الفهرس 
Acknowledgement
Chapter ( 1 )Only 14 pages are availabe for public view
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Abstract
In patients with ESRD receiving kidney replacement therapy transplant enormously improves quality of life and survival, However, because of the high demand and limited supply of available kidneys, many patients will undergo dialysis for up to many years or more before kidney transplant. After transplantation, maximizing graft longevity becomes a focus of care. Graft loss results in return to dialysis, retransplantation, or death. Better results are associated with shorter periods of time on dialysis and the best results are achieved with preemptive transplantation.
Timely referral for transplantation is essential to maximize benefit and should begin when patients estimated glomerular filtration rate drops to less than 20 ml/min/m.
This prospective cohort study was established to evaluate kidney transplant in Assuit university hospital and to predict the outcome after one year.
Evaluation factors affecting renal graft survival were illustrated in this study as before and after one year, with determining of the difficulties facing this transplant program.
Since the current immunosuppressive regimens play a central role in its pathogenesis, relentless efforts should be made to define the optimal steroid and/or calcineurin inhibitors sparing protocols.
Medical Evaluation of the Living Donor according to protocol and priority in nephrology unite were recorded along with Medical evaluation of the recipient
Complications of renal transplantation can be classified as pathological or surgical. Pathological complications include rejection, infection, and cardiovascular events, while surgical complications involve vascular and urological complications, lymphocele, wound infection, and herniation.
In the current study we evaluated different characteristics of 40 renal recipients and their donors. Renal recipient had significantly lower mean age in comparison to donors (30.55±10.24 vs. 41.28±9.83 (years); p< 0.001). Majority (95%) of recipients was males while majority (70%) of donors was females (p< 0.001). Majority of both groups was married. Also, majority (72.5%) of recipients was employed and majority (62.5%) of donors was un-employed.
Major causes of ESRD (55%) unknown etiology were chronic pyelonephritis in 7 (17.5%) followed polycystic kidney disease in two patients. Mean duration of dialysis before transplantation was 18.1±21.88 months. Mother was the most frequent donor (32.5%) followed by the sister (25%) and the brother (15%). Three recipients received graft from their fathers. There was only one living un-related donor.
After transplantation; there was significant increase in hemoglobin level and calcium with significant reduction in phosphorus, urea and creatinine. Other data showed no significant change after transplantation as sodium, potassium, magnesium, alkaline phosphatase, PTH and glucose.
There were 7 (17.5%) patients had surgical difficulty transplantation Two patients suffered acute rejection while 5 (12.5%) patients had chronic rejection. Three patients developed DM and 17 (42.5%) patients developed HTN. Uremic cardiomyopathy was improved in all patients. Seven patients had proteinuria.
A total of 6 (15%) recipients were died and 34 (85%) subjects were still alive. Based on the current study, predictors for posttransplataion complications were history of diabetes mellitus, pre-transplantation leucocytosis, and high blood urea nitrogen and creatinine, history of renal disease, age and low-density lipoproteins.
In conclusion although renal transplantation- in usual- has many benefits with generally accepted outcome, some patients may develop postoperative complications up to graft loss or even mortality. So, frequent evaluation of patients with high vulnerability to such complications is mandatory. The optimal utilization of the factors we have identified as risk factors, in development of future risk prediction models, may improve discrimination and calibration. Such models in turn may guide the judgment clinicians need to make on the highest risk recipient and donor.
Future recommendations include follow up:
- Renal transplant patients more than one year to determine long term outcomes and complications.
- Using different protocols still requires further investigation.