Renal Transplant and outcomes at 1wins, Trichy

G. Balaji

Consultant Nephrologist, 1win, Cantonment, Trichy

Background

One in 10 person in the world suffers from CKD. Nearly 800 million people suffer from CKD worldwide. CKD can occur in any age, Etiology may varies but DM and HT are the two most common causes for CKD. The common treatment options for CKD were renal transplant, haemodialysis and peritoneal dialysis.

Renal transplantation is a definitive treatment for CKD; there are 2 types of renal transplant,

Isograft – between identical twins
Allograft – members of same species.

Allograft renal transplant

Most common type of transplant in India

Living donor – related, unrelated donors
Cadaveric donor – donation after brain dead

Management of renal allograft recipient

Triple immune suppressants- TAC/MMF/Steroids
Induction agents- based of risk profile
Basiliximab/ATG/ATLG

Introduction

Renal transplant at Kauvery was started in year 2010, majority were living donors. We are nearing 1000 transplants so far,

Total renal transplants done at Kauvery since 2014

Living donor transplant – 682
Cadaveric donor transplant – 77

Results and Discussion

1. Year wise distribution of living donor transplants

Year	Alive	%	Death	%	Failure	%	Nephrectomy	%	Not follow	%	Total
2014	1	17	3	50	2	33	0	0	0	0	6
2015	4	44	3	33	2	22	0	0	0	0	9
2016	6	29	9	43	5	24	0	0	1	5	21
2017	25	40	27	43	6	10	3	5	2	3	63
2018	26	49	13	25	12	23	0	0	2	4	53
2019	36	62	13	22	7	12	1	2	1	2	58
2020	28	61	14	30	4	9	0	0	0	0	46
2021	87	78	15	14	4	4	2	2	3	3	111
2022	86	77	18	16	7	6	0	0	1	1	112
2023	94	86	11	10	4	4	0	0	0	0	109
2024	84	89	8	9	0	0	2	2	0	0	94
Over All	477	70	134	20	53	8	8	1	10	1	682

2. Sex distribution of living donor transplant

Year	Male	%	Female	%	Total
2014	6	100	0	0	6
2015	8	89	1	11	9
2016	17	81	4	19	21
2017	54	86	9	14	63
2018	45	85	8	15	53
2019	45	78	13	22	58
2020	39	85	7	15	46
2021	92	83	19	17	111
2022	93	83	19	17	112
2023	93	85	16	15	109
2024	85	90	9	10	94
Over All	577	85	105	15	682

3. Male recipients

Year	Age					Male Total	%
	10–20	21–30	31–40	41–50	Above 50
2014	0	1	3	2	0	6	100%
2015	0	0	6	2	0	8	89%
2016	1	5	5	3	3	17	81%
2017	4	12	18	13	7	54	86%
2018	6	12	14	9	4	45	85%
2019		12	15	11	7	45	78%
2020	2	11	14	8	4	39	85%
2021	7	29	25	20	11	92	83%
2022	3	21	30	28	11	93	83%
2023	6	18	26	25	18	93	85%
2024	2	21	18	28	16	85	90%
Over All	31	142	174	149	81	577	85%

4. Female recipients

Year	Female					Female Total	%
	10–20	21–30	31–40	41–50	Above 50
2014	0	0	0	0	0	0	0%
2015	0	1	0	0	0	1	11%
2016	0	3	1			4	19%
2017	1	4		2	2	9	14%
2018	1	1	4		2	8	15%
2019	0	5	4	4		13	22%
2020	0	1	5	1		7	15%
2021	4	2	9	3	1	19	17%
2022	2	3	10	3	1	19	17%
2023	0	6	6	4		16	15%
2024	0	1	5	1	2	9	10%
Over All	8	27	44	18	8	105	15%

5. Age wise outcome of living donor transplant

Age	Alive	%	Death	%	Failure	%	Nephrectomy	%	Not follow	%	Total
10–20	27	69	7	18	4	10	0	0	1	3	39
21–30	120	71	23	14	24	14	1	1	1	1	169
31–40	148	68	46	21	16	7	4	2	4	2	218
41–50	125	75	31	19	8	5	1	1	2	1	167
Above 50	57	64	27	30	1	1	2	2	2	2	89
Over All	477	70	134	20	53	8	8	1	10	1	682

