A Decade of Live Related Donor Kidney Transplant: Experience in a Tertiary Care Hospital of Bangladesh

Abstract

Background: Kidney transplantation is the preferred treatment for end stage kidney disease (ESKD). Live related donor kidney transplant was started in BIRDEM General Hospital, Bangladesh, on 6^th November 2004. The aim of this study was to share our last 10 years’ experience of live related donor kidney transplant.

Methods: A questionnaire was formed and data were collected from the hospital records. We retrospectively evaluated patients’ clinical and laboratory findings.

Results: A total of 111 live related donor kidney transplants were performed from 2004 to 2014. Male:female was 2.3:1. The mean age of the recipients was 37.45 ± 10.58 years. The causes of ESKD were chronic glomerulonephritis (CGN) (52, 46.9%), diabetes mellitus (DM) (31, 27.9%), hypertension (26, 23.4%), chronic pyelonephritis (1, 0.9%) and obstructive nephropathy (1, 0.9%). Pre-emptive transplantation was done in 4 (3.6%) patients. Patients on continuous ambulatory peritoneal dialysis and haemodialysis were 2 (1.8%) and 105 (94.6%) respectively. Most of the donors were siblings (55.9%). Majority (64.9%) had an uncomplicated recovery. The commonest complication during post-transplant hospital stay was infection (27.0%), mostly urinary tract infection (21.6%). Surgical failure was experienced in 1 (0.9%) and acute rejection was noted in 2 (1.8%) patients. Other complications were renal vein thrombosis (1, 0.9%), haemolytic uremic syndrome (1, 0.9%), acute tubular necrosis (1, 0.9%), peri-renal collection (1, 0.9%), pericardial effusion (1, 0.9%) and clot retention in urinary bladder (2, 1.8%). Mean post-transplant hospital stay was 12.39 ± 4.27 days. Mean duration from surgery to normalization of serum creatinine was 5.75 ± 4.15 days. During discharge, 71.2% patients had normal renal function (RF) with mean serum creatinine 1.03 ± 0.15 mg/dl and 26.1% patients had gradually improving RF with mean serum creatinine 2.01 ± 1.04 mg/dl. As induction, 61 (55%) patients received basiliximab and as maintenance therapy all patients received oral prednisolone, calcinurine inhibitor and mycophenolate. In the first year of transplant, 49.5% patients suffered from infections, of which urinary tract infection was the commonest (55.9%). Incidence of chronic allograft nephropathy in CGN, DM and hypertension patients were 25%, 19.4% and 23.1% respectively. Graft survival at 1 year, 3 years and 5 years was 94.06%, 85.88% and 77.27% respectively. Patient survival at 1 year, 3 years and 5 years was 98.1%, 88.24% and 84.09% respectively.

Conclusions: Our results are comparable or in some aspects, even better in comparison to other centers of both developing and developed world. In a center of a developing country with limited facility and resource, these achievements are encouraging.

Birdem Med J 2018; 8(3): 198-202