Factors predicting early graft function in Renal Transplantation.

INTRODUCTION : Renal transplantation is the treatment of choice for end stage renal disease , defined as glomerular filtration rate less than 15 ml /min/ 1.73 metre square body surface area. It is being increasingly offered for chronic kidney diseases with better creatinine clearance also, in view of its long term improvement of the quality of life. There are two main types of renal transplantation, namely live renal transplantation and cadaver renal transplantation. Live renal transplantation is being done in many centres across India. However cadaver transplants are done in very few centres in the country. Our institute is one of the pioneers in doing cadaver renal transplants in the whole country. We have done around 130 cavdaveric transplantations so far and are the leading institute as far as cadaver transplantations are concerned . Our institute is also leading the way among government institutes in live renal transplantations with 989 transplantations done so far. Transplantation is an example of multi- disciplinary team approach involving not only urologists and nephrologists, but also anaesthetists. neurosurgeons and pathologists working in concert to produce the best results for the patient. Each recipient surgery is a study of the anatomy of the pelvis and each donor surgery is a study of retroperitoneal anatomy. Hence it requires considerable training and has a steep learning curve. In spite of the being done with considerable surgical expertise and careful nephrological management, some cases of renal transplant recipients do not achieve the expected graft function in the long run. one such factor predicting the graft functioning in the long run is the estimation of early graft function at the end of the first week post transplant . in this study we have analysed the factors responsible for the early graft functioning of both live and cadaver renal transplants and the causes for delayed graft functioning. AIM OF THE STUDY: To determine the factors predicting early graft function in both live and cadaver renal transplantations. To determine the factors responsible for delayed graft functioning. MATERIALS AND METHODS: Inclusion Criteria: All renal transplantation cases done between march 16, 2013 to march 4, 2014. Exclusion Criteria: Patients with a failed previous transplantation. Informed consent obtained from all the patients after explaining details of the study. All details were recorded in a proforma as an inpatient procedure. Analysis was done with the collected details prospectively. Donor age , sex, BMI, comorbid illness, functioning status of the donor kidney (renogram) were collected. Recipient factors like age, sex, BMI, duration and severity of ESRD,associated bladder (cystogram) disorders will be collected Operative factors like perfusion time, cold ischemia time, type of perfusion solution, perfusion before versus after bench dissection, anastamosis time were noted. Other inadvertent factors like blood pressure fall, need for blood transfusion, vasopressor support were also recorded. CONCLUSION : In conclusion , our study shows that delayed graft functioning is a independent prognostic factor to predict the long term graft survival . It is an even more significant predictor of graft survival than HLA matching and thus achieving early graft function is of paramount importance. In our study we found out that prolonged cold ischemia time and significant hypotension both independently can produce delayed graft function .Hence every effort should be made to reduce the duration of cold ischemia in cadaveric transplantations as well as to avoid significant hypotension. Other factors like recipient age, gender, ABO mismatch, donor side were not significant predictors of delayed graft function