6. Donor relationship with recipients

Relationship	Total
Mother	257
Wife	140
Others	106
Father	85
Sister	71
Brother	12
Husband	11
Over All	682

7. Recipient survival after transplant

Year	Alive - Follow up					Alive Total
	1	2–3	4–5	6–7	More than 8
2014	-	-	-	-	1	1
2015	-	-	-	-	4	4
2016	-	-	-	-	6	6
2017	-	-	-	-	25	25
2018	-	-	-	26	-	26
2019	-	-	-	36	-	36
2020	-	-	28	-	-	28
2021	-	-	87	-	-	87
2022	-	86	-	-	-	86
2023	-	94	-	-	-	94
2024	84	-	-	-	-	84
Over All	84	180	115	62	36	477

8. Transplant outcomes

Year	Alive - Follow up					Alive Total	Death - Follow up					Death Total	Failure - Follow up				Failure Total
	1	2–3	4–5	6–7	More than 8		1	2–3	4–5	6–7	More than 8		2–3	4–5	6–7	More than 8
2014	-	-	-	-	1	1	-	-	-	-	3	3	-	-		2	2
2015	-	-	-	-	4	4	-	-	-	-	3	3	-	-		2	2
2016	-	-	-	-	6	6	-	-	-	-	9	9	-	-		5	5
2017	-	-	-	-	25	25	-	-	-	-	27	27	-	-		6	6
2018	-	-	-	26	-	26	-	-	-	13	-	13	-	-	12	-	12
2019	-	-	-	36	-	36	-	-	-	13	-	13	-	-	7	-	7
2020	-	-	28	-	-	28	-	-	14	-	-	14	-	4	-	-	4
2021	-	-	87	-	-	87	-	-	15	-	-	15	-	4	-	-	4
2022	-	86	-	-	-	86	-	18	-	-	-	18	7	-	-	-	7
2023	-	94	-	-	-	94	-	11	-	-	-	11	4	-	-	-	4
2024	84	-	-	-	-	84	8		-	-	-	8	-	-	-	-	-
Over All	84	180	115	62	36	477	8	29	29	26	42	134	11	8	19	15	53

9. Living donor- recipient’s outcome

Year	Nephrectomy - Follow up				Nephrectomy Total	Not follow - Follow up				Not follow Total
	1	4–5	6–7	More than 8		2–3	4–5	6–7	More than 8
2014	-	-	-	-	-	-	-	-	-	-
2015	-	-	-	-	-	-	-	-	-	-
2016	-	-	-	-	-	-	-	-	1	1
2017	-	-	-	-	3	-	-	-	2	2
2018	-	-	-	-	-	-	-	2	-	2
2019	-	-	1	-	1	-	-	1	-	1
2020	-	-	-	-	-	-	-	-	-	-
2021	-	2	-	-	2	-	3	-	-	3
2022	-	-	-	-	-	1	-	-	-	1
2023	-	-	-	-	-	-	-	-	-	-
2024	2	-	-	-	2	-	-	-	-	-
Over All	2	2	1	3	8	1	3	3	3	10

10. Cadaver transplant

Year	Male	%	Female	%	Total
2014	1	50	1	50	2
2015	4	67	2	33	6
2016	5	83	1	17	6
2017	4	67	2	33	6
2018	7	78	2	22	9
2019	4	100		0	4
2020	3	60	2	40	5
2021	3	75	1	25	4
2022	6	67	3	33	9
2023	9	82	2	18	11
2024	11	73	4	27	15
Over All	57	74	20	26	77

11. Sex distribution of cadaveric recipients

Year	Male					Male Total	%	Female				Female Total	%	Total
	10–20	21–30	31–40	41–50	Above 50			21–30	31–40	41–50	Above 50
2014	-	-	-	1	-	1	50%	-	1	-	-	1	50%	2
2015	-	1	2	1	-	4	67%	-	1	1	-	2	33%	6
2016	1	-	2	2	-	5	83%	-	-	1	-	1	17%	6
2017	-	-	3		1	4	67%	-	-	2	-	2	33%	6
2018	-	1	-	4	2	7	78%	-	1		1	2	22%	9
2019	-	2	-	1	1	4	100%	-	-	-	-	0	0%	4
2020	-	1	1	-	1	3	60%	2	-	-	-	2	40%	5
2021	-	-	1	2	-	3	75%	-	-	1	-	1	25%	4
2022	1	-		4	1	6	67%	-	-	2	1	3	33%	9
2023	-	-	2	4	3	9	82%	-	1	1	-	2	18%	11
2024	-	2	1	4	4	11	73%	1		2	1	4	27%	15
Over All	2	7	12	23	13	57	74%	3	4	10	3	20	26%	77

