Transcript ALL TRANSPLANTS AS PER GUIDELINES BY APPROPRIATE …

Dr. Ravi Angral
MS (PGI Chandigarh)
Transplant & Vascular Surgeon
Kidney Hospital & Lifeline Medical
Institutions, Jalandhar (Punjab)
LANDMARKS

Established in 1990.

Started First Dialysis Unit in Jalandhar in
1991.

Renal Transplantation program started in
1996.
VALUE ADDITION FOR
TRANSPLANT UNIT

Department of Pulmonology & Critical Care
Medicine: To deal with infectious complications.

In-house drug (Tacrolimus) level monitoring:
Micro particles enzymes Immuno Assay (MIA).

State-of-the-Art, 14 bedded Dialysis Unit with
Fresenius AquaB DUO Double Stage RO Plant.
DIALYSIS UNIT
REVERSE OSMOSIS PLANT
(Fresenius AquaB DUO Double Stage RO Plant)
DIALYSIS RECORD
(Oct 2011 to Oct 2012)
Total Dialysis Done in 1 Year: 17268
1800
1600
1400
1200
1000
800
600
400
200
0
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Dialysis Done
RENAL TRANSPLANTATION UNIT
TRANSPLANT COORDINATOR
Kidney Hospital-Transplants
October 1997 to December 2006
60
Oct-97
1998
1999
2000
2001
2002
2003
50
40
30
20
2004
2005
2006
10
0
Total number of Transplants: 299
Kidney Hospital – Transplants
January 2007 to October 2012
Transplants done till date
620
Swap Transplants

First Swap Transplantation
introduced in Feb 2009.
– Husband & Wife from
Himachal Pradesh.
– Husband and Wife from
Uttar Pradesh. Still doing
well, under follow-up

Total swap cases till date: 8
First Swap Transplantation
Participating Couples
Paper Presentation at
International Level
Details of last 100 Transplant Cases
(Apr 2011 to Oct 2012)



Total = 100
Related = 89
Unrelated = 11
– Swap: 3
– Mother-in-Law: 3
– Uncle / Aunt: 2
– Brother-in-Law: 2
– Cousin: 1
All unrelated cases undertaken after getting due permission
from Appropriate Authority and respective Authorization
Committee.
Break-up of 89 Related Donors
Break-up of 11 Unrelated Cases
ALL TRANSPLANTS DONE AS PER GUIDELINES
BY APPROPRIATE AUTHORITY \ DRME

Form 1-A used for Related Donors.

Form 1-B used for Spouses.

Form 1-C used for Unrelated Donors.

For all related donors Form-3 duly signed by
Pathologist confirming relation of related
donor as per HLA match.
GUIDELINES FOLLOWED WITH
REGARD TO RECIPIENT

AFFIDAVITS STATING
– No monetary consideration.
– No middlemen involved.
– Risk involved in surgery, anaesthesia.
GUIDELINES FOLLOWED WITH
REGARD TO DONOR




Only related donor accepted - brother, sister,
parents, children.
Relations duly supported by - HLA, family
photographs, video films.
Identity - established by voter card, driving
license, I D card, educational certificate.
Affidavits certifying – relation, no monetary
consideration, consent to donate, risk
involved in surgery and anesthesia ,
complications.
DONOR WORK-UP FOR SURGERY
Complete haemogram
 Sugar profile, LFT, Viral markers
 Renal profile – urea , cr., Urine re & me, 24 hrs,
pr/cr ratio
 USG, IVP, DTPA Scan
 CT Angiography
 HLA typing , Lymphocytic cross match , cmv status
 Cardiac clearance – echo, coronary angio
 Gynae clearance
 Psychiatric fitness-by psychiatrist

VIDEO CONSENT

With family members

Nature of procedure

Consent for surgery

Success of transplantation
VIDEO CONSENT
BASIC DISEASE BREAK-UP
MULTIPLE VESSELS

Total cases: 6

Double renal arteries: 5

Triple renal arteries: 1

Managed by bench surgery

All have stable graft function in follow-up
OUR RESULTS OF LAST 1 YEAR

Total Transplants
: 100

Immediate Success
: 100%

Death during transplant : Nil
Rejection Episodes
 Acute Rejections: 13 (13%)
 Antibody Mediated Rejections: 3

Responded to MP + ATG + Retux: 1

ATG + Plasmapherisis + Retux: 1

ATG + Plasmapherisis + IVIG: 1
 Graft failure: 1 case
Paper Presentation at
International Level
MORBIDITY & MORTALITY

No mortality within 30 days of surgery

Expired in Follow-up : 4
– Extensive fungal chest infection: 2
– PCP Pneumonia: 1
– Cardiac event: 1
SURGICAL COMPLICATIONS

Re-exploration: 4 cases
– Perigraft Hematoma
– Compression
– Graft dysfunction
FOLLOW-UP

Recipients
– 1st to 3rd Month : Twice a week
– 3rd to 6th Month : 15 days
– After 6 Months
: Monthly
DONOR
(Regular follow-up)

Every month after discharge for 6 months.

Twice a month for 6 months.

Yearly.
Documents provided for inspection

Application form & connected documents

Original affidavits

Follow-up records

Discharge cards

Original files of transplant cases