Etiology and determinants of allograft dysfunction.

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. Due to shortage organs and long waiting period in cadaver transplant prevention of second or re transplant is more important. To improve the graft survival identifying etiology of graft dysfunction or loss is more important. Once we identified the etiology we have to evaluate for immunologic, nonimmunologic, modifiable, non modifiable risk factors to improve the graft and patient survival. METHODS : All renal transplant recipients on regular follow up are included - September 2009 to march 2011. Those who died and those who are in irregular follow up during the period of study are excluded from the study. All the patient having graft dysfunction underwent renal biopsy. CONCLUSION : According to Univariate analysis following conclusion were made Tacrolimus gives a better graft survival than cyclosporine for both live and cadaveric transplants. Donor age has significant impact on long term graft survival; younger the donor better the outcome. With female donors the graft dysfunction is more, may be due to difference in antigencity and smaller renal mass. The Male recipients do worse than female recipients; probably due to female recipients has higher degree of sensitization to HLA antigen. Blood group, cross match results, day one urine output, First post operative day creatinine, discharge creatinine are not having significant association with cause graft dysfunction. Delayed graft function has significant impact on long term graft survival according to Univariate analysis. Side of the kidney , number of blood vessels, post operative events are not statistically significant to cause graft dysfunction