S. Mohta, Sowmya Sridharan, R. Gopalakrishnan, N. Prasad, S. Bansal, G. Makharia
Diarrhea after solid organ transplantation is a common problem. Posttransplant diarrhea can lead to dehydration, weight loss, graft dysfunction, frequent hospitalization and increased mortality. Posttransplant diarrhea is seen in 20%–25% of patients within 2 years of transplantation and it can be both due to infections and the drugs. The most common cause of drug causing diarrhea is mycophenolate mofetil, and tacrolimus. The common infective causes of diarrhea in posttransplant recipients include viral infections (norovirus, sapovirus, cytomegalovirus [CMV]), bacterial infections (Salmonella, Clostridium difficile, Aeromonas, Campylobactor, Enterotoxigenic, and Enterohemorrhagic Escherichia coli) and parasitic infections (Cryptosporidium, Giardia lamblia, Microsporidia Cyclospora, Strongyloidiasis etc.). Because of overall poor hygienic conditions, infective diarrhea is common in South Asian region. Since most cases of acute diarrhea are infective, and many with viral etiologies, conservative management using oral rehydration solution, antidiarrheal drugs, and where appropriate, a short course of antibiotics helps in the resolution of most cases. A detailed evaluation should be performed in patients with chronic diarrhea, recurrent diarrhea, and those with graft dysfunction. The evaluation of diarrhea should include stool microscopy for ova and cysts, special stains for opportunistic parasitic infection, and molecular diagnostic tools like multiplex Polymerase chain reaction. Colonoscopic and upper gastrointestinal endoscopic examination with biopsies are required to investigate for CMV infection, malabsorption syndrome, inflammatory bowel diseases and posttransplant lymphoproliferative disorder. Although the causes of diarrhea are numerous, an algorithmic approach should be followed both for the diagnosis and the treatment of diarrhea in an organ transplant recipient.
{"title":"Diarrhea in solid organ transplant recipients in the South Asian Region - Expert group opinion for diagnosis and management","authors":"S. Mohta, Sowmya Sridharan, R. Gopalakrishnan, N. Prasad, S. Bansal, G. Makharia","doi":"10.4103/ijot.ijot_79_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_79_21","url":null,"abstract":"Diarrhea after solid organ transplantation is a common problem. Posttransplant diarrhea can lead to dehydration, weight loss, graft dysfunction, frequent hospitalization and increased mortality. Posttransplant diarrhea is seen in 20%–25% of patients within 2 years of transplantation and it can be both due to infections and the drugs. The most common cause of drug causing diarrhea is mycophenolate mofetil, and tacrolimus. The common infective causes of diarrhea in posttransplant recipients include viral infections (norovirus, sapovirus, cytomegalovirus [CMV]), bacterial infections (Salmonella, Clostridium difficile, Aeromonas, Campylobactor, Enterotoxigenic, and Enterohemorrhagic Escherichia coli) and parasitic infections (Cryptosporidium, Giardia lamblia, Microsporidia Cyclospora, Strongyloidiasis etc.). Because of overall poor hygienic conditions, infective diarrhea is common in South Asian region. Since most cases of acute diarrhea are infective, and many with viral etiologies, conservative management using oral rehydration solution, antidiarrheal drugs, and where appropriate, a short course of antibiotics helps in the resolution of most cases. A detailed evaluation should be performed in patients with chronic diarrhea, recurrent diarrhea, and those with graft dysfunction. The evaluation of diarrhea should include stool microscopy for ova and cysts, special stains for opportunistic parasitic infection, and molecular diagnostic tools like multiplex Polymerase chain reaction. Colonoscopic and upper gastrointestinal endoscopic examination with biopsies are required to investigate for CMV infection, malabsorption syndrome, inflammatory bowel diseases and posttransplant lymphoproliferative disorder. Although the causes of diarrhea are numerous, an algorithmic approach should be followed both for the diagnosis and the treatment of diarrhea in an organ transplant recipient.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"23 - 33"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48118854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijot.ijot_118_21
