Medical Complications in Living Donor Kidney Transplant Recipients in the Developing World

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Abstract

Introduction

Kidney transplantation leads to a complex milieu in the human body. Engraftment of a solid organ with the help of multiple immunomodulating agents in a patient with pre-existing complexity of uremic environment puts these individuals into a special risk of predictable and unforeseen complications. In this study we aim to investigate the medical complications observed during the follow up of living kidney recipients in our centre.

Materials and Methods

First 250 patients who underwent living donor kidney transplant from 8/8/2008 to 16/7/2014 were taken for study. Their follow up data were recorded in Microsoft Excel®. Major medical complications were recorded and descriptive study was done.

Results and Discussion

Of the 250 patients, 202 (80.8%) were male and 48 (19.2%) were females. As data from 26 (10.4%) of these were missing, 224 patients were taken for analysis. Mean age was (35.63±10.9) years.

Results and Discussion

The complications are presented in Table 1.

Results and Discussion

Infections were the most common complication after kidney transplant involving 94.2% of our patients. Despite our infection prevention strategies, lifelong immunosuppression poses a great risk of infections. Our strategies are: vaccination against hepatitis B, influenza, pneumococcus, meningococcus and MMR done at least 1 month prior to transplantation; Ceftriaxone 1g and Cefazolin 1g just before OT; and post transplant universal cytomegalovirus prophylaxis with 450 mg/d valganciclovir for 3 months, Bactrim SS for 6 months, and Candid oral solution for 3 months.

Results and Discussion

As we do not have facilities to diagnose viral infections, all diarrhea episodes have been counted as infection but could be noninfectious.

Results and Discussion

Mandatory use of multiple anti-rejection medications also poses risk to these patients. We use triple immunosuppression with tacrolimus, mycophenolate mofetil (MMF) and prednisolone. We invariably use diltiazem to boost tacrolimus levels. Hypertension, diabetes mellitus, leucopenia and other blood cell disorders, acne and gum hypertrophy are known adverse effects of these medicines. Our study showed hypertension in 91.5% and leucopenia in 35.27% patients. Induction with antithymocyte globulin, and use of valganciclovir, MMF and Bactrim are the potential causes of leucopenia.

Results and Discussion

Posttransplant diabetes mellitus (PTDM) occurred in 33.04% patients.

Results and Discussion

Indication biopsies were performed in 43.3% patients. Total 131 indication biopsies were done, of which 29.01% showed acute cellular rejection, 17.56% showed glomerulonephritis and 12.21% showed antibody mediated injuries. Acute tubular necrosis was seen in 9 patients (biopsy proven-7, clinical-2).

Results and Discussion

Graft renal artery stenosis occurred in 5 patients.

Conclusions

Living donor kidney transplant recipients may suffer a wide range of complications. Infections and graft related complications should be the main targets in their continued care after transplantation.

Keywords

Kidney transplantation, Vaccination, Diabetes mellitus, Hypertension, Tacrolimus

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