dr. ravi angral ms (pgi chandigarh) transplant & vascular surgeon
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
Dr. Ravi AngralDr. Ravi AngralMS (PGI Chandigarh)MS (PGI Chandigarh)
Transplant & Vascular SurgeonTransplant & Vascular Surgeon
Kidney Hospital & Lifeline Medical Kidney Hospital & Lifeline Medical Institutions, Jalandhar (Punjab)Institutions, Jalandhar (Punjab)
LANDMARKSLANDMARKS
Established in 1990.Established in 1990.
Started First Dialysis Unit in Jalandhar in Started First Dialysis Unit in Jalandhar in 1991.1991.
Renal Transplantation program started in Renal Transplantation program started in 1996.1996.
VALUE ADDITION FOR VALUE ADDITION FOR TRANSPLANT UNITTRANSPLANT UNIT
Department of Pulmonology & Critical Care Department of Pulmonology & Critical Care
Medicine:Medicine: To deal with infectious complications. To deal with infectious complications.
In-house drug (Tacrolimus) level monitoring:In-house drug (Tacrolimus) level monitoring:
Micro particles enzymes Immuno Assay (MIA).Micro particles enzymes Immuno Assay (MIA).
State-of-the-Art, 14 bedded Dialysis Unit State-of-the-Art, 14 bedded Dialysis Unit with with
Fresenius AquaB DUO Double Stage RO Plant.Fresenius AquaB DUO Double Stage RO Plant.
REVERSE OSMOSIS PLANTREVERSE OSMOSIS PLANT((Fresenius AquaB DUO Double Stage RO Plant)Fresenius AquaB DUO Double Stage RO Plant)
DIALYSIS RECORDDIALYSIS RECORD(Oct 2011 to Oct 2012)(Oct 2011 to Oct 2012)
0200400600800
10001200140016001800
Oct
-11
Nov
-11
Dec
-11
Jan-
12
Feb-
12
Mar
-12
Apr-
12
May
-12
Jun-
12
Jul-1
2
Aug-
12
Sep-
12
Oct
-12
Total Dialysis Done in 1 Year: 17268
Dialysis Done
Kidney Hospital-TransplantsKidney Hospital-TransplantsOctober 1997 to December 2006October 1997 to December 2006
0
10
20
30
40
50
60
Oct-97
1998
1999
2000
2001
2002
2003
2004
2005
2006
Total number of Transplants: 299
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
Total = 100Total = 100 Related = 89Related = 89 Unrelated = 11Unrelated = 11
– Swap: 3Swap: 3
– Mother-in-Law: 3Mother-in-Law: 3
– Uncle / Aunt: 2Uncle / Aunt: 2
– Brother-in-Law: 2Brother-in-Law: 2
– Cousin: 1Cousin: 1
All unrelated cases undertaken after getting due permission All unrelated cases undertaken after getting due permission from Appropriate Authority and respective Authorization from Appropriate Authority and respective Authorization
Committee.Committee.
Details of last 100 Transplant CasesDetails of last 100 Transplant Cases(Apr 2011 to Oct 2012)(Apr 2011 to Oct 2012)
ALL TRANSPLANTS DONE AS PER GUIDELINES ALL TRANSPLANTS DONE AS PER GUIDELINES BY APPROPRIATE AUTHORITY \ DRMEBY APPROPRIATE AUTHORITY \ DRME
Form 1-A used for Related Donors.Form 1-A used for Related Donors.
Form 1-B used for Spouses.Form 1-B used for Spouses.
Form 1-C used for Unrelated Donors.Form 1-C used for Unrelated Donors.
For all related donors Form-3 duly signed by For all related donors Form-3 duly signed by
Pathologist confirming relation of related Pathologist confirming relation of related
donor as per HLA match.donor as per HLA match.
GUIDELINES FOLLOWED WITH GUIDELINES FOLLOWED WITH REGARD TO RECIPIENTREGARD TO RECIPIENT
AFFIDAVITS STATING AFFIDAVITS STATING
– No monetary consideration.No monetary consideration.
– No middlemen involved.No middlemen involved.
– Risk involved in surgery, anaesthesia.Risk involved in surgery, anaesthesia.
GUIDELINES FOLLOWED WITH GUIDELINES FOLLOWED WITH REGARD TO DONORREGARD 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.
DONOR WORK-UP FOR SURGERYDONOR 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
VIDEO CONSENTVIDEO CONSENT
With family membersWith family members
Nature of procedureNature of procedure
Consent for surgeryConsent for surgery
Success of transplantationSuccess of transplantation
MULTIPLE VESSELSMULTIPLE VESSELS
Total cases: 6Total cases: 6
Double renal arteries: 5Double renal arteries: 5
Triple renal arteries: 1Triple renal arteries: 1
Managed by bench surgeryManaged by bench surgery
All have stable graft function in follow-upAll have stable graft function in follow-up
OUR RESULTS OF LAST 1 YEAROUR RESULTS OF LAST 1 YEAR
Total TransplantsTotal Transplants : 100: 100
Immediate SuccessImmediate Success : 100%: 100%
Death during transplantDeath during transplant : Nil: Nil
Rejection EpisodesRejection Episodes
Acute Rejections: 13 (13%)Acute Rejections: 13 (13%)
Antibody Mediated Rejections: 3Antibody Mediated Rejections: 3
Responded to MP + ATG + Retux: 1Responded to MP + ATG + Retux: 1
ATG + Plasmapherisis + Retux: 1ATG + Plasmapherisis + Retux: 1
ATG + Plasmapherisis + IVIG: 1ATG + Plasmapherisis + IVIG: 1
Graft failure: 1 caseGraft failure: 1 case
MORBIDITY & MORTALITYMORBIDITY & MORTALITY
No mortality within 30 days of surgeryNo mortality within 30 days of surgery
Expired in Follow-up : 4Expired in Follow-up : 4
– Extensive fungal chest infection: 2Extensive fungal chest infection: 2
– PCP Pneumonia: 1PCP Pneumonia: 1
– Cardiac event: 1Cardiac event: 1
Re-exploration: 4 casesRe-exploration: 4 cases
– Perigraft HematomaPerigraft Hematoma
– Compression Compression
– Graft dysfunctionGraft dysfunction
SURGICAL COMPLICATIONSSURGICAL COMPLICATIONS
FOLLOW-UPFOLLOW-UP
RecipientsRecipients
– 11stst to 3 to 3rdrd Month Month : Twice a week: Twice a week
– 33rdrd to 6 to 6thth Month Month : 15 days: 15 days
– After 6 MonthsAfter 6 Months : Monthly: Monthly
DONORDONOR(Regular follow-up)(Regular follow-up)
Every month after discharge for 6 months.Every month after discharge for 6 months.
Twice a month for 6 months. Twice a month for 6 months.
Yearly. Yearly.
Documents provided for inspectionDocuments provided for inspection
Application form & connected documentsApplication form & connected documents
Original affidavitsOriginal affidavits
Follow-up recordsFollow-up records
Discharge cardsDischarge cards
Original files of transplant casesOriginal files of transplant cases