H. E. El Hennawy, A. Al Hashemy, Abdullah S. Al Faifi, O. Safar, M. Obeid, M. Gomaa, Ayed Alkhalaqi, Mashair Babiker, A. Abdelaziz, RawaM Al Humaid, M. Zaitoun, KhalidA AlAlsheikh
Background: The outcome of pediatric renal transplantation (RT) has improved over the last decades. Aims and Objectives: To study the outcome of pediatric transplantation at our center including patient and graft survival, acute rejection, and surgical complications. Materials and Methods: A retrospective review of pediatric RT outcomes at the only transplant center in Southern Saudi Arabia. Results: between 11/2013 till 03/2020, 63 RT were performed in pediatric recipients 2 through 18 years of age (mean 11.7 ± 3.75) including 43 patients (68.2%) aged 14 and younger. Average BMI-height-age-z were 66.05 ± 6.65 percentile. 49 patients (77.7%) received kidneys from adult living donors (LD), 8(16%) were unrelated donors.41% had preemptive KT. The commonest known etiologies of ESRD were focal segmental glomerulosclerosis, Post Urethral valve, and dysplastic kidney (9.5% each). Thymoglobulin and Basiliximab were used as induction therapy in 37 (58.7%) and 26 (41.3%) patients respectively. With a mean follow-up of 80 months, 1-year and 5-year graft survival rates for LD and deceased donors were (97.2%, 86.4%) and (96.4%, 76%) respectively. 1-year and 5-year patients survival rates were 100%. Conclusions: pediatric renal transplantation outcome at our center, despite the low volume of cases, is encouraging.
{"title":"Pediatric renal transplantation in Southern Saudi Arabia: A single-center retrospective study","authors":"H. E. El Hennawy, A. Al Hashemy, Abdullah S. Al Faifi, O. Safar, M. Obeid, M. Gomaa, Ayed Alkhalaqi, Mashair Babiker, A. Abdelaziz, RawaM Al Humaid, M. Zaitoun, KhalidA AlAlsheikh","doi":"10.4103/ijot.ijot_118_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_118_21","url":null,"abstract":"Background: The outcome of pediatric renal transplantation (RT) has improved over the last decades. Aims and Objectives: To study the outcome of pediatric transplantation at our center including patient and graft survival, acute rejection, and surgical complications. Materials and Methods: A retrospective review of pediatric RT outcomes at the only transplant center in Southern Saudi Arabia. Results: between 11/2013 till 03/2020, 63 RT were performed in pediatric recipients 2 through 18 years of age (mean 11.7 ± 3.75) including 43 patients (68.2%) aged 14 and younger. Average BMI-height-age-z were 66.05 ± 6.65 percentile. 49 patients (77.7%) received kidneys from adult living donors (LD), 8(16%) were unrelated donors.41% had preemptive KT. The commonest known etiologies of ESRD were focal segmental glomerulosclerosis, Post Urethral valve, and dysplastic kidney (9.5% each). Thymoglobulin and Basiliximab were used as induction therapy in 37 (58.7%) and 26 (41.3%) patients respectively. With a mean follow-up of 80 months, 1-year and 5-year graft survival rates for LD and deceased donors were (97.2%, 86.4%) and (96.4%, 76%) respectively. 1-year and 5-year patients survival rates were 100%. Conclusions: pediatric renal transplantation outcome at our center, despite the low volume of cases, is encouraging.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"355 - 360"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49031814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Nerli, Pulkit Gupta, Priyabrata Adhikari, Neeraj S. Dixit, S. Ghagane, Parveen Pathan
The novel coronavirus (severe acute respiratory syndrome coronavirus [SARS-CoV-2]) has spread out to most of the world with the World Health Organization (WHO) classifying it as a global pandemic. There exists very little information on the infectious course of COVID-19 in immunocompromised individuals, including transplant recipients. We report a case of a young adult who tested positive for SARS-CoV-2 in the immediate postoperative period following renal transplantation.
