135TH ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS 2022
30th September 2022
At BMICH, Colombo.
Symposium on
Solid Organ transplantation
Kidney transplantation - Challenges and
Experiences
Kidney transplantation
Causes for chronic kidney dise
Chronic Kidney Disease of unkn
Paediatric kidney transplant
Teaching Hospital Anuradhapura
The university transplant unit
Live donor nephrectomy
Organ preservation
Iliac vessel mobilisation
Renal vessels ananstomosis
Ureter anastomois
Surgical aspects
user experience
Relationship of live donors (T
Area of residence of donors
Live Donor profile
Donor vascular variations
Vascular reconstruction
6. Kidney transplantation
First successful kidney transplantation in the world - 1954
First live donor Kidney transplantation in Sri Lanka - 1985
First cadaveric donor Kidney transplantation – 2003
Many transplantations are done today – Government / private
Number of potential recipients are also increasing
7. Causes for chronic kidney disease - Adults
Diabetes mellitus - 67.1%
Nephritis - 20.0%
Obstructive uropathy - 4.3%
Chronic Kidney Disease of unknown aetiology (CKDu)
- 2.8% / 94.0% (ANP)
University unit , Colombo
8. Paediatric kidney transplantation
Causes ESRF
Glomerulonephritis - (30%)
Renal dysplasia - (26%)
Reflux Nephropathy - (17%)
Obstructive uropathy - (17%).
The evaluation of kidney transplantation in children and adolescents; a single unit
experience, Colombo : s.n., 2021. 50 Annual Academic Sessions - 2021 of The
College Of Surgeons of Sri Lanka. Vol. 39 Issue Supplement S1 , p. . ISSN 1391-491X.
9. Causes for chronic kidney disease - Adults
Diabetes mellitus - 67.1%
Nephritis - 20.0%
Obstructive uropathy - 4.3%
Chronic Kidney Disease of unknown aetiology (CKDu)
- 2.8% / 94.0% (ANP)
University unit , Colombo
12. Chronic Kidney Disease of Unknown aetiology
(CKDu)
An interstitial nephritis
Affects rice farming
community
Cause
Fertilizers
Pesticides
Dehydration
Males > females
13. Prevalence - 15%–23%
KT recipients (THA)
CKDu - 94.0%
Male : female – 85.4% : 14.6%
Chronic Kidney Disease of Unknown aetiology
(CKDu)
J,Arudchelvam,W Laksiri. Outcome of live Donor renal transplantation among patients with chronic kidney disease of unknown
aetiology (CKDu), Presented at 45th annual Academic Sessions Of The College Of Surgeons Of Sri Lanka, August 2016. Colombo.
14. Prevalence of CKDu – 15%
Population of NCP - 1,259,567 (2011 census)
? Total patients with CKDu - 188935
Chronic Kidney Disease of Unknown aetiology
(CKDu)
World Health Organization Report on Chronic Kidney Disease of Unknown Aetiology in Sri Lanka. [Last visited on 2013 Nov 10].
15. Anuradhapura 2016
Registered patients – 18400
On dialysis – 280
KT done – 18
Dialysis access created in 2016 – 383
In hospital deaths (2016) – 298
J,Arudchelvam,W Laksiri. Outcome of live Donor renal transplantation among patients with chronic kidney disease of unknown
aetiology (CKDu), Presented at 45th annual Academic Sessions Of The College Of Surgeons Of Sri Lanka, August 2016. Colombo
Chronic Kidney Disease of Unknown aetiology
(CKDu)
16. The university transplant unit
Colombo (2017)
Patients on dialysis – 3023
Renal transplantations - 38
Colombo 2017
18. Live donor nephrectomy
Lateral decubitus position
lower costal margin over
the kidney rest
kidney rest is raised and
the operating table is
flexed
19. Live donor nephrectomy
Incision in line with
the 12th rib.
Kidney, ureter, vessels
mobilised
20. Organ preservation
Kidney perfused with cold
preservation solution
Histidine Tryptophan
Ketoglutarate (HTK) solution
28. Kidney Transplantation
Teaching Hospital Anuradhapura
(FEB 2015 TO AUG 2017)
Renal transplants - 52
Live donor - 80.5%
Cadaveric - 19.5%
1.J,Arudchelvam,W Laksiri. Outcome of live Donor renal transplantation among patients with chronic kidney disease of unknown
aetiology (CKDu), Presented at 45th annual Academic Sessions Of The College Of Surgeons Of Sri Lanka, August 2016. Colombo.
