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Dr. Ravi Angral MS (PGI Chandigarh) Transplant & Vascular Surgeon

Dr. Ravi Angral MS (PGI Chandigarh) Transplant & Vascular Surgeon Kidney Hospital & Lifeline Medical Institutions, Jalandhar (Punjab). LANDMARKS. Established in 1990. Started First Dialysis Unit in Jalandhar in 1991. Renal Transplantation program started in 1996.

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Dr. Ravi Angral MS (PGI Chandigarh) Transplant & Vascular Surgeon

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

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

  3. 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.

  4. DIALYSIS UNIT

  5. REVERSE OSMOSIS PLANT(Fresenius AquaB DUO Double Stage RO Plant)

  6. DIALYSIS RECORD(Oct 2011 to Oct 2012)

  7. RENAL TRANSPLANTATION UNIT

  8. TRANSPLANT COORDINATOR

  9. Kidney Hospital-TransplantsOctober 1997 to December 2006 Total number of Transplants: 299

  10. Kidney Hospital – TransplantsJanuary 2007 to October 2012

  11. Transplants done till date 620

  12. 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

  13. First Swap Transplantation Participating Couples

  14. Paper Presentation at International Level

  15. 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.

  16. Break-up of 89 Related Donors

  17. Break-up of 11 Unrelated Cases

  18. 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.

  19. GUIDELINES FOLLOWED WITH REGARD TO RECIPIENT AFFIDAVITS STATING No monetary consideration. No middlemen involved. Risk involved in surgery, anaesthesia.

  20. 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.

  21. 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

  22. VIDEO CONSENT With family members Nature of procedure Consent for surgery Success of transplantation

  23. VIDEO CONSENT

  24. BASIC DISEASE BREAK-UP

  25. 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

  26. OUR RESULTS OF LAST 1 YEAR Total Transplants : 100 Immediate Success : 100% Death during transplant : Nil

  27. 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

  28. Paper Presentation at International Level

  29. 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

  30. SURGICAL COMPLICATIONS • Re-exploration: 4 cases • Perigraft Hematoma • Compression • Graft dysfunction

  31. FOLLOW-UP Recipients 1st to 3rd Month : Twice a week 3rd to 6th Month : 15 days After 6 Months : Monthly

  32. DONOR(Regular follow-up) Every month after discharge for 6 months. Twice a month for 6 months. Yearly.

  33. Documents provided for inspection Application form & connected documents Original affidavits Follow-up records Discharge cards Original files of transplant cases

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