{"title":"Coronavirus infection in immediate postrenal transplant period - A case report","authors":"R. Nerli, Pulkit Gupta, Priyabrata Adhikari, Neeraj S. Dixit, S. Ghagane, Parveen Pathan","doi":"10.4103/ijot.ijot_97_20","DOIUrl":"https://doi.org/10.4103/ijot.ijot_97_20","url":null,"abstract":"The novel coronavirus (severe acute respiratory syndrome coronavirus [SARS-CoV-2]) has spread out to most of the world with the World Health Organization (WHO) classifying it as a global pandemic. There exists very little information on the infectious course of COVID-19 in immunocompromised individuals, including transplant recipients. We report a case of a young adult who tested positive for SARS-CoV-2 in the immediate postoperative period following renal transplantation.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"458 - 460"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijot.ijot_133_21
N. Rao, A. Chandra, S. Saran, A. Singh, S. Singh
Background: Kidney transplant recipients (KTRs) are deemed to be at a high risk of severe coronavirus disease (COVID-19). Herein, we describe the clinical, laboratory profiles, management, and outcomes of 26 KTRs who developed COVID-19 during the first and second waves of the pandemic from a tertiary care center in northern India. Methods: This retrospective observational study included KTRs detected with COVID-19 infection during the first wave (March–November 2020) and the second wave (March–July 2021). Their clinical and laboratory investigations, management aspects, and outcomes were compared, using data retrieved from clinical and telenephrology records, and the hospital information system. Results: Of the 23 KTRs, 20 were male (86%), 20 patients had fever (86%), and cough and breathlessness were seen in 19 (82%) and 12 (52%), respectively. Acute graft dysfunction was seen in 6 (26%) patients, and the need for renal replacement was seen in 4 (17%) patients. Supplemental oxygen by reservoir mask was utilized in 10 (43%) patients, high-flow nasal cannula in 3 (13%), noninvasive mechanical ventilation in 4 (17%), and invasive mechanical ventilation in 6 (26%) patients. All the KTRs with moderate and severe COVID illness and 6/7 nonsurvivors were infected during the second wave. Overall mortality in this group of patients was very high at 27%, and the mortality in the group on mechanical ventilation was 100%. Conclusions: The second wave of the COVID-19 pandemic was associated with greater severity of illness and high mortality in KTRs.
{"title":"COVID-19 infection in kidney transplant recipients during the first versus the second wave - Retrospective Observational study from a single center","authors":"N. Rao, A. Chandra, S. Saran, A. Singh, S. Singh","doi":"10.4103/ijot.ijot_133_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_133_21","url":null,"abstract":"Background: Kidney transplant recipients (KTRs) are deemed to be at a high risk of severe coronavirus disease (COVID-19). Herein, we describe the clinical, laboratory profiles, management, and outcomes of 26 KTRs who developed COVID-19 during the first and second waves of the pandemic from a tertiary care center in northern India. Methods: This retrospective observational study included KTRs detected with COVID-19 infection during the first wave (March–November 2020) and the second wave (March–July 2021). Their clinical and laboratory investigations, management aspects, and outcomes were compared, using data retrieved from clinical and telenephrology records, and the hospital information system. Results: Of the 23 KTRs, 20 were male (86%), 20 patients had fever (86%), and cough and breathlessness were seen in 19 (82%) and 12 (52%), respectively. Acute graft dysfunction was seen in 6 (26%) patients, and the need for renal replacement was seen in 4 (17%) patients. Supplemental oxygen by reservoir mask was utilized in 10 (43%) patients, high-flow nasal cannula in 3 (13%), noninvasive mechanical ventilation in 4 (17%), and invasive mechanical ventilation in 6 (26%) patients. All the KTRs with moderate and severe COVID illness and 6/7 nonsurvivors were infected during the second wave. Overall mortality in this group of patients was very high at 27%, and the mortality in the group on mechanical ventilation was 100%. Conclusions: The second wave of the COVID-19 pandemic was associated with greater severity of illness and high mortality in KTRs.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"361 - 365"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42755329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kalal, Suresh K. Sharma, N. Rana, Ashok Kumar, Deepti Mathur
