Introduction:
Currently, the demand for end-stage chronic kidney disease patients requiring kidney transplantation is increasing, and not only kidney transplantation (KT) but also liver and heart transplantion are on the rise in Vietnam. Since 2019, Thong Nhat Hospital (TNH), a multidiscipline general and affiliated hospital, at Ho Chi Minh City, has participated to the ISN-TTS Trio sister transplantation center program (STCP) with Westmead Hospital (WH) and Cho Ray Hospital (CRH). After completing staff training at CRH and receiving approval from the Ministry of Health, TNH performed its first kidney transplantation on May 10, 2022, with support from CRH. This study have evaluated the results of kidney transplantation in the first 13 cases at Thong Nhat Hospital.
Methods:
Retrospective combined with cross-sectional description, on first 13 patients with kidney transplant performed by both teams CRH and TNH from May 2022 to May 2024. For the KT procedures, CRH team predominantly performed in the first 3 cases of KT, then partially transferred to TNH team in the next 10 cases of KT. All donors and recipients were originated from TNH and has been followed by TNH nephrologist team pre- and post KT. Simulect, pulse methylprednisolone and ATP were used for induction therapy. Triple regimen with tacrolimus, mycofenolate mofetil and prednisone used for maintenance therapy.
Results:
Among the 13 cases of kidney transplantation from living donors: 6 cases involved donors who were the patient's parents, 4 cases involved donors who were the patient's siblings, and the remaining 3 cases involved donors who were not related by blood (among them, one transplant involved a wife donating a kidney to her husband). The average age of the donors was 41.8 years. The average eGFR was 109.6 mcm/L. The mean number of HLA mismatch varied from 0-6. All cases involved the donation of the left kidney, which was retrieved via laparoscopic surgery. The kidney was selected based on glomerular filtration function, with the less functional or diseased kidney (due to conditions like kidney stones, renal cysts, or ureteropelvic junction obstruction) being removed to leave the better-functioning kidney for the donor. Simulect were used for induction therapy in the 9 related pairs, 1 pair was related but had to use methylprednisolone due to lack of simulect. ATP was used as an induction therapy for 3 unrelated pairs. In 13 cases, the donated kidney had one artery, and in one case, the kidney had two arteries. In 12 cases, the right iliac fossa was chosen for transplantation, while in one case, the kidney was transplanted into the left iliac fossa because the recipient had a right iliac artery stenosis. All 13 transplant cases had urine output immediately on the operating table, with an average urine output of 658 ml/h after 24 hours. Kidney function nearly returned to normal after 5 days. The creatinine levels at 5 days and 3 months post-transplant were 94.5 µmol/L and 103.3 µmol/L, respectively. The average hospital stay for kidney recipients was 10 days. Postoperative recovery was stable, with 2 cases of early JJ stent removal due to stent migration to the bladder, and 3 cases of urinary tract infection after surgery. There were no instances of acute rejection. The average hospital stay for donors was 7 days.The average serum creatinine level at 3 month- post kidney donation was 105.2 (mcmol/l).
Conclusions:
All 13 patients who received kidney transplants from living donors were successful, with normal kidney function post-transplant. 100% of the patients had stable postoperative outcomes. All patients tolerated immunosuppressive drugs well, and there were no cases of acute rejection. With support from Cho Ray Hospital through the ISN-TTS Trio sister transplantation center program (STCP), Thong Nhat Hospital is striving to become an independent transplantation center in the coming years.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.