Analysis of Cadaver Renal Transplant in Government Stanley Hospital.

INTRODUCTION : Treatment option for Chronic Kidney Disease-Stage5 (CKD-stage5) patients fall into three categories viz., Haemodialysis, Peritoneal dialysis and Renal Transplantation. Many studies proved that the kidney transplantation is distinctly superior and it is associated with reduced mortality and morbidity compared to haemodialysis or peritoneal dialysis. The renal donors are of three types viz. live related, live unrelated and cadaver. With nuclear families, working members in the family and the increased prevalence of diabetes mellitus and hypertension among general population, it is difficult for the CKD-stage5 patients to get suitable willing live donors. The only option for them will be cadaver donors. AIM OF THE STUDY : To evaluate the short term outcome of recipients of deceased donor grafts. CONCLUSION : Cadaver transplantation is the need of the day and is bound to increase with lesser number of live related transplants. Optimal HLA mismatching between recipient and donor is not being performed in India. Cadaver transplant with increasing experience have more successful outcome. Reduction in cold ischemic time by sharing the organ within the City, availability of emergency cross-match facility and performing transplant surgery without delay will improve the graft survival. Use of induction therapy might avert early graft failures. Patients with CKD Stage-5 on maintenance haemodialysis without voluntary live related donor will benefit immensely by cadaver transplantation. In our study, three patients died due to sepsis. Early detection of sepsis, aggressive treatment and possibly regular checking up of CMV status could improve graft outcome in medium term. One patient was lost due to surgical cause which would improve with further experience. One patient died of early sepsis and fungal infection. Source of infection could have been from cadaver. Induction therapy might have averted immediate rejection and graft rupture which occurred in one patient in our study. Early detection and aggressive treatment of CMV infection which would avert the graft loss in one of our patients. One patient with HCV developed sepsis and died. For him HCV was not treated. To conclude, cadaver transplant is a challenge and the results would improve with attacking multiple causes of graft failure. Avoiding HCV infection during dialysis, gaining more experience in transplant surgery, surveillance of infection from cadaver donor, induction therapy, regular CMV surveillance, early detection and treatment of sepsis should go a long way in improving the results. In addition, the ideal of sharing HLA matched kidney across the State or India remains a distant dream. In the absence of such HLA based sharing, more declaration of brain death in our own centre, immediate cross-match facility and early surgery are logistical factors which would improve the deceased donor graft survival