Background: Organ transplantation is a life-saving treatment for patients with end-stage organ failure all over the world, and the demand for organs has increased as a result. Organ donation involves legal, psychological, and ethical considerations. Many countries around the world have reported that people's attitudes toward organ donation are influenced by various factors such as knowledge, education, and religion. The existing study sought to explore the awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan. Materials and Methods: A cross-sectional hospital-based survey was conducted with 445 adult populations who were visiting the hospital. Self-Structured Awareness Assessment Scale for Organ Donation and Attitude Assessment Scale for Organ Donation were used. Data analysis was done using the SPSS software 22.0 version. Results: 74.61% of participants were aware about organ donation. Statistically (P < 0.001) higher odds for organ donation willingness was found among participants who were aware that organ such as eye (odd ratio [OR]: 10.34, 95% confidence interval [CI]: 4.40–24.25, P < 0.001), heart (OR: 4.71.95% CI: 2.68–8.25), P ≤ 0.001), intestine (OR: 2.26, 95% CI: 1.41–3.6, P = 0.001), skin OR: 2.93, 95% CI: 1.83–4.70) P ≤ 0.001), extremities (Lower and upper) (OR: 2.46,95% CI: 1.53–3.95, P ≤ 0.001) can be donated or transplanted. 40.6% of the participants disagree that it is better to die than to receive an organ from another person. Interestingly, 35.28% of the participants agreed that organ donation is a true donation and a real service to mankind. Conclusions: This study not only echoes low awareness of organ donation among the adult population in Western Rajasthan, India but also reflects low and neutral level of positive attitude and willingness for organ donation.
{"title":"Awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan: A cross-sectional hospital-based survey","authors":"N. Kalal, Suresh K. Sharma, N. Rana, Ashok Kumar, Deepti Mathur","doi":"10.4103/ijot.ijot_38_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_38_22","url":null,"abstract":"Background: Organ transplantation is a life-saving treatment for patients with end-stage organ failure all over the world, and the demand for organs has increased as a result. Organ donation involves legal, psychological, and ethical considerations. Many countries around the world have reported that people's attitudes toward organ donation are influenced by various factors such as knowledge, education, and religion. The existing study sought to explore the awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan. Materials and Methods: A cross-sectional hospital-based survey was conducted with 445 adult populations who were visiting the hospital. Self-Structured Awareness Assessment Scale for Organ Donation and Attitude Assessment Scale for Organ Donation were used. Data analysis was done using the SPSS software 22.0 version. Results: 74.61% of participants were aware about organ donation. Statistically (P < 0.001) higher odds for organ donation willingness was found among participants who were aware that organ such as eye (odd ratio [OR]: 10.34, 95% confidence interval [CI]: 4.40–24.25, P < 0.001), heart (OR: 4.71.95% CI: 2.68–8.25), P ≤ 0.001), intestine (OR: 2.26, 95% CI: 1.41–3.6, P = 0.001), skin OR: 2.93, 95% CI: 1.83–4.70) P ≤ 0.001), extremities (Lower and upper) (OR: 2.46,95% CI: 1.53–3.95, P ≤ 0.001) can be donated or transplanted. 40.6% of the participants disagree that it is better to die than to receive an organ from another person. Interestingly, 35.28% of the participants agreed that organ donation is a true donation and a real service to mankind. Conclusions: This study not only echoes low awareness of organ donation among the adult population in Western Rajasthan, India but also reflects low and neutral level of positive attitude and willingness for organ donation.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"411 - 418"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45912720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Deswal, V. Ramasubramanian, A. Rana, S. Bansal, S. Mahajan
Typhoid, paratyphoid, leptospirosis, scrub typhus, and melioidosis are some of the common bacterial infections which are endemic in the region of South Asia. Typhoid and paratyphoid cause enteric fever which is a common cause of fever in the general population in this region. It is caused by Salmonella through contaminated food and water. Enteric fever is one of the most common causes of fever in travelers in this region. Leptospirosis is a zoonotic disease caused by Leptospira and occurs due to direct contact with animals like or through abraded skin after the monsoon in the endemic area. Fever and jaundice are the most common presentations. Scrub typhus is caused by mite Orientia tsutsugamushi and it has now emerged as one of the most common causes of pyrexia in this region. Melioidosis is an uncommon infection caused by the bacteria Burkholderia pseudomalle, which is endemic in some regions of South Asia and is usually seen in immunocompromised individuals. Melioidosis is often called great mimicker due to a variety of clinical manifestations which might confuse it with other diseases. All these infections can cause fever or other systemic complications involving various organs in transplant recipients, so they should be kept as part of differential diagnosis of pyrexia in transplant recipients. There are no recommendations to screen for these infections in transplant candidates or donors, however, transplant candidates or donors with fever should be investigated for these infections and transplant should be deferred until full recovery and for some time thereafter.
