This study analyzed 415 consecutive living donor renal transplants performed in Sri Lanka between 2006-2011 to identify factors affecting overall graft and patient outcomes. The results showed a 92% graft survival rate and 85% overall patient survival rate at a mean follow up of 36 months. Acute rejection within the first month was identified as an independent predictor of poor graft outcome. The study concluded that earlier referral for transplant, better HLA matching, increasing the donor pool, and balancing graft survival vs. patient survival could help optimize outcomes.

1. Gunawansa N,
Cassim MRN,
Wijeyaratne SM.
LIVE DONOR RENAL
TRANSPLANTATION
IN SRILANKA: FACTORS AFFECTING
OVERALL OUTCOME

2. Kidney transplantation is the most
effective therapy for ESRD
Ojo, J Am Soc Neph, 2001;12:589
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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3. Introduction
• Medium and long-term patient / graft survival
statistics after Live Donor Renal Transplantation (LDRT)
in Sri Lanka is largely unknown
• The overall outcome of LDRT depends on numerous
patient, donor and graft related variables
• Early identification of above predictors will help in
optimizing overall graft and patient outcomes
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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4. Methodology
• Prospective computerized database
• July 2006 – November 2011
• University Vascular and Transplant Unit, Colombo.
• Inclusion – All consecutive LDRT
• Exclusion – re-transplants, cadaveric
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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5. Methodology contd.
• All transplants performed as simultaneous donor and
recipient operations
• relatively constant cold ischaemia time of <2 hours
• Standardized immunosuppression regime (MMF,
prednisolone, cyclosporin/tacrolimus)
• Single dose monoclonal Ab induction for those with a HL
A mismatch >50%
Graft failure = need for maintenance dialysis,
re-transplantation or death due to graft non-function
within 1 yr of transplantation*
* Weiss-Salz et al. Clin Transplant 2004: 18: 571–575
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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6. Factors Determining Overall Outcome
• Type of donor (cadaveric vs. living)
• HLA Matching (related, unrelated)
• Sensitization
• Duration of pre-Tx dialysis
• Recipient Age
• Donor Age
• Cold ischaemia time, warm ischaemia time
• Acute rejection, chronic rejection
• Primary renal pathology
• CMV status
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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7. Variables analyzed
• Type of donor (cadaveric vs. living)
• HLA Matching and sensitization
• Duration of pre-Tx dialysis
• Recipient Age
• Donor Age
• Cold ischemia time
• Acute rejection, chronic rejection
• Primary renal pathology
• CMV status
• Multivariate log regression
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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8. Results
• 415 consecutive LDRT
• Complete follow-up data available – 397 (95%)
• Mean follow-up – 36 (3-66) months.
• Mean recipient age – 42 (17-72) years
• Mean donor age – 39 (20-60) years
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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9. 18 Lost to follow up 397 (95%)
complete follow up data
32 (8%) Graft failures
365 (92%) Graft survival
24 PGF 8 SGF
337 (85%)
overall patient survival
5 re-transplanted
19 dead
5 re-transplanted or
3 on waiting list
415 LDRT
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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10. Results contd.
• Graft survival - 365/397 (92%)
• Graft Failures (GF); 32 (8%)
– 24 primary GF
– 05 successfully re-transplanted, 19 dead
– 08 secondary GF (Mean graft survival – 10 months)
– 05 re-transplanted, 03 activated on waiting list
• Overall patient survival – 337/397 (85%)
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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11. Causes of death
• Sepsis – 48 (80%)
• myocardial ischaemia – 4 (7%)
• stroke – 4 (7%)
• PE – 2 (3%)
• Unknown – 2 (3%)
Sepsis MI Stroke PE Other
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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12. Kaplan- Meir Curve – Graft survival
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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13. Predictors of GF
Variable Univariate analysis
P
Multivariate analysis
OR (95%CI) P
Recipient age: >50y/<50y 0.63 0.06-5.13 0.627
Donor age: >40y/<40y 0.85 0.12-4.22 0.71
CMV infection: Y/N 0.11 0.86-15.07 0.09
HLA mismatch: >50%/<50% 0.04 1.74-6.64 0.07
Pre-Tx dialysis:
<12 months/<12 months
0.03 1.17-13.54 0.06
Biopsy proven ac. Rejection:
Y/N
0.01 1.35-10.23 0.014
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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14. Conclusions
• Our mid-term graft / patient survival figures match
favorably with comparable settings elsewhere
• Pre-Tx dialysis for >1 year, HLA mismatch of >50%
showed a positive correlation to outcome although not
statistically significant
• Acute rejection within the first month was an independent
predictors of poor outcome
• Care of primary GF is suboptimal - restricted access to
HD, advanced immunosuppressant regimes and the
lack of a cadaveric transplant program until now
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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15. Recommendations
• Earlier referral for transplant
• Better HLA match wherever possible
• Increasing the donor pool (regular deceased donor
program)
• A better balance of saving the graft versus saving
the patient
LIVE DONOR RENAL TRANSPLANTATION IN SRI LANKA: FACTORS AFFECTING OVERALL OUTCOME
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