed episodes of rejection. 8 patients developed infections in the post transplant period with urinary tract infection being the commonest (62%), occurring at a mean time of 6.4 days post transplant. Conclusions: The pediatric kidney transplantation programme at AIMS has a success rate that is comparable to international standards. High quality kidney transplant program can be established in low income country like India. Our 1 & 5 year graft survival & rejection rates are comparable to western statistics. http://dx.doi.org/10.1016/j.ijt.2015.09.016
indian journal of transplantation 9 (2015) 47–60
Abstract #: ISOT2015-78 Spectrum of infections post renal transplant – A retrospective study G. Ranjith Menon, Zachariah Paul, Anil Mathew, Rajesh Nair, George Kurian Amrita Institute of Medical Sciences, Kochi, India Background: Infections are a major cause of morbidity and mortality in kidney transplant recipients. To some extent, these may be preventable. Careful pretransplant screening, immunization, and post-transplant prophylactic antimicrobials may all reduce the risk for post-transplant infection. Aims: The primary objective was to determine the spectrum of infections that occurs in renal transplant recipients. Methodology: This retrospective study included 150 renal transplant recipients over a period of three years at Amrita Institute of Medical Sciences. Results: There were 66 documented infectious events in the recipients. The majority of the infections were urinary tract infections (36%) followed by respiratory infections (25.5%). The majority of the infections occurred after 6 months post transplant followed by those occurring between one and six months. Conclusions: The most common infection was urinary tract infection and the most common pathogen was E. coli, majority occurred in the first month post transplant. Most infections occurred in the age group of 20–39 years. Most infections were bacterial in origin. Several other infections like superficial mycoses. http://dx.doi.org/10.1016/j.ijt.2015.09.014 Abstract #: ISOT2015-83 Predicting the future! – Role of ‘‘zero hour’’ – Post revascularisation graft biopsy in predicting graft outcome in renal allograft recipients Garima Aggarwal, Anil Mathew, Seethalekshmy, Rajesh Nair, George Kurian Amrita Institute of Medical Sciences, Kochi, Kerala, India Background: Several attempts have been made to predict the early graft out come by assessing the histologic changes in zero-hour graft biopsy. The post-revascularisation ‘‘zero hour’’ biopsy (within half an hour after revascularisation in the recipient) of renal allograft may provide useful information on subclinical renal lesions like global glomerular sclerosis, IF/ TA, hyalinization of arterioles, ATN and rarely crescents, glomerulonephritis, tubulitis, and other immunological changes, present in the healthy donors and the pathological changes which are being transmitted from the donor to recipient via grafted kidney. Aims: To assess the influence of implantation chronic abnormalities on kidney allograft function at the 3rd and 12th month and rejection episodes in renal allograft recipients. Methodology: In 126 renal allograft recipients, ‘‘zero hour’’ post-revascularization (within half an hour after revascularisation of the graft in the recipient) wedge biopsies were histologically evaluated for global glomerulosclerosis, interstitial fibrosis/tubular atrophy, hyalinosis in vessels, acute tubular injury and Banff 2009 grading. Findings were correlated with graft function at 3 months and 12 months and rejection episodes occurring within 12 months of follow-up.
Results: We found no association between implantation chronic abnormalities and kidney allograft function measured by eGRF at 3 months and 1 year after renal transplantation or with the number of rejection episodes. Biopsies from 57 donors had unremarkable morphology and from 69 donors had associated changes; however, there was no difference in graft outcome among this group as well. Acute tubular injury was the most common injury reported. No case of hyperacute rejection was seen. Conclusions: Zero biopsies provide no significant prognostic information. The morphology of several chronic changes that evolve in kidney transplant is unspecific. Zero biopsies constitute a reference point for future graft histological assessments. http://dx.doi.org/10.1016/j.ijt.2015.09.015 Abstract #: ISOT2015-84 Outcome of pediatric renal transplants in a tertiary care centre in South India Kartik Ganesh, Zachariah Paul, Anil Matthew, Rajesh Nair, George Kurian Amrita Institute of Medical Science and Research, Kochi, India Background: Renal transplantation is the treatment of choice for children with end stage renal disease (ESRD) (1). Although adult renal transplant programs are in existence in India for more than three decades, pediatric programs have lagged behind. Registry data systems for dialysis and transplantation do not exist in the country. The exact incidence and prevalence of chronic renal failure in children is not known. Aims: To analyse the profile of pediatric renal transplant recipients at Amrita Institute of Medical Sciences and to calculate the patient and graft survival. Methodology: A retrospective analysis of data of all pediatric patients who underwent transplant at AIMS was done. Clinical and demographic data of donors and recipients were collected and analysed. A comparison of characteristics with the adult transplant programme was also made. Results: 29 patients underwent live related transplant, one underwent cadaveric transplantation. Median age & weight of the recipients at transplantation were 183 months and 35.7 kg respectively; M:F ratio was 11:19. Sixteen children had glomerular disease and 11 had tubulointerstitial disease. Preemptive transplantation was done in 2 patients, 90% received hemodialysis and 3% received peritoneal dialysis prior to transplantation. The mean duration of dialysis was 3 months. The most common donor was the mother. Immunosuppression medications included cyclosporine, azathioprine, tacrolimus, mycophenolate mofetil and corticosteroids. Graft survival at 1 year for 26 out of 30 recipients was 96%. At 5 years, for 15 patients, graft survival was 80%. 2 patients (6%) developed episodes of rejection. 8 patients developed infections in the post transplant period with urinary tract infection being the commonest (62%), occurring at a mean time of 6.4 days post transplant. Conclusions: The pediatric kidney transplantation programme at AIMS has a success rate that is comparable to international standards. High quality kidney transplant program can be established in low income country like India. Our 1 & 5 year graft survival & rejection rates are comparable to western statistics. http://dx.doi.org/10.1016/j.ijt.2015.09.016