Indian Journal of Transplantation最新文献

{"title":"A clinical comparison of propofol and etomidate in patients with end-stage renal disease undergoing renal transplantation","authors":"Praveenkumar Shekhrajka, V. Goyal, Ganesh Nimje, Lipika Saxena, S. Mittal, B. Baj","doi":"10.4103/ijot.ijot_11_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_11_23","url":null,"abstract":"Background: Induction of anesthesia is a critical part of anesthetizing patients with end-stage renal disease, as they are at risk of wide hemodynamic fluctuation due to their pathophysiological alterations in the cardiovascular system. It is desirable to use pharmacological agents that provide hemodynamic stability with fewer adverse effects. Aims and Objectives: This study aimed to evaluate the effects of propofol and etomidate by comparing hemodynamic variables such as a change in mean arterial pressure (MAP) and heart rate (HR) during induction, laryngoscopy, and up to 10 min after tracheal intubation as a primary outcome and any associated adverse effect as a secondary outcome. Methods: After getting institutional ethical committee approval, 60 American Society of Anesthesiologist Grade III patients aged 20–60 years, scheduled for renal transplantation, were randomized into two groups (Group P: propofol 1% and Group E: etomidate). The dose of induction agents was targeted to achieve a bispectral index value of 40. Hemodynamic variables were recorded at induction, laryngoscopy, and up to 10 min after tracheal intubation. Adverse effects related to the study drug were recorded. Results: The decrease in MAP in Group P was statistically significant (P < 0.05) as compared to Group E, at induction of anesthesia. We observed a significant increase in HR at induction of anesthesia in Group E (P < 0.05). The incidence of myoclonus was 0 versus 73.3% in Groups P and E, respectively, while pain on injection and hypotension were more in Group P (P < 0.05). Conclusions: In conclusion, etomidate provides better hemodynamic stability with fewer adverse effects in patients with end-stage renal disease.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"229 - 232"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45057480","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}

{"title":"Clinical outcomes of T-cell-mediated rejection in renal allografts","authors":"E. Fernando, A. Chiniwalar, Poongodi Annadurai, K. Valavan, Sujit Surendran, N. S. Srinivasa Prasad","doi":"10.4103/ijot.ijot_89_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_89_22","url":null,"abstract":"Background: T-cell-mediated rejection (TCMR) occurs in 10%–12% of renal allografts. TCMR manifests as a rise in serum creatinine, decreased urine output, fever, and graft tenderness. It has a negative impact on long-term allograft function. Hence, we did a retrospective analysis of patients with TCMR to know the pattern, risk factors, and treatment outcome. Materials and Methods: We analyzed retrospectively clinical characteristics, laboratory data, renal biopsy reports, precipitating factors, treatment modalities, and outcomes from case records and biopsy registers of 30 patients with TCMR between July 2019 and June 2021 in our institution. Results: Out of 30 patients studied, 80% were males and 20% were females. The mean age was 29.67 ± 8.8 years. Live-related renal transplantation accounted for 80% of patients. Native kidney disease was not known in 63%. The mean duration of rejection was 21.73 ± 23.24 months. Among the various risk factors studied, low tacrolimus levels were seen in 56.7%, which was statistically significant (P < 0.05). All the patients were treated for rejection, and improvement was seen in most and 10.7% showed no improvement. Conclusion: Most patients with TCMR improved with treatment. Inadequate immunosuppression was the risk factor for TCMR in the maximum number of our patients. Compliance was good in most patients.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"198 - 201"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48833139","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}

{"title":"Tuberculosis and hepatitis C virus coinfection in a renal transplant recipient: A therapeutic challenge","authors":"V. Jayaprakash, A. Rathoon, Rishabh Gupta, S. Sreedhar","doi":"10.4103/ijot.ijot_27_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_27_23","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"268 - 269"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48291864","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}

{"title":"Perioperative predictors of postoperative short-term morbidity to donor after donor nephrectomy for renal transplantation","authors":"Ambala Rajeevan, Midhun P. Gopalakrishnan","doi":"10.4103/ijot.ijot_116_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_116_21","url":null,"abstract":"Introduction: Transplantation has been established as a superior mode of renal replacement therapy now. The demand for renal transplantation exceeds the available organs by far and this shortage led to an increase of renal transplantations from living donors. In this context, we did this study to find out perioperative predictors of postoperative short-term morbidity to donor after donor nephrectomy for renal transplantation. Patients and Methods: This was a retrospective study done in a urology tertiary care center from January 1, 2015, to December 31, 2019, among patients who underwent donor nephrectomy for renal transplantation. The sample size was 202. Data were collected using a pro forma and the same were analyzed by appropriate statistical methods using SPSS software. Results: Perioperative factors correlated to paralytic ileus on Pearson's correlation analysis were body mass index and right-sided donor nephrectomy. However, no perioperative factor was found to be predictive of paralytic ileus on regression analysis. Preoperative pyuria and postoperative total white blood cell count were correlated as well as predictive of wound infection. Conclusion: This study shows perioperative predictive factors related to postoperative short-term morbidity to donor and different grades and types of postoperative morbidity among donors after donor nephrectomy in renal transplantation within the first 6 months of surgery.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"185 - 189"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49281885","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}