2.Arudchelvam, J., (2017). First case of enbloc dual kidney transplantation in Sri Lanka: a case report and review of literature. Sri
Lanka Journal of Surgery. 35(2), pp.24–25. DOI: http://doi.org/10.4038/sljs.v35i2.8387Arudchelvam, J. et al., (2016). The first
simultaneous pancreas kidney transplantion in Sri Lanka. Sri Lanka Journal of Surgery. 35(4), pp.46–47.
29. Gender
Male - 85.4%
Female - 14.6%
Mean age – 41.9 years (20-64)
J,Arudchelvam,W Laksiri. Outcome of live Donor renal transplantation among patients with chronic kidney disease of unknown
aetiology (CKDu), Presented at 45th annual Academic Sessions Of The College Of Surgeons Of Sri Lanka, August 2016. Colombo.
Kidney Transplantation
Teaching Hospital Anuradhapura
(FEB 2015 TO AUG 2017)
32. Relationship of live donors (THA)
42
30
16
12
blood related non related Spouse Distant Relative
0
5
10
15
20
25
30
35
40
45
LIVE DONORS
blood related
non related
Spouse
Distant Relative
Proceedings of the annual Scientific Sessions of The College of Surgeons of Sri Lanka 2017
33. Area of residence of live donors (THA)
97%
3%
AREA
NCP
OUTSIDE
Proceedings of the annual Scientific Sessions of The College of Surgeons of Sri Lanka 2017
34. Kidney transplantation - Colombo
Total - 83
Gender of recipients
Male - 75.3%
Female - 24.7%
Mean age - 45.4 years (15-73)
Donor type
Live - 50 (60.2%)
Deceased donor - 33 (39.8 %)
Colombo 2022 (unpublished)
35. Kidney transplantation
Colombo / Anuradhapura
Colombo ANP
Recipient age (years ) 45.4 (15-73) 41.9 (20-64) P - 0.6913
Male/ female(%) 75.3 / 24.7 85.4/ 14.6 P - 0.1610
Cause of CKD (CKDu) 2.8% 94.0% P < 0.0001
Cause of CKD
(DM)
67.1% 4.5% P < 0.0001
Donors (males %) 64.8% 50.0% P -0.4413
36. Live Donor profile - Colombo
Total - 159
Males - 103 [64.8%]
Mean age - 38.2 years [23-63]
Donor side
Left - 106 [66.7%]
Arudchelvam J, Laksiri W. Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience
of a single surgeon. Sri Lanka Journal of Surgery. 2021;39(2):28–30
37. Donor vascular variations
Number of arteries
• Single RA - 136 [85.5%]
• Early branching- 34 [21.4%]
Arudchelvam J, Laksiri W. Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience of
a single surgeon. Sri Lanka Journal of Surgery. 2021;39(2):28–30. DOI: http://doi.org/10.4038/sljs.v39i2.8817
38. Donor vascular variations
• Multiple RA - 23 [14.5%]
[2 in 21 and 3 in 2]
Arudchelvam J, Laksiri W. Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience of
a single surgeon. Sri Lanka Journal of Surgery. 2021;39(2):28–30. DOI: http://doi.org/10.4038/sljs.v39i2.8817
42. Donor vascular variations and outcome
Renal veins
Single artery - 6.8%
Multiple artery / EB - 25.7% [p-0.004]
Arudchelvam J, Laksiri W. Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience
of a single surgeon. Sri Lanka Journal of Surgery. 2021;39(2):28–30. DOI: http://doi.org/10.4038/sljs.v39i2.8817
43. Donor vascular variations and outcome
Association of complications
Haematoma
EB [5.9% vs. 0.8%]
Right DN [3.8% vs. 0.9% / p>0.05].
Arudchelvam J, Laksiri W. Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience
of a single surgeon. Sri Lanka Journal of Surgery. 2021;39(2):28–30. DOI: http://doi.org/10.4038/sljs.v39i2.8817
44. Enbloc renal transplantation
• First enbloc renal transplantation in Sri Lanka
- June 2017
Arudchelvam, J., (2017). First case of enbloc dual kidney transplantation in Sri Lanka: a case report and review of literature. Sri
Lanka Journal of Surgery. 35(2), pp.24–25. DOI: http://doi.org/10.4038/sljs.v35i2.8387Arudchelvam, J. et al., (2016).