{"title":"Expert group opinion for endemic bacterial infections in South Asia in solid organ transplant recipients - Typhoid, paratyphoid, leptospirosis, scrub typhus, and melioidosis","authors":"V. Deswal, V. Ramasubramanian, A. Rana, S. Bansal, S. Mahajan","doi":"10.4103/ijot.ijot_5_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_5_22","url":null,"abstract":"Typhoid, paratyphoid, leptospirosis, scrub typhus, and melioidosis are some of the common bacterial infections which are endemic in the region of South Asia. Typhoid and paratyphoid cause enteric fever which is a common cause of fever in the general population in this region. It is caused by Salmonella through contaminated food and water. Enteric fever is one of the most common causes of fever in travelers in this region. Leptospirosis is a zoonotic disease caused by Leptospira and occurs due to direct contact with animals like or through abraded skin after the monsoon in the endemic area. Fever and jaundice are the most common presentations. Scrub typhus is caused by mite Orientia tsutsugamushi and it has now emerged as one of the most common causes of pyrexia in this region. Melioidosis is an uncommon infection caused by the bacteria Burkholderia pseudomalle, which is endemic in some regions of South Asia and is usually seen in immunocompromised individuals. Melioidosis is often called great mimicker due to a variety of clinical manifestations which might confuse it with other diseases. All these infections can cause fever or other systemic complications involving various organs in transplant recipients, so they should be kept as part of differential diagnosis of pyrexia in transplant recipients. There are no recommendations to screen for these infections in transplant candidates or donors, however, transplant candidates or donors with fever should be investigated for these infections and transplant should be deferred until full recovery and for some time thereafter.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"63 - 76"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41803606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijot.ijot_110_21
S. Gang, A. Rana, S. Bansal
Urinary tract infection (UTI) is one of the common infections in solid organ transplant recipients and the most common infection in kidney transplant recipients. UTI in the early posttransplant period is associated with significant morbidity and graft dysfunction. Female gender, advanced age, presence of urinary tract abnormalities, and diabetes mellitus are some of the risk factors for UTI. The emergence of multi-drug resistant bacteria has made the treatment difficult and one needs to be aware of the local antibiotic resistance pattern when treating empirically. These patients should be treated adequately and those with recurrent UTI would need long-term prophylaxis. Asymptomatic bacteriuria should only be treated if it occurs within the first 2–3 months of transplant, otherwise, it can lead to the emergence of the resistant organism without any benefit. To reduce the risk of UTI after transplant, the Foley's catheter should be removed within 3–5 days, DJ stent should be removed within 2–3 weeks and the recipient should be kept on routine prophylaxis for 6 months.
