Indian Journal of Transplantation最新文献

{"title":"Urinary Mitochondrial Deoxyribonucleic Acid","authors":"Brijesh Yadav, Narayan Prasad, Ravi Shankar Kushwaha, Manas Ranjan Patel, Dharmendra Singh Bhadauria, Anupma Kaul","doi":"10.4103/ijot.ijot_37_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_37_23","url":null,"abstract":"Abstract Background: Acute kidney injury (AKI) is one of the common manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. An early identification of AKI is of paramount importance to modulate the management of AKI, limiting the severity, avoiding nephrotoxic medicines, and modifying the drug dose depending on renal function. Aim: To determine the utility of urinary mitochondrial deoxyribonucleic acid (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting coronavirus disease 2019 (COVID-19)-associated AKI and mitochondrial stress. Materials and Methods: Live-related renal transplant recipients (RTRs) ( n = 66), who acquired SARS-CoV-2 infection and were admitted to a COVID hospital were included and subclassified into AKI ( n = 19) with > 1.5-fold rise in serum creatinine level from the pre-COVID-19 serum creatinine level, and non-AKI ( n = 47) whose serum creatinine value remained stable, or a rise of <1.5-fold of the baseline values of pre-COVID-19. A 50 mL urine sample was collected and urinary mt-DNA and NGAL was determined by the reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assays methods. Results: Both the urinary mitochondrial gene NADH dehydrogenase (ND-1) and NGAL level were significantly higher in the AKI group compared to non-AKI. The mean ND-1 gene Ct in the AKI group was (19.44 ± 2.58 a.u) compared to non-AKI (21.77 ± 3.60; P = 0.013). The normalized ND-1 gene cycle of threshold (Ct) in AKI was 0.79 ± 0.11 a.u compared to non-AKI (0.89 ± 0.14; P = 0.007). The median urinary NGAL level in AKI group was (453.53; range, 320.22–725.02, 95% confidence interval [CI]) ng/mL compared to non-AKI (212.78; range, 219.80–383.06, 95% CI; P = 0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58–70.39) ng/mg in the AKI group compared to 11.26 ng/mg (0.41–329.71) in the non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713, uNGAL was 0.663, and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. Conclusions: Urinary mt-DNA quantification can detect the post-COVID mitochondrial distress with higher sensitivity than uNGAL in RTRs.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357372","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":"Policy Suggestions for Transplantation of Organs in India","authors":"Shyamli Varshney, Pooja Kansra, Anurag Garg","doi":"10.4103/ijot.ijot_7_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_7_23","url":null,"abstract":"One of the most honorable acts of humanity is the donation of an organ or organs to save the lives of patients with severe diseases that necessitate organ replacement. Organs can be donated by people who are alive as well as dead. India has seen a noteworthy upsurge in organ donation following the death of the brain in recent years. There are various legal, clinical, ethical, and technical constraints implicated in the current organ donation and transplantation systems in terms of registering recipients, matching donors with recipients, removing organs, delivering organs, and transplanting organs. An end-to-end system is essential to ensure an impartial and competent organ donation and transplantation process. Use of blockchain technology in order to better manage organ donation and allocation can be one of the most efficient ways to remedy this situation. The article proposes blockchain-based solution to ensure complete decentralization, security, traceability, privacy, and trustworthiness in the donation and transplantation of organs. By performing confidentiality, safety, and privacy analyses and linking our projected resolution with the prevailing one, we evaluate the performance of the suggested solution. Adopting the above-mentioned measures will lead to the creation of block chain platforms or hyper ledger fabric frameworks, streamlining organ donation and allocation processes, which will benefit India as it moves toward the digital future in health care.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358655","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":"Understanding and Implementation of the Important Difference between ISO15189:2012 and ISO15189:2022: Medical Laboratories Requirements for Quality and Competence","authors":"Vikash Chandra Mishra, Vimarsh Raina","doi":"10.4103/ijot.ijot_73_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_73_23","url":null,"abstract":"Dear Editor, ISO15189 is a formal recognition by an authorized national accreditation body (National Accreditation Board for Testing and Calibration Laboratories [NABL] in the case of India) that a medical laboratory is capable of doing particular activities as per the standard. The International Organization for Standardization (ISO) developed ISO15189, which is the current, globally approved standard for medical laboratory practice.[1] In the Transplantation of Human Organ and Tissue Act 2014, there is a reference to NABL and medical laboratories that adhere to ISO standards. This