Dr. Ravi Angral MS (PGI Chandigarh) Transplant & Vascular Surgeon

Dr. Ravi AngralDr. Ravi AngralMS (PGI Chandigarh)MS (PGI Chandigarh)

Transplant & Vascular SurgeonTransplant & Vascular Surgeon

Kidney Hospital & Lifeline Medical Kidney Hospital & Lifeline Medical Institutions, Jalandhar (Punjab)Institutions, Jalandhar (Punjab)

LANDMARKSLANDMARKS

Established in 1990.Established in 1990.

Started First Dialysis Unit in Jalandhar in Started First Dialysis Unit in Jalandhar in 1991.1991.

Renal Transplantation program started in Renal Transplantation program started in 1996.1996.

VALUE ADDITION FOR VALUE ADDITION FOR TRANSPLANT UNITTRANSPLANT UNIT

Department of Pulmonology & Critical Care Department of Pulmonology & Critical Care

Medicine:Medicine: To deal with infectious complications. To deal with infectious complications.

In-house drug (Tacrolimus) level monitoring:In-house drug (Tacrolimus) level monitoring:

Micro particles enzymes Immuno Assay (MIA).Micro particles enzymes Immuno Assay (MIA).

State-of-the-Art, 14 bedded Dialysis Unit State-of-the-Art, 14 bedded Dialysis Unit with with

Fresenius AquaB DUO Double Stage RO Plant.Fresenius AquaB DUO Double Stage RO Plant.

DIALYSIS UNITDIALYSIS UNIT

REVERSE OSMOSIS PLANTREVERSE OSMOSIS PLANT((Fresenius AquaB DUO Double Stage RO Plant)Fresenius AquaB DUO Double Stage RO Plant)

DIALYSIS RECORDDIALYSIS RECORD(Oct 2011 to Oct 2012)(Oct 2011 to Oct 2012)

0200400600800

10001200140016001800

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb-

12

Mar

-12

Apr-

12

May

-12

Jun-

12

Jul-1

2

Aug-

12

Sep-

12

Oct

-12

Total Dialysis Done in 1 Year: 17268

Dialysis Done

RENAL TRANSPLANTATION RENAL TRANSPLANTATION UNITUNIT

TRANSPLANT COORDINATORTRANSPLANT COORDINATOR

Kidney Hospital-TransplantsKidney Hospital-TransplantsOctober 1997 to December 2006October 1997 to December 2006

0

10

20

30

40

50

60

Oct-97

1998

1999

2000

2001

2002

2003

2004

2005

2006

Total number of Transplants: 299

Kidney Hospital – TransplantsJanuary 2007 to October 2012

Transplants done till dateTransplants 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 First Swap Transplantation Participating CouplesParticipating Couples

Paper Presentation at International Level

Total = 100Total = 100 Related = 89Related = 89 Unrelated = 11Unrelated = 11

– Swap: 3Swap: 3

– Mother-in-Law: 3Mother-in-Law: 3

– Uncle / Aunt: 2Uncle / Aunt: 2

– Brother-in-Law: 2Brother-in-Law: 2

– Cousin: 1Cousin: 1

All unrelated cases undertaken after getting due permission All unrelated cases undertaken after getting due permission from Appropriate Authority and respective Authorization from Appropriate Authority and respective Authorization

Committee.Committee.

Details of last 100 Transplant CasesDetails of last 100 Transplant Cases(Apr 2011 to Oct 2012)(Apr 2011 to Oct 2012)

Break-up of 89 Related DonorsBreak-up of 89 Related Donors

Break-up of 11 Unrelated CasesBreak-up of 11 Unrelated Cases

ALL TRANSPLANTS DONE AS PER GUIDELINES ALL TRANSPLANTS DONE AS PER GUIDELINES BY APPROPRIATE AUTHORITY \ DRMEBY APPROPRIATE AUTHORITY \ DRME

Form 1-A used for Related Donors.Form 1-A used for Related Donors.