{"title":"Expert group opinion for urinary tract infection in solid organ transplant recipients in South Asia","authors":"S. Gang, A. Rana, S. Bansal","doi":"10.4103/ijot.ijot_110_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_110_21","url":null,"abstract":"Urinary tract infection (UTI) is one of the common infections in solid organ transplant recipients and the most common infection in kidney transplant recipients. UTI in the early posttransplant period is associated with significant morbidity and graft dysfunction. Female gender, advanced age, presence of urinary tract abnormalities, and diabetes mellitus are some of the risk factors for UTI. The emergence of multi-drug resistant bacteria has made the treatment difficult and one needs to be aware of the local antibiotic resistance pattern when treating empirically. These patients should be treated adequately and those with recurrent UTI would need long-term prophylaxis. Asymptomatic bacteriuria should only be treated if it occurs within the first 2–3 months of transplant, otherwise, it can lead to the emergence of the resistant organism without any benefit. To reduce the risk of UTI after transplant, the Foley's catheter should be removed within 3–5 days, DJ stent should be removed within 2–3 weeks and the recipient should be kept on routine prophylaxis for 6 months.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"82 - 88"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48492467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Anupama, I. Pradeep, Sharon Mathews, G. Abraham, R. Parthasarathy, M. Mathew, Saravana Sundaraja, A. Kurien, N. Palaniappan
Aim: The objective of this study is to review the pathology and outcome of kidney allograft nephrectomies performed in a single renal transplant center in South India. In our regional center, a total of 721 renal transplants were done between January 2001 and March 2020, of which 18 underwent transplant nephrectomy (TN). Materials and Methods: Clinical data concerning patient characteristics, duration of allograft functions, indications, complications, and subsequent follow-up details were assessed. The median age of patients at the time of transplantation who underwent TN was 35 years. Among the 18 allografts, 16 were from live-related donors and a deceased donor after circulatory/brain death in two patients. Associated comorbidities found at the time of transplantation mainly consist of diabetes mellitus, hypertension, and coronary artery disease. A standard triple immunosuppressive regimen along with mTOR inhibitors was followed in all patients. The morphology of the allograft nephrectomy was studied in elusive graft dysfunction. Results: In our study, while the infection was found to be the leading cause of renal allograft failure clinically, on pathological examination of TN specimens, rejection (44.44%) contributed to failure the most. Early graft failure (55.56%) was related to hyperacute rejection or vascular complications. Late graft failure (44.44%) was associated with infection and rejection. No significant mortality was observed in our study. Conclusion: Clinicopathological correlation to arrive at a diagnosis for graft failure contributes to more effective postnephrectomy care of the patient since often the underlying pathology is masked by other incidental occurrences. It also aids in gauging the patient's chances of undergoing further transplant and graft survival.
{"title":"Clinicopathological correlation of transplant nephrectomies in elusive graft dysfunction - An observational study","authors":"S. Anupama, I. Pradeep, Sharon Mathews, G. Abraham, R. Parthasarathy, M. Mathew, Saravana Sundaraja, A. Kurien, N. Palaniappan","doi":"10.4103/ijot.ijot_94_20","DOIUrl":"https://doi.org/10.4103/ijot.ijot_94_20","url":null,"abstract":"Aim: The objective of this study is to review the pathology and outcome of kidney allograft nephrectomies performed in a single renal transplant center in South India. In our regional center, a total of 721 renal transplants were done between January 2001 and March 2020, of which 18 underwent transplant nephrectomy (TN). Materials and Methods: Clinical data concerning patient characteristics, duration of allograft functions, indications, complications, and subsequent follow-up details were assessed. The median age of patients at the time of transplantation who underwent TN was 35 years. Among the 18 allografts, 16 were from live-related donors and a deceased donor after circulatory/brain death in two patients. Associated comorbidities found at the time of transplantation mainly consist of diabetes mellitus, hypertension, and coronary artery disease. A standard triple immunosuppressive regimen along with mTOR inhibitors was followed in all patients. The morphology of the allograft nephrectomy was studied in elusive graft dysfunction. Results: In our study, while the infection was found to be the leading cause of renal allograft failure clinically, on pathological examination of TN specimens, rejection (44.44%) contributed to failure the most. Early graft failure (55.56%) was related to hyperacute rejection or vascular complications. Late graft failure (44.44%) was associated with infection and rejection. No significant mortality was observed in our study. Conclusion: Clinicopathological correlation to arrive at a diagnosis for graft failure contributes to more effective postnephrectomy care of the patient since often the underlying pathology is masked by other incidental occurrences. It also aids in gauging the patient's chances of undergoing further transplant and graft survival.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"419 - 424"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44290257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
COVID-19 is a global pandemic with the chronically immunosuppressed transplant recipients being the most vulnerable both to infection as well as complications of COVID-19. Here, we report a case of live-related renal allograft recipient who presented with complaints of loose stools and new-onset graft dysfunction 2 years posttransplant. He tested positive for COVID-19 infection. On allograft biopsy, there were significant immunoglobulin A (IgA) deposits with no evidence of rejection or ATN or crescents or significant chronicity. The initial pretransplant biopsy of the recipient had revealed chronic glomerulonephritis with nil deposits. The donor had no evidence of hematuria or hypertension and had a preserved GFR. We, therefore, considered the possibility of the unmasking of IgA deposits posttransplantation diagnosed in a recipient with COVID-19 infection.