{"title":"Morphology of lungs in pulmonary lymphangioleiomyomatosis – A unique case of bilateral lungs and heart transplant","authors":"S. Chandanwale, Y. Ingale, P. Patel, A. Verma","doi":"10.4103/ijot.ijot_21_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_21_23","url":null,"abstract":"Pulmonary lymphangioleiomyomatosis (LAM) is an extremely rare low–grade neoplasm. It occurs either sporadically or with tuberous sclerosis complex. Sporadic type usually affects women in reproductive age group. The patient usually gives a history of dyspnea of long duration. With characteristic clinical findings including high-resolution computed tomography findings, a diagnosis of pulmonary LAM can be suspected. Histopathology findings in some cases can be subtle. Cells of LAM consistently express smooth muscle markers such as smooth muscle actin and desmin on immunohistochemistry. Cells also express melanocytic marker such as HMB-45, Melan-A, and microphthalmia transcription factor. Due to the scarcity of reports on morphological features in pulmonary LAM, we are tempted to report morphological features of lungs in a 36-year-old female who successfully underwent bilateral lung and heart transplant at a tertiary care center.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"258 - 261"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45780940","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}

{"title":"Renal allograft survival: Incidence and risk factors associated with graft dysfunction","authors":"F. Alalawi, Kashif Gulzar, A. Seddik, Hind Alnour, Maseer Ahmad, S. Najad, Osman Osman, Hussain Yousif, M. Railey, A. Alhadari","doi":"10.4103/ijot.ijot_93_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_93_22","url":null,"abstract":"Background: Renal transplantation is considered the best available therapy for patients suffering from end-stage kidney disease. Improvement in allograft outcome, patient survival, and quality of life are the most important indicators of the effectiveness of renal transplantation. Short-term allograft survival has improved significantly, however, long-term allograft survival and associated risk factors need to be studied. Objectives: This single-center study aims to determine the incidence of long-term graft dysfunction (GD) and the associated risk factors among renal transplant recipients in Dubai Hospital, Dubai, United Arab Emirates. Materials and Methods: A single-center longitudinal cohort analysis of 506 renal transplant follow-up recipients' allograft functions was analyzed through a detailed chart review. We hypothesized that different recipients' characteristics such as age (present and age at the time of transplantation), gender, history of acute rejection, posttransplant viral infections (hepatitis B virus, hepatitis C virus [HCV], Cytomegalovirus, BK virus), and comorbid would affect allograft function in renal transplant recipients. Allograft dysfunction is defined as a 15%–20% increase in creatinine from baseline. We assessed the incidence of allograft dysfunction and associated risk factors. Results: The median age of transplant recipients and the age at the time of transplantation were 55 ± 21 and 39 ± 14.93 years, respectively. About 61.85% (n = 313) of the transplant population were males. The incidence of allograft dysfunction in the study period was 57.15%. In our study population, 1-, 5-, and 10-year graft survival rate was 98.62%, 82.35%, and 54.90%, respectively. Independent risk factors include age, male gender, history of acute rejection, HCV infection, and diabetes mellitus (DM). Posttransplant DM (PTDM) is not associated with GD. Conclusion: Allograft dysfunction is quite common among renal transplant recipients. Independent risk factors in our analysis include age, male gender, history of acute rejection, HCV infection, and DM. PTDM is not associated with GD.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"190 - 197"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48760398","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}

{"title":"A plant pathogen in a human host! A case report and a review of literature","authors":"N. Jose, R. Alam, V. Balaji, T. Kodiatte, J. Eapen, E. John, S. Varughese","doi":"10.4103/ijot.ijot_92_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_92_22","url":null,"abstract":"In this case report, we present a renal transplant recipient who developed an infection due to a plant pathogen – Pantoea agglomerans. This pathogen is a rare organism with no case reports in a renal transplant recipient from India so far. A 50-year-old renal transplant recipient presented with fever for 20 days associated with productive cough and upper back pain. She had received her graft kidney 8 months earlier in a deceased donor program in her local state. In the immediate postoperative period, she had one episode of a mixed rejection, which required a course of antithymocyte globulin and plasmapheresis. On examination, tenderness was noted in her upper back over the cervical and thoracic vertebrae. Her computed tomography scan showed a collection over the cervical vertebrae and consolidation in the lung. Blood culture grew P. agglomerans. P. agglomerans is a rare plant pathogen usually occurring after trauma involving organic debris being deposited within the body. Spontaneously occurring infection is seen only in special situations such as immunocompromised states, malignancy, or excessive antacid use. It has been known to cause lung infections, bone and joint infections, and fever with systemic signs. Spontaneously occurring infections like in this patient are very rare with a handful of case reports worldwide. In an immunocompromised host, a multitude of infections can occur. This case report highlights the importance of removing unnecessary medication from our transplant recipients and optimizing immunosuppression while pursuing the underlying microbiologic cause of infection aggressively.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"252 - 254"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43229245","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}

