I am currently working as Director and Head of the Department of Nephrology at Medanta Hospital, Gurgaon, which is a multispeciality hospital of 1200 beds in the National capital region Delhi. Dr Bansal has been trained in Nephrology at SGPGIMS Lucknow, considered one of India's best institutes for Nephrology. I am also the coordinator of the DNB Nephrology teaching program in Nephrology and am actively involved in training new Nephrology doctors. Dr Bansal has been involved in the care of more than 3000 kidney transplant recipients till now. Dr Bansal is also an avid researcher and has published more than 100 original articles and many book chapters in the field of Nephrology and kidney transplantation. Some of his notable research work includes the first report of Kidney Transplantation in an HIV-positive patient in India, the First Report and subsequent series of ABO-incompatible kidney transplants in India, the first report of Steroid free kidney transplant in India, paired kidney transplantation in India etc. Recently he published a supplementation on Transplant Infectious disease guidelines for South Asia in the Indian Journal of Transplantation as guest editor and a summary of these guidelines has been published in `Transplantation`. I have published multiple articles in Infection in Transplant patients including HIV, Histoplasmosis, Mucormycosis, Dengue, Scrub Typhus etc.
I am also the current general secretary of the Indian Society of Nephrology. I have been the past secretary of the Delhi Nephrology Society and an executive member of the Indian Society of Organ Transplantation. I am also a member of the educational committee of transplantation, a member South Asia Regional Board International Society of Nephrology and have been appointed as Chair of the local organising team World Congress of Nephrology 2025 to be held in India.
Challenges and outcomes with kidney re-transplantation
Shyam B Bansal1, Pooja P Lokkur1, Abhyuday S Rana1, Ankur Mittal1, Neha Manhas1.
1Department of Nephrology and Kidney Transplant, Medanta - The Medicity, Gurugram , India
Background: Kidney transplant is the treatment of choice for patients with end-stage kidney disease. Although the field of transplant is ever-evolving and striving towards better graft survival, there are many immunological and non-immunological causes of graft failure. This necessitates need for re-transplantation for the second or even third time. Re-transplant of kidney comes with its own set of challenges in the form of a sensitized and already immunosuppressed host with surgical and medical challenges in the peri- and post-transplant period. There is little data of re-transplantation from India.
Methods: A retrospective analysis of patients who underwent renal transplant between 2012 and 2023 was done. Pre-transplant risks, including medical, surgical and immunological risks were studied. Intraoperative significant events were noted. Clinical outcomes in the form of acute rejection, death-censored graft survival and patient survival were studied.
Results: In a patient population of 2700 transplants between 2012 and 2023, sixty-five patients underwent second transplant and 3 patients underwent third transplantation.
The average age of the retransplant population was 40.69 ± 10 years and included 83.8 percent were males. Two patients underwent ABO-incompatible transplants, and four patients underwent pre-emptive transplant. The average dialysis vintage was 10.26 months prior to a retransplant. Flow cross-match was positive in 8 out of 68 patients with a significant donor- specific antibody in 5 patients requiring pre-transplant desensitization with plasmapheresis. Majority of the patients were given rabbit ATG (Thymoglobulin) (69%) as the induction agent. Delayed graft function was seen in only one patient. Biopsy-proven acute rejection was seen in 17.6 percent of patients.
Chronic rejection on biopsy was seen in 5.8 percent of patients. Around 40 percent of patients had infections in post-transplant period, most common infection being urinary tract infection. Two patients had graft loss due to chronic rejection. Death-censored graft survival was 96.6% at last follow-up.
Conclusion: The outcomes of kidney re-transplantation was good in our study despite challenges and it should be offered to everyone with graft failure.
[1] Re-transplantation
[2] Outcomes
