#3385 A STUDY OF CLINICAL SPECTRUM AND THE OUTCOME IN LIVE KIDNEY TRANSPLANT RECIPIENTS IN A TERTIARY CARE CENTRE OF INDIA
Authors: Sharma Manjuri , Singh Suresh , Doley Prodip Kumar , Pegu Gayatri 
Published: June 2023

Abstract

Background and Aims
Kidney transplantation has become the treatment of choice for end-stage renal disease as it leads to longer survival and superior quality of life. There is a remarkable disparity in the access and outcome of kidney transplant across the world. Limited health care resources, difficulty in access or sometimes non availability of appropriate medications, difficulties with transportation, limited availability of Nephrologists are common challenges in developing countries and also within a country like India due to diverse socioeconomic and cultural backgrounds. We present the pattern of infection, various causative organisms, causes of allograft dysfunction and the clinical outcome of the admitted live kidney transplant recipients in Nephrology department of a tertiary care center from North-East India.

Method
This was a single center retrospective observational study carried out in Nephrology Department of Gauhati Medical College, Guwahati, India. The data were collected from the medical records. All the admissions of live renal allograft recipients during the period May 2017- May 2022, were included in the study.

Results
Out of a total of 156 admissions of renal transplant recipients, male to female ratio was 3.7: 1. Among the live KTRs basic disease, most common was chronic glomerulonephritis (44.8%) followed by CTID (23.9%). Infection related complications were present in 72 (46.1%) cases. Among infection UTI (n = 29, 16.6%) was most common followed by pneumonia (n = 24, 15.4%). Various causes of graft dysfunction (biopsy proven) were ATI (Acute tubular injury), CNI toxicity, chronic ABMR, acute ABMR, recurrence of basic disease, acute TCMR and chronic TCMR. NODAT was found in 14 (9%) of the cases. Out of theses 4 cases, 1 had bacterial pneumonia and 3 had UTI. Of 72 admissions with infection, total 8 patients succumbed to their illness with mortality rate of 11.1%. The most common cause of mortality was sepsis due to UTI.

Conclusion
The number of admissions of renal transplant cases has increased significantly in last 5 years, indicating the increased availability and affordability of renal transplantation in our country. Of 156 admitted live KTRs, infection was seen in 46.1% (n = 72) cases. UTI remained the most common infection (n = 29, 16.6%) followed by pneumonia (n = 24, 15.4%). Graft dysfunction was seen in 33.9% (n = 53) cases. Chronic ABMR was the most common cause (n = 30, 19.2%) for graft dysfunction. Neglect of necessary hygiene, ignorance of regular follow up and dysregulated immunosuppressive doses have contributed to high infection rate. Lack of regular follow up in post-transplant period due to logistic issues or lack of education and awareness, lack of access to immunosuppressive drugs, etc. are major contributing factors for graft dysfunction in our set up. The condition worsens with the difficult terrain, repeated floods, and lack of transportation from remote areas in Nort Eastern part of India.