Causes of Graft Dysfunction in Live Related Kidney Transplantation in a Tertiary Care Hospital.

Abstract

Introduction: Renal transplantation remains the treatment of choice for end-stage renal disease (ESRD). Graft dysfunction or adverse events following renal transplantation are associated not only with short & long term graft outcome, but also with patient survival. Living kidney donation is a scheduled event that offers the advantage of optimal preparation for the recipient and donor. Restoration & preservation of renal function post transplant depends on many factors. Attempts should therefore been made to improve early graft function by a variety of mechanical, pharmacological and organ allocation strategies.

Objectives: To identify the causes of graft dysfunction in renal allograft recipients.

Method: In this prospective study, a total of 40 renal allograft recipients as well as 40 donors were evaluated. ESRD patients and kidney donors preoperative details and clinical parameters were recorded in structured questionnaire. Peroperative variables like induction with antibody, cold ischemia time, warm ischemia time, peroperative hypotension, peroperative blood transfusion, peroperative urine production were recorded. Early postoperative clinical variables like BP, hourly urine production, temperature were monitored and biochemical Hb%, Tc, Dc, ESR, blood urea, serum creatinine, s. electrolytes, cyclosporin level (C2 level), urine RME & CS and imaging USG of transplanted kidney and duplex study of renal vessels were done. On the basis of creatinine reduction ratio(CRR) on post transplant day 7, renal allograft recipients were divided into IGF and RGF/graft dysfunction group respectively and evaluation and causes of graft dysfunction were recorded. Data were processed and analyzed using computer software SPSS (Statistical package for social science) version 12.

Results: The mean age of donors was 39.15±10.09 years with a male female ratio 1:1.7. The mean age of renal allograft recipients was 32.30±8.85 years with a male to female ratio of 3.5:1. Among 40 patients, 52.5% recipients had IGF and 47.5% had RGF. At day 7 posttransplantation period mean serum creatinine in IGF group was 130.10±14.45 ìmol/L and in RGF group was 237.32±123.85 ìmol/L which was statistically strongly significant (p value <0.0001). Regarding causes of graft dysfunction at day 7 post transplant period, cold ischemia time (p value 0.043) and postoperative urine production within 6 hours (p value 0.0001) were found statistically significant.

Conclusion: This study showed that 52.5% renal allograft recipient had IGF and 47.5 % renal allograft recipient had graft dysfunction(RGF). Significant causes of graft dysfunction were long cold ischemia time in minute and peroperative urine production in ml within 6 hours after anastomosis of vessels.

Mugda Med Coll J. 2022; 5(2): 60-66