Original Article Renal transplantation in Nepal: Beginning of a new era! DIBYA S SHAH, SHAILENDRA SHRESTHA and MUKUNDA P KAFLE Department of Nephrology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine (IOM), Kathmandu, Nepal KEY WORDS: End Stage Renal Disease, Nepal, primary outcome, renal transplant, secondary outcome. Correspondence: Dr Dibya Singh Shah, Department of Nephrology, TUTH, IOM, Kathmandu, Nepal. Email: dibyasingh@hotmail.com; Dr Shailendra Shrestha, Department of Nephrology, TUTH, IOM, Kathmandu, Nepal. Email: shailendra_1975@hotmail.com Accepted for publication 24 February 2013. Accepted manuscript online 5 March 2013. doi:10.1111/nep.12046 Source of Support: Nil. Conflicts of Interest: Nil. SUMMARY AT A GLANCE Shah et al. describe the first 70 live donor kidney transplants performed in Nepal, since the development of a national, government sanctioned, transplant service. This is a truly remarkable achievement. ABSTRACT: Aim: To assess the first year outcomes in terms of patient survival rate, graft survival rate and secondary outcomes after starting the first live related renal transplant in Tribhuvan University Teaching Hospital, Nepal. Methods: A retrospective analysis was done of the first 70 renal transplants, who have completed a minimum of 1 year of follow up. All recipients were on Tacrolimus, Mycophenolate Mofetil, and corticosteroids. Results: Patient and graft survival rate at the end of one year was 94.3% (95% confidence interval (CI) 86.2–97.8). Mean serum creatinine and esti- mated glomerular filtration rate at 1 year was 115  25 mmol/L (range 63–192) and 66  15 mL/min per 1.73 m 2 (range 37–102) respectively. Twenty-two episodes of biopsy proven acute rejection occurred in 18 recipi- ents (25.7%). Three patients (4.2%) had acute tubular necrosis; however, only one (1.4%) had delayed graft function. One patient, with focal segmen- tal glomerulosclerosis had recurrence of native kidney disease. Thirty-two episodes of urinary tract infection were observed in 22 recipients (31.4%), and Escherichia coli was the most commonly isolated organism, 17 (53.1%) out of 32 episodes. New onset diabetes mellitus after transplant occurred in 16 recipients (22.8%). Conclusion: One-year patient survival, graft survival and secondary out- comes of our kidney transplant recipients, with our limited facilities, were within acceptable limits. Nepal is a small South-east Asian country, between India and China, with a population of approximately 29 million, 1 and per capita income of US$645. 2 Health care in Nepal is pro- vided by both the public and private sector; however the private sector is limited to urban areas. Government provides primary health care services free of cost at a district level through sub health posts, health posts, primary health care centres and district hospitals. Secondary and tertiary level health care is provided at a reasonable cost by zonal/regional hospitals and specialized tertiary care centres. Total expendi- ture on health per capita in 2010 was US$66, which was equivalent to 5.5% of GDP. 3 As in other developing countries, the burden of non- communicable diseases, including chronic kidney disease (CKD), is increasing in Nepal. 4,5 The estimated incidence of End Stage Renal Disease (ESRD) in Nepal is around 2900 new cases per year, based on the estimated ESRD incidence of about 100 cases/million population per year in developing nations. 6 However, a recent population based study in India showed it to be around 232/million population per year, 7 suggesting the incidence in Nepal may actually be higher. Unfortunately, because of the lack of a renal registry in Nepal, the exact incidence and prevalence of ESRD in the country is not known. A haemodialysis (HD) service was started in Nepal in 1987 8 but is available only in a few of the tertiary level centres. 9 Studies done in India and Pakistan show that only about 10% of the newly diagnosed ESRD patients contemplate maintenance haemodialysis (MHD), out of which only about 10% continue MHD for >3 months. 6 The scenario is similar in Nepal; a major reason for this high dropout rate relates to financial circumstances. The cost of twice weekly haemodi- alysis in Nepal is approximately US$250–300 per month in the government hospital and approximately US$400–500 Nephrology 18 (2013) 369–375 © 2013 The Authors Nephrology © 2013 Asian Pacific Society of Nephrology 369