{"title":"Influence of ABO compatibility on haploidentical hematopoietic stem-cell transplant","authors":"R. Sawant, S. Sen, Deepali Naker","doi":"10.4103/ijot.ijot_134_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_134_21","url":null,"abstract":"Introduction: Allogenic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for hematologic malignancies. Nowadays, usually, haploidentical stem cell transplant is performed across the ABO blood group barrier; however, the effect of ABO incompatibility on haploidentical hematopoietic stem-cell transplantation is still uncertain. Methodology: Retrospective analysis of data of patients who underwent haploidentical hematopoietic stem-cell transplantation at our hospital was performed. The patient cohort was classified in to two arms: ABO compatible and ABO-incompatible haploidentical stem cell transplantation. ABO-incompatible was further categorized as major mismatch, minor mismatch and bidirectional mismatch. The average follow-up period was 6 months posttransplant for which the following parameters were studied: (a) engraftment kinetics for white blood cell (WBC) and platelets, (b) graft rejection, (c) overall graft survival, (d) graft-versus-host disease (GVHD), and (e) clinical variation in outcome for patients receiving peripheral blood stem cell/bone marrow harvest (BMH) as the source of stem cells. Results: The median age of recipients for both ABO compatible and ABO incompatible was 24 years and most of them were parent-offspring transplants. A total of 39 patients underwent haploidentical stem cell transplantation during the study period. Our cohort consisted of 23 ABO-compatible patients and 17 ABO incompatible patients. Out of these 17, 6 were major mismatch, 11 were minor mismatch and none were bidirectional mismatch. Of these 39 patients, 82% (32/39) engrafted within the normal expected time frame. The average days to WBC and platelet engraftment in these subgroups were noted to be as follows: Major – 12 and 18 days, compatible – 9 and 17 days, and minor – 10 and 17 days, respectively. Graft failure was observed in 20% (8/39) of patients, of which 4 patients had undergone ABO-compatible transplants while 4 patients had undergone minor ABO incompatible transplants. In this study, we observed that major ABO incompatibility had severe risk of GVHD (17%) compared to compatible (39%) and minor (27%) blood group mismatch. The overall survival rate in 6 months was equal (70%) in both arms. 5/39 patients, i.e., 12% received BMH as the source of stem cells, of these 80% are alive. Conclusion: Haploidentical transplants done in patients with ABO-incompatible donors had outcomes comparable to the ABO-compatible group. The risk of severe GVHD did not increased in the ABO mismatch group. Recipient of BMH had a marginally better graft survival.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"181 - 184"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42923300","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}

{"title":"Advancing the quality of life after transplantation","authors":"N. Prasad","doi":"10.4103/ijot.ijot_62_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_62_23","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"167 - 168"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355777","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}

{"title":"Lived experiences and expectations of postkidney transplant patients: A phenomenological study","authors":"Priya, M. Dutta, D. Kenwar","doi":"10.4103/ijot.ijot_55_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_55_22","url":null,"abstract":"Background: Kidney transplantation is the treatment of choice for most of the patients with end-stage renal disease. Transplantation brings many responsibilities related to medication adherence, immunosuppression, prevention of infection, regular follow-ups, etc. To meet the challenges faced by postkidney transplant patients, there is a need for deeper understanding of how people with kidney transplant learn to adapt to life posttransplant. Aim: The present study aims to explore the lived experiences of postkidney transplant patients. Materials and Methods: A phenomenological research design was adopted. By using purposive sampling technique, 18 postkidney transplant patients were enrolled. Data were collected through unstructured interviews and analyzed by using descriptive statistics for quantitative and Colaizzi's method for qualitative data. Results: Based on participants' responses, total 9 themes and 26 subthemes were extracted after data analysis. The main themes emerged were as follows: relief from dialysis-associated problems, perceived social neglect before and after transplant, burden of posttransplant regimen, impact on occupation, attitude toward donor, posttransplant lifestyle modifications, concerns about future quality of life, effect on family and children, and facilitating agents in transplant process. Conclusion: The present study concluded that the quality of life of participants after transplantation had improved in terms of relief from the dialysis-associated suffering. Worries about duration of graft function, future health, and cost were prevalent. There is a need to provide additional information, multidimensional support, and interventions following transplantation that target these concerns. This may support kidney recipients, better prepare for adaptation to life after transplant, and lead to improvements in the patient experience.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"17 1","pages":"202 - 208"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44359124","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}