Dr. Ravi Angral

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• Dr. Ravi Angral
• MS (PGI Chandigarh)
• Transplant Vascular Surgeon
• Kidney Hospital Lifeline Medical Institutions,
  Jalandhar (Punjab)

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LANDMARKS

• Established in 1990.
• Started First Dialysis Unit in Jalandhar in 1991.
• Renal Transplantation program started in 1996.

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VALUE ADDITION FOR TRANSPLANT UNIT

• Department of Pulmonology Critical Care
  Medicine To deal with infectious complications.
• In-house drug (Tacrolimus) level monitoring
  Micro particles enzymes Immuno Assay (MIA).
• State-of-the-Art, 14 bedded Dialysis Unit with
  Fresenius AquaB DUO Double Stage RO Plant.

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DIALYSIS UNIT
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REVERSE OSMOSIS PLANT(Fresenius AquaB DUO Double
Stage RO Plant)
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DIALYSIS RECORD(Oct 2011 to Oct 2012)
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RENAL TRANSPLANTATION UNIT
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TRANSPLANT COORDINATOR
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Kidney Hospital-TransplantsOctober 1997 to
December 2006
Total number of Transplants 299
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Kidney Hospital TransplantsJanuary 2007 to
October 2012
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Transplants done till date
620
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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

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First Swap Transplantation Participating Couples
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Paper Presentation at International Level
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Details of last 100 Transplant Cases(Apr 2011 to
Oct 2012)

• Total 100
• Related 89
• Unrelated 11
• Swap 3
• Mother-in-Law 3
• Uncle / Aunt 2
• Brother-in-Law 2
• Cousin 1
• All unrelated cases undertaken after getting due
  permission from Appropriate Authority and
  respective Authorization Committee.

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Break-up of 89 Related Donors
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Break-up of 11 Unrelated Cases
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ALL TRANSPLANTS DONE AS PER GUIDELINES BY
APPROPRIATE AUTHORITY \ DRME

• Form 1-A used for Related Donors.
• Form 1-B used for Spouses.
• Form 1-C used for Unrelated Donors.
• For all related donors Form-3 duly signed by
  Pathologist confirming relation of related donor
  as per HLA match.

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GUIDELINES FOLLOWED WITH REGARD TO RECIPIENT

• AFFIDAVITS STATING
• No monetary consideration.
• No middlemen involved.
• Risk involved in surgery, anaesthesia.

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GUIDELINES FOLLOWED WITH REGARD 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.

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DONOR 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

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VIDEO CONSENT

• With family members
• Nature of procedure
• Consent for surgery
• Success of transplantation

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VIDEO CONSENT
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BASIC DISEASE BREAK-UP
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MULTIPLE VESSELS

• Total cases 6
• Double renal arteries 5
• Triple renal arteries 1
• Managed by bench surgery
• All have stable graft function in follow-up

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OUR RESULTS OF LAST 1 YEAR

• Total Transplants 100
• Immediate Success 100
• Death during transplant Nil

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Rejection Episodes

• Acute Rejections 13 (13)
• Antibody Mediated Rejections 3
• Responded to MP ATG Retux 1
• ATG Plasmapherisis Retux 1
• ATG Plasmapherisis IVIG 1
• Graft failure 1 case

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Paper Presentation at International Level
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MORBIDITY MORTALITY

• No mortality within 30 days of surgery
• Expired in Follow-up 4
• Extensive fungal chest infection 2
• PCP Pneumonia 1
• Cardiac event 1

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SURGICAL COMPLICATIONS

• Re-exploration 4 cases
• Perigraft Hematoma
• Compression
• Graft dysfunction

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FOLLOW-UP

• Recipients
• 1st to 3rd Month Twice a week
• 3rd to 6th Month 15 days
• After 6 Months Monthly

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DONOR(Regular follow-up)

• Every month after discharge for 6 months.
• Twice a month for 6 months.
• Yearly.

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Documents provided for inspection

• Application form connected documents
• Original affidavits
• Follow-up records
• Discharge cards
• Original files of transplant cases

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