Deceased Donor Renal Transplantation: Our Experience at a Tertiary Care Centre in Karnataka, India

Abstract

Introduction and Objective: End-stage renal disease (ESRD) causes renal failure requiring renal replacement therapies like dialysis or transplantation. [1] With the increasing incidence of diabetes, hypertension and aging population ESRD prevalence is rising [2]. In India, 1,75,000 ESRD patients are added every year out of which only 10% receive renal replacement therapy and 2.4% undergo transplantation. Due to limited live donor pool and stringent rules on unrelated donors there is a significant organ shortage. Deceased Donor Renal Transplantation (DDRT) is an effective solution for bridging the gap in demand and supply [4]. This paper presents our five-year DDRT experience (Jan 2019 – Sept 2024), analysing demographics, outcomes and various other factors highlighting the need to expand DDRT to meet rising demand of renal transplantation among ESRD patients, especially without a live related donor.
Methods: A retrospective study was done, and data was compiled and analysed of 32 recipients who underwent deceased donor renal transplantations done between January 2019 – September 2024 under the Department of Urology at our centre. Various donor and recipient characteristics were analysed with other factors affecting the outcome of deceased donor renal transplantation, postoperative complications along with graft and patient survival.
Results: The mean recipient age was 45 ± 11 years and donor age was 39 ± 12 years, with 31% of recipients and 22% of donors being female. Chronic interstitial nephritis was the primary cause of ESRD, followed by chronic glomerulonephritis. All patients received preoperative induction with anti-thymocyte globulin (ATG) and postoperative immunosuppression with a Tacrolimus-based regimen. The mean cold ischemia time (CIT) was 573 ± 217 minutes, with CIT >600 minutes showing a statistically significant association with delayed graft function (DGF) and acute rejection (p = 0.038). DGF occurred in 47% of patients, while acute rejection affected 18%, with antibody-mediated rejection (ABMR) as the predominant type (50%). Graft nephrectomy was required in 12.5% of cases, primarily due to ABMR. Post-transplant mortality was 18.8%, mainly due to sepsis and cardiovascular events. Patient survival rates were 76% at 1 year and 73.3% at 2 years, while graft survival was 72% at 1 year and 66.6% at 2 years. Kaplan-Meier analysis showed mean patient survival of 46.6 ± 4.8 months and mean graft survival of 51.6 ± 3.8 months.Conclusion: Our study highlights the effectiveness of DDRT at our centre, with favourable patient and graft survival rates. Our study also concludes that DDRT is an excellent alternative to fill the organ shortage by increasing the donor pool for renal transplantation and improve the outcome and QOL of ESRD patients especially without a live related donor awaiting transplantation.