45. Enbloc renal transplantation
• 3 ½ year old donor – youngest donor
• Cause of death – snake bite,
respiratory arrest
• Recipient – 44 year old
• At present well and having normal
creatinine
Arudchelvam, J., (2017). First case of enbloc dual kidney transplantation in Sri Lanka: a case report and review of literature. Sri
Lanka Journal of Surgery. 35(2), pp.24–25. DOI: http://doi.org/10.4038/sljs.v35i2.8387Arudchelvam, J. et al., (2016).
46. Outcome of kidney transplantation
Auradhapura
Mean follow up – 59.42 weeks
( 3.7 – 138.8)
Survival – 92.7%
J Arudchelvam, et.al. O u t c o m e o f l i v e d o n o r k i d n e y transplantation (ldkt) among patients with chronic
kidney disease of unknown aetiology (CKDU), ANNUAL ACADEMIC SESSIONS 2016, THE COLLEGE OF SURGEONS
OF SRI lankaat: COLOMBO
47. Outcome of kidney transplantation
University unit
Mean follow up – 4.6 years
Survival – 84.8%
48. Paediatric kidney transplantation
Lady Ridgeway Hospital for Children (LRH) Colombo
Number - 23
Mean age - 11.7 years (4-17)
Males - 65.2%
Mean weight - 24.6 kg.
Live donor KT – 21 (91%)
Pre -emptive - 14(60%)
The outcome of kidney transplantation in children and adolescents: Asingle unit experience. AANishanthan, K AN Chanaka,
AM Alabadaarachchi, J Arudchelvam, M H PGodakandage, M R N Cassim, R M PD Kularathne, S M Wijeyaratne, TD
GooneratneColombo : s.n., 2021. 50 Annual Academic Sessions - 2021 of The College Of Surgeons of Sri Lanka. Vol. 39 Issue
Supplement S1 , p. 77. ISSN 1391-491X.
49. Paediatric kidney transplantation
Early complications
Bleeding - 17%
Pyelonephritis - 4%
Lower respiratory tract infection - 4%
Immediate post op death - 4%
Acute rejection - 34%
Serum creatinine at discharge - 122 mmol/l
The outcome of kidney transplantation in children and adolescents: Asingle unit experience. AANishanthan, K AN Chanaka, AM
Alabadaarachchi, J Arudchelvam, M H PGodakandage, M R N Cassim, R M PD Kularathne, S M Wijeyaratne, TD
GooneratneColombo : s.n., 2021. 50 Annual Academic Sessions - 2021 of The College Of Surgeons of Sri Lanka. Vol. 39 Issue
Supplement S1 , p. 77. ISSN 1391-491X.
50. Paediatric kidney transplantation
Mean follow-up - 24 months (4-60)
Survival – 96.0%
The outcome of kidney transplantation in children and adolescents: Asingle unit experience. AANishanthan, K AN Chanaka,
AM Alabadaarachchi, J Arudchelvam, M H PGodakandage, M R N Cassim, R M PD Kularathne, S M Wijeyaratne, TD
GooneratneColombo : s.n., 2021. 50 Annual Academic Sessions - 2021 of The College Of Surgeons of Sri Lanka. Vol. 39 Issue
Supplement S1 , p. 77. ISSN 1391-491X.
51. Life long treatment and follow up –
poor social back ground
Poor home condition
Exposure to same risk factors for CKDu
Infections
Pneumonia
Fungal
52. Life long treatment and follow up
Unusual infections - Fungal
ANP (from January 2014 to April 2015)
6 cases
Males – 5 (83.3%)
Mean age - 50.2years (42 - 55)
Multiple skin lesions (3-5) involving
hands and feet
Antifungal therapy and local excision
Recurrence - 2 (33.3%)
N Herath, N Madarasingha, R Dassanayake, J,Arudchelvam, et.al.Post Renal Transplant Endemic Fungal Infection; A Case Series.
August 2015 Volume 33, Issue Supplement S ISSN 1391-491X.
53. The future directions
Prevention of Chronic Kidney disease
CKDu
DM
Improve deceased donor numbers
Introduce more facilities to the transplantation centres
Improve the social and economic status