Form 1-B used for Spouses.Form 1-B used for Spouses.

Form 1-C used for Unrelated Donors.Form 1-C used for Unrelated Donors.

For all related donors Form-3 duly signed by For all related donors Form-3 duly signed by

Pathologist confirming relation of related Pathologist confirming relation of related

donor as per HLA match.donor as per HLA match.

GUIDELINES FOLLOWED WITH GUIDELINES FOLLOWED WITH REGARD TO RECIPIENTREGARD TO RECIPIENT

AFFIDAVITS STATING AFFIDAVITS STATING

– No monetary consideration.No monetary consideration.

– No middlemen involved.No middlemen involved.

– Risk involved in surgery, anaesthesia.Risk involved in surgery, anaesthesia.

GUIDELINES FOLLOWED WITH GUIDELINES FOLLOWED WITH REGARD TO DONORREGARD 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 SURGERYDONOR 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 CONSENTVIDEO CONSENT

With family membersWith family members

Nature of procedureNature of procedure

Consent for surgeryConsent for surgery

Success of transplantationSuccess of transplantation

VIDEO CONSENT

BASIC DISEASE BREAK-UPBASIC DISEASE BREAK-UP

MULTIPLE VESSELSMULTIPLE VESSELS

Total cases: 6Total cases: 6

Double renal arteries: 5Double renal arteries: 5

Triple renal arteries: 1Triple renal arteries: 1

Managed by bench surgeryManaged by bench surgery

All have stable graft function in follow-upAll have stable graft function in follow-up

OUR RESULTS OF LAST 1 YEAROUR RESULTS OF LAST 1 YEAR

Total TransplantsTotal Transplants : 100: 100

Immediate SuccessImmediate Success : 100%: 100%

Death during transplantDeath during transplant : Nil: Nil

Rejection EpisodesRejection Episodes

Acute Rejections: 13 (13%)Acute Rejections: 13 (13%)

Antibody Mediated Rejections: 3Antibody Mediated Rejections: 3

Responded to MP + ATG + Retux: 1Responded to MP + ATG + Retux: 1

ATG + Plasmapherisis + Retux: 1ATG + Plasmapherisis + Retux: 1

ATG + Plasmapherisis + IVIG: 1ATG + Plasmapherisis + IVIG: 1

Graft failure: 1 caseGraft failure: 1 case

Paper Presentation at International Level

MORBIDITY & MORTALITYMORBIDITY & MORTALITY

No mortality within 30 days of surgeryNo mortality within 30 days of surgery

Expired in Follow-up : 4Expired in Follow-up : 4

– Extensive fungal chest infection: 2Extensive fungal chest infection: 2

– PCP Pneumonia: 1PCP Pneumonia: 1

– Cardiac event: 1Cardiac event: 1

Re-exploration: 4 casesRe-exploration: 4 cases

– Perigraft HematomaPerigraft Hematoma

– Compression Compression

– Graft dysfunctionGraft dysfunction

SURGICAL COMPLICATIONSSURGICAL COMPLICATIONS

FOLLOW-UPFOLLOW-UP

RecipientsRecipients

– 11stst to 3 to 3rdrd Month Month : Twice a week: Twice a week

– 33rdrd to 6 to 6thth Month Month : 15 days: 15 days

– After 6 MonthsAfter 6 Months : Monthly: Monthly

DONORDONOR(Regular follow-up)(Regular follow-up)

Every month after discharge for 6 months.Every month after discharge for 6 months.

Twice a month for 6 months. Twice a month for 6 months.

Yearly. Yearly.

Documents provided for inspectionDocuments provided for inspection

Application form & connected documentsApplication form & connected documents

Original affidavitsOriginal affidavits

Follow-up recordsFollow-up records

Discharge cardsDischarge cards

Original files of transplant casesOriginal files of transplant cases