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Kidney transplantation (KT) is an ideal treatment for end stage kidney failure patients. 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 the staffs training at CRH and receiving the approval from the Ministry of Health, TNH started the first KT in May 10, 2022, with the support of CRH. We report the first 5 new case of KT proceeded within the 2 years of ISN-TTS STCP level B (2022-2023)
Case series report 5 living related KT, performed by both teams CRH and TNH from May 2022 to Aug 2023. For the KT procedures, CRH team predominantly performed in the first 3 cases of KT, then partially transferred to TNH team in the next 2 cases of KT. All donors and recipients were originated from TNH and has been followed by TNH nephrologist team pre- and post KT. Simulect and pulse methylprednisolone were used for induction therapy. Triple regimen with tacrolimus, mycofenolate mofetil and prednisone used for maintenance therapy.
In the 5 living related KT, the donor sources were 3 from parents and 2 from siblings, mean donor age was 42yo. All donors were healthy, mean eGFR (CKD-EPI 2021) 101 ml/min/1.73m2. The panel reactive antibodies were mainly negative or very low (2%).The mean number of HLA mismatch varied from 0-3. Laparoscopic nephrectomy was proceeded in all left donor kidneys. Only the 3rd donor had 2 left renal arteries. After mean length of stay (LOS) of 7 days, the donors were discharged without complication. Mean eGFR at 3 month- post kidney donation was 75ml/min/1,73.
Simulect were used for induction therapy in the first 4 cases and was not available for the last case. All recipients had immediate graft function. Mean recipient LOS was 10 days. The post operative period was unremarkable, only 1 patient spontaneously voided part of the JJ catheter on day 5, led to the early removal of this catheter. All patients tolerated to the immunosuppressive drugs. No acute rejection was reported. Mean serum creatinine post KT was 95.8 and 111 mM/L at 5 days and 3 month (only for 3 cases).
Pair 1
Pair 2
Pair 3
Pair 4
Pair 5
Donor characteristics
Relation with the recipient
Mother
Father
Sister
Brother
Age (yo)
46
51
35
32
BMI (kg/m2)
18.36
21.45
25.91
26.06
22.5
Pre-kidney donation
- Serum creatinine (mM/L)
61.1
60.0
78
96
64
- eGFR (CKD-EPI 2021)
108
112
88
93
104
24h albuminuria (mg)
2.9
1.0
16.31
3.27
12.26
LOS (days)
6
8
7
Post kidney donation at 3 months
- serum creatinine (mM/L)
81
105
113
101
73
76
60
Recipient characteristics
Gender
Male
Female
16
17
24
20.56
17.39
20.29
16.71
25.6
Causes of End stage kidney failure
FSGS
Unknown
Hypertension
IgA nephropathy
Waiting time (months)
9
22
52
20
Number of HLA mismatch
3
1
0
2
PRA (%)
2% ( class I)
14
10
Post kidney transplantation
Serum creatinine
-after 5 days
94
109
74
99
-3 months
117
124
92
Proteinuria at 3 months
0.2
0.06
After the successful outcomes of the first 5 cases of KT with the hand-on support from CRH, TNH will grow to become the 24th independent KT center of Vietnam in the nearest future.