indian journal of transplantation 9 (2015) 73–81
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Abstracts Poster Abstract #: ISOT2015-72 Challenges in management in donor kidney with PUJ obstruction – Case report Areef Tamboli, Umesh Oza, S.W. Thatte, Bichu Bombay Hospital Institute of Health sciences, Mumbai, India Background: PUJ obstruction is one of the most important cause of upper urinary tract obstruction. Intermittent or Partial PUJO is a challenge to diagnose and deal with and produces difﬁculties intraoperatively. It can have serious implications in recipient. Aims: Evaluation and management of borderline donor PUJ obstruction. Methodology: A 25-year-old male underwent a live-related renal transplant for end-stage renal disease in March 2015. He received a haplo-matched kidney from his aunt. Imaging of the donor showed a box-shaped extra-renal pelvis on the left side. The donor never had any symptoms and the preoperative well-tempered diuretic renogram revealed a normal drainage pattern with no evidence of obstruction. Intraoperatively, however, there was inadequate drainage from PUJ, with morphology suggestive of PUJO. So decision for pelvi-native ureterostomy was taken. DJ stent was placed across the anastomosis. Stent was removed after 3 wks. However patient could not pass urine. USG showed ballooning of renal pelvis. PCN was put as wire could not be negotiated across PUJ. Later retrograde DJ was put. Stent removed after 2 wks; however, patient had similar problems. Decision for reexploration was taken. Intraoperatively, PUJ was nondependent, so redo anastomosis was done over stent. Stent was removed after 4 wks. Results: Postoperative course was uneventful with stable graft function with serum creatinine maintained at 1 mg%. Conclusions: Borderline or intermittent PUJ obstruction is a challenge to diagnose and manage. It may have a serious implications in recipient. Diuretic renogram commonly used in these cases gives equivocal results in 15–17% cases. In case of doubt, intraoperative decision is most important. http://dx.doi.org/10.1016/j.ijt.2015.09.063 Abstract #: ISOT2015-32 Predictors of delayed graft function in renal allograft recipients Elenjickal Elias John, J.S. Sandhu Dayanand Medical College And Hospital, Ludhiana, India Background: Delayed graft function is a common complication affecting renal grafts immediately post-transplantation.
DGF is deﬁned as serum creatinine more than 3 mg/dl with requirement for dialysis within 1 week of transplant. Although the causes of DGF include prerenal,intrarenal and post-renal insults, ischemic ATN is by far the most common cause. Risk factors of DGF include recipient factors like male sex, longer dialysis vintage, and HLA mismatching and donor factors like advanced age and cold ischemia time. Aims: (1) To study the incidence and causes of DGF among renal allograft recipients at our center. (2)To analyse various donor and recipient factors affecting early graft function. Methodology: This study was carried out in the Department of Nephrology and Renal Transplant at Dayanand Medical College Ludhiana. All patients undergoing renal transplantation between 1st January 2015 till 31st June 2015 were included in this study. A detailed history of baseline donor and recipient charachteristics were taken. Recipient characteristics included age, gender, BMI, basic disease, time spent on dialysis, prior blood transfusions, prior failed transplantation, and cross matching proﬁle. Donor characteristics include age, sex, relationship with recipient and donor eGFR. Graft function and clinical proﬁle of these patients were studied upto 1 week posttransplant. Tacrolimus levels were sent on day 4 of transplant. All cases of DGF were subjected to Doppler ultrasound of transplant kidney and kidney biopsy. All cases of rejection were classiﬁed as per Modiﬁed Banff Classiﬁcation of Renal Allograft Pathology. Results: A total of 52 patients underwent renal transplantation at our center. Of the 52 recipients, 44 were males and 8 were females. All transplants were carried out among live related donors. Of the 52 recipients, 14 developed DGF (26.9%). The most common cause of DGF was ATN (5 cases). Acute Antibody Mediated Rejection occurred in 3 cases who were treated with pulse steroid, Plasmapheresis and Iv Ig. Repeat renal biopsy was done in these 3 patients after 7 days of treatment. Clinical and histological recovery seen in all 3 of them. Of the 14 cases of DGF, 2 developed acute cellular rejection and were treated with pulse steroid. The remaining cases of DGF were due to urological causes, i.e., lymphocoele, urinary leak, transplant kidney pyonephrosis, and renal vein thrombosis. There was 1 case of allograft loss due to renal vein thrombosis wherein patient underwent transplant kidney nephrectomy. Advanced donor age was found to be the most signiﬁcantly associated risk factor of DGF. Conclusions: The prevalence of DGF varies from center to center. DGF is a major obstacle for allograft survival, as it can be compounded by acute rejection and chronic allograft nephropathy. http://dx.doi.org/10.1016/j.ijt.2015.09.064