The present study was conducted to find out the changes in immunosuppressant drug prescription pattern and trends in kidney transplant patients. In this study 613 Indian transplant patients who underwent kidney transplantation between July 2004 and June 2011 were enrolled. Various data of all transplant patients including immunosuppressant drug medication, changes in the prescription, use of antibody for induction and antirejection treatment were collected during their hospital stay and ambulatory visit. Antibody use as an induction agent has increased from during the study period. Induction was used in 23.1% during the year 2005 and increased to 44.4% during the year 2009. Among induction agent ATG was most commonly preferred agent, followed by daclizumab and basiliximab (24% ATG Vs 6.9% daclizumab Vs 6.9% basiliximab). Use of tacrolimus has increased (94% on tacrolimus vs 6% on cyclosporine in 2010). Mycophenolate mofetil is most commonly used antiproliferative agent (80% on MMF vs 20% on azathioprine in 2010). Trend is towards more use of MMF though azathioprine is being used in significant number of patients. Analysis of maintenance immunosuppression after renal transplant showed 60% patient maintained their original regimen over 7 years of follow up. Sirolimus was introduced in 1.5 to 7% patients during follow up period. Anti rejection treatment was required in 22-47% renal transplant recipients and trend towards decreasing rejection episode was seen. Steroids were used in the treatment of rejection in 90-100% patients. Use of ATG for treatment of rejection has increased from 11.5% in 2005 to 40% in 2010-11. By this study we conclude that immunosuppressant drugs have passed through significant changes during the year 2005 to 2011. Use of ATG as an induction agent and for treatment of rejection has increased. Similarly MMF and tacrolimus are most commonly used in maintenance regimen for renal transplant patients.

Objective: To identify incidence and determinant of new-onset of diabetes after transplant (NODAT) in Indian renal transplant recipients. Methods: In this study Indian renal transplant recipients who were not diabetic before transplant and underwent kidney transplantation between July 2004 and June 2011 were enrolled. Various data of all transplant patients including age, gender, body weight, pre transplant Hepatitis C virus (HCV), Hepatitis B virus (HBV) infection status, Human Leukocyte Antigens (HLA) mismatch, maintenance immunosuppressant drug, usage of antibodies, anti rejection treatment, patients and graft survival, post-transplant infection including HCV, HBV, Herpes and Cytomegalo virus (CMV) infection were noted down. In this study patients who had taken anti diabetic medicine beyond 1 month were considered as diabetic. Results: Total 537 renal transplant recipients were enrolled in the study. Patients age (P<0.0001), body weight (P=0.042) and HLA mismatch (P=0.015) were significantly effected on prevalence of NODAT. Other parameters like sex (P=0.862), type of donor (P=0.191), pre transplant HBV (P=0.285) and pre transplant HCV (P=0.201) were not significantly affecting development of NODAT. NODAT prevalence was not significantly affected by different Calciurine Inhibitors (CNIs) (P=0.079), antibodies (P=0.671) and by anti rejection therapy (P=0.115). Post-transplant infection was significantly higher in NODAT patients (P=0.022) and mainly among them CMV infection was prevalent (P=0.002). Other infections were found similar in patients with or without NODAT. NODAT was not significantly affecting patients survival (P=0.828) and graft survival (P=0.101). Conclusion: Age more than 45 years, body weight more than 70 kilogram, HLA mismatch, tacrolimus treatment are significantly affecting development of NODAT in Indian transplant recipients. NODAT is strongly associated with development of post-transplant infection and among them CMV infection was prevalent.

Newer potent immunosuppressive medications show marked improvements in short-term allograft function but long-term allograft survival continues to be inadequate. Non immunological factors have been increasingly identified as potentially important mediators of reduced long-term renal allograft function known as chronic allograft nephropathy. H ypertension is considered as one of this non immunological risk factor for progressive graft dysfunction. Hypertension is common after transplantation and is present in 50% to 90% of renal transplant recipients. Increasingly severe post -transplantation hypertension is associated with increasing risk of graft loss, and control of hypertension is associated with improved graft survival. Hypertension is a risk factor for both CV disease and kidney graft failure. Here we discussed about post transplant hypertension and its impact on graft function. We also discussed about causes of HT following renal transplant with special emphasis on role of immunosuppressive medication in development of hypertension. At the end we have reviewed management of post transplant HT.