12. Cadaver kidney recipients age distribution

Age	Alive	%	Death	%	Failure	%	Nephrectomy	%	Not on follow up	%	Total
10–20	0	0	2	100	0	0	0	0	0	0	2
21–30	5	50	3	30	2	20	0	0	0	0	10
31–40	5	31	7	44	2	13	0	0	2	13	16
41–50	20	61	11	33	0	0	1	3	1	3	33
Above 50	9	56	6	38	1	6	0	0	0	0	16
Over All	39	51	29	38	5	6	1	1	3	4	77

13. Cadaver transplant outcome

Year	Alive	%	Death	%	Failure	%	Nephrectomy	%	Not follow	%	Total
2014	0	0	0	0	0	0	0	0	2	100	2
2015	2	33	2	33	1	17	0	0	1	17	6
2016	1	17	4	67	1	17	0	0	0	0	6
2017	1	17	4	67	0	0	1	17	0	0	6
2018	4	44	5	56	0	0	0	0	0	0	9
2019	1	25	0	0	3	75	0	0	0	0	4
2020	3	60	2	40	0	0	0	0	0	0	5
2021	2	50	2	50	0	0	0	0	0	0	4
2022	3	33	6	67	0	0	0	0	0	0	9
2023	10	91	1	9	0	0	0	0	0	0	11
2024	12	80	3	20	0	0	0	0	0	0	15
Over All	39	51	29	38	5	6	1	1	3	4	77

14. Cadaver outcome over years

Year	Alive - Follow up					Alive Total	Death - Follow up					Death Total	Failure - Follow up		Failure Total
	1	2–3	4–5	6–7	More than 8		1	2–3	4–5	6–7	More than 8		6–7	More than 8
2014	-	-	-	-	-		-	-	-	-	-	-	-	-	-
2015	-	-	-	-	2	2	-	-	-	-	2	-	-	1	1
2016	-	-	-	-	1	1	-	-	-	-	4	-	-	1	1
2017	-	-	-	-	1	1	-	-	-	-	4	-	-	-	-
2018	-	-	-	4	-	4	-	-	-	5	-	-	-	-	-
2019	-	-	-	1	-	1	-	-	-	-	-	-	3	-	-
2020	-	-	3	-	-	3	-	-	2	-	-	-	-	-	-
2021	-	-	2	-	-	2	-	-	2	-	-	-	-	-	-
2022	-	3		-	-	3	-	6	-	-	-	-	-	-	-
2023	-	10		-	-	10	-	1	-	-	-	-	-	-	-
2024	12			-	-	12	3		-	-	-	3	-	-	-
Over All	12	13	5	5	4	39	3	7	4	5	10	29	3	2	5

15. Cadaver recipients follow up

Year	Alive	%	Death	%	Failure	%	Nephrectomy	%	Not follow	%	Total
1	12	80	3	20	0	0	0	0	0	0	15
2–3	13	65	7	35	0	0	0	0	0	0	20
4–5	5	56	4	44	0	0	0	0	0	0	9
6–7	5	38	5	38	3	23	0	0	0	0	13
More than 8	4	20	10	50	2	10	1	5	3	15	20
Over All	39	51	29	38	5	6	1	1	3	4	77

Conclusion

Renal transplant is the definitive treatment for CKD patients. In spite of complications of renal transplant such as rejection, infections, survival rate with renal transplant is better than HD/PD. Outcomes are improving for cadaver transplant recipients.

Outcomes can be further improved by better selection of patients and regular monitoring and follow up.

Acknowledgment

Nephrologists
Urologists
Anesthesiologists
All other departments
Nursing community
Lab services/transport dept
Transplant Co-Ordinators
Kauvery Management.

Kauverian Bookshelf

Applied Medical Statistics

Renal Transplant and outcomes at 1wins, Trichy