First experience of cadaveric renal transplantation in Sri Lanka

Objectives: To analyse the outcome of 50 consecutive cadaveric renal transplants performed in Sri Lanka.

Methods: This was a single-centre longitudinal cohort study conducted in the Nephrology and Kidney Transplant Unit, Teaching Hospital Kandy, Sri Lanka. Records of 50 Sri Lankan cadaveric renal transplant recipients from 7th December 2004 to 1st September 2013 were reviewed and categorized according to early graft function, cold ischaemia time and the duration of dialysis before surgery.

Results: Out of the 50 patients, twenty one (42%) had immediate graft function (IGF), 26 (52%) delayed graft function (DGF), and 2 (4%) primary non function (PNF). The average cold ischaemia time (CIT) was 8.8 hours. Out of 23 patients who died during the study period, 19 (82.6%) died although they had a functioning graft. Infection was the commonest cause of death (n=15; 65.2%). Rejection occurred in four (17.4%). Patient survival was 77.3% at one year, 63.0% at three years and 46% at five years. Graft survival was 93.2% at one year, 88.9% at 3 years and 84.6% at 5 years when death with a functioning graft was censored. Univariate analysis revealed that neither CIT nor duration of dialysis before transplant affected patient survival. There was no significant difference in patient survival between DGF and IGF.

Conclusions: The events occurring in the early period following renal transplantation do not have a significant impact on long term graft outcome or patient survival. Infection is the commonest cause of death after renal transplantation and efforts should be directed to understand and prevent this complication.