1. Recent management of Renal Transplantation in a Developing Country like Bangladesh, R Alam, Islam M S, R Alam, H Rahman, HU Rashid Department of Nephrology, BSMMU, Dhaka, Bangladesh

2. Background   Renal Tx is the treatment of choice for most patients with end stage renal diseases (ESRD).   Despite marked improvements in short-term renal allograft function and survival with newer immunosuppressive drugs, still renal graft loses continue to be a constant problem. (Ref. Transplantation 64:2004.)   Both immunological & non-immunological factors have been identified as an important risk factor to develop chronic graft loss.

3. Background (Contd.)  Cardiovascular complications specially HTN has been to be an independent non- immunological risk factor for graft loss as well as morbidity & mortality in transplanted recipient. (Ref.Nephrol Dial transplant 10: 1995 & Kidney Int.47:1995).  In our Country, renal Transplantation started since 1988 at the then IPGMR now in BSMMU.

4. Only live related Tx. facilities are available at present, though caderveric Tx law has been passed by the Govt. in 1999 but still not implemented due to lack of infrastructure for cadeveric Tx. Only live related Tx. facilities are available at present, though caderveric Tx law has been passed by the Govt. in 1999 but still not implemented due to lack of infrastructure for cadeveric Tx. Donor scarcity is a major factor to increase number of Tx. though huge number of ESRD patients are on MHD & waiting for Tx. Donor scarcity is a major factor to increase number of Tx. though huge number of ESRD patients are on MHD & waiting for Tx. However no published data were available for those patients transplanted in our centre However no published data were available for those patients transplanted in our centre Background ( Contd.)

5. In these study we are trying to: (1) Post Tx evaluation of the recipient. (2) To see the complication of the post Tx. patient. Tx. patient. (3) To observe the survival rate of the Tx. patient. Tx. patient.

6. Materials & Methods: Duration of Study: 1995 – 2005 Total No. of Tx.: 214 No. of Patient survival = 138 (64.48%) Total No. of Death = 57 (26.63%) Total No. of graft dysfunction put on dialysis:19(8.87%)

7. Use of Immno suppressive protocol in our centre: Initial use of immuno suppressive:  Cyclosporine 6mg/kg  MMF 1000mg/day  Prednisolon.5mg/kg NB: - Cyclosporin dose may be adjustable according to C 2 level - No induction therapy given in any patient - No induction therapy given in any patient

8. After one year (maintenance dose)  Azathiopurin 2mg/kg  Prednisolon 7.5 to 10 mg/day NB: Periodic check-up blood count, renal function.

9. RESULTS: Year wise distribution of Tx. Year No. of Tx No. of Death No. of Graft dysfunction put on HD 199572- 19962082 1997921 19981231 19991632 20002983 20012352 20023382 20032684 20041541 20052441

10. Causes of Death  Graft failure = 12 (21.15%)  Infections = 28 (49.12%)  MI = 8 (14.13%)  CVD = 7 (12.28%)  Unexplained = 2(3.51%)

11. No. of Study Recipient : 115 Male: 86 Female: 29 Mean age : 31.52 ±11 (18-48 yrs) Primary causes of ESRD:-  GN = 73 (63.48%)  HTN = 28 (24.35%)  CPN = 10 (8.69%)  DN = 2 (1.74%)  Unknown = 2 (1.74 %)

12. Relation with donor:  Mother = 37 (32.17%)  Brother = 33 (28.70%)  Sister = 18 (15.65%)  Father = 15 (13.14%)  Spouse = 3 (2.61%)  Uncle = 2 (1.73%)

13. Post Tx. evaluation of the Recipient HTN = 83 (72.17%) Acute Graft dysfunction = 42 (36.52%) – recovered Chest Infection = 32 (27%) Post Tx. proteinuria = 29 (25.22%) Chr. Graft dysfunction = 29 (25.22%) DM = 22 (19.13%) UTI = 25 (21.74%) CMV = 18 (15.65%) CVD = 9 (7.83%) Cyst in Tx. Kidney = 7. (6.18%)

14. Post Tx. Survival Rate in our centre 1 year= 85% 3 year= 75% 5 year= 65% 7 year= 55% 10 year= 50%

15. Fig: Tx. Patient Survival Rate

16. Tx. On January,2000

17. Tx. on July, 2003

18. Tx on Oct.,2005 (Mother is Donor)

19. Summary: (1) Renal Tx is the best form of treatment in selective ESRD patients. (2) But number of Tx is inadequate as compared to number of ESRD in each year (3) At present live related Tx is being done at BSMMU, Kidney Foundation,NIKDU & BIRDEM in our country. (4) Mothers are the commonest source of donor. (5) 1 year patient survival rate is about 85%, 5 year about 65% & 10 year 50%. (6) Infection is the major cause of death in post transplant patients.

20. Conclusion:  Only 1–2% of ESRD patients are getting opportunity for Tx.  Quality of life is better after successful Tx.  Can be use these immunosuppression in developing country  To increase number of Tx. needed - - Awareness of Renal disease & Tx. - Awareness of Renal disease & Tx. - To over come the donor scarcity - To over come the donor scarcity - Increase number of Tx. centre. - Increase number of Tx. centre.  Both Govt. and private sector should come forward to over come the obstacles.