{"title":"Unmasking of immunoglobulin a deposits posttransplant due to COVID-19 AKI-incidental or causal – A nephrologists' dilemma a case report","authors":"L. Dogra, M. Sahay, K. Ismal, P. Vali","doi":"10.4103/ijot.ijot_78_20","DOIUrl":"https://doi.org/10.4103/ijot.ijot_78_20","url":null,"abstract":"COVID-19 is a global pandemic with the chronically immunosuppressed transplant recipients being the most vulnerable both to infection as well as complications of COVID-19. Here, we report a case of live-related renal allograft recipient who presented with complaints of loose stools and new-onset graft dysfunction 2 years posttransplant. He tested positive for COVID-19 infection. On allograft biopsy, there were significant immunoglobulin A (IgA) deposits with no evidence of rejection or ATN or crescents or significant chronicity. The initial pretransplant biopsy of the recipient had revealed chronic glomerulonephritis with nil deposits. The donor had no evidence of hematuria or hypertension and had a preserved GFR. We, therefore, considered the possibility of the unmasking of IgA deposits posttransplantation diagnosed in a recipient with COVID-19 infection.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"461 - 462"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45783327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post renal transplant opportunistic infections always pose a challenge to the clinician due to the varied nonspecific clinical manifestations and prove fatal if not diagnosed and treated early. Here, we present a case report of a patient who was 22 years post renal transplantation with amphotericin-resistant disseminated cryptococcal infection concurrent with cytomegalovirus colitis treated successfully with oral fluconazole and ganciclovir. The clinician should always take into account the antibiotic susceptibility and culture sensitivity of cryptococcosis to diagnose this rare yet emerging phenomenon of azole resistance. Furthermore, to the best of our knowledge, this is the first reported case of amphotericin-resistant cryptococcosis in posttransplant setting.
{"title":"Amphotericin B-resistant disseminated cryptococcal infection with concurrent cytomegalovirus colitis in a renal transplant recipient - A case report","authors":"M. Gaur, J. Sethi, M. Prakash","doi":"10.4103/ijot.ijot_31_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_31_21","url":null,"abstract":"Post renal transplant opportunistic infections always pose a challenge to the clinician due to the varied nonspecific clinical manifestations and prove fatal if not diagnosed and treated early. Here, we present a case report of a patient who was 22 years post renal transplantation with amphotericin-resistant disseminated cryptococcal infection concurrent with cytomegalovirus colitis treated successfully with oral fluconazole and ganciclovir. The clinician should always take into account the antibiotic susceptibility and culture sensitivity of cryptococcosis to diagnose this rare yet emerging phenomenon of azole resistance. Furthermore, to the best of our knowledge, this is the first reported case of amphotericin-resistant cryptococcosis in posttransplant setting.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"16 1","pages":"428 - 430"},"PeriodicalIF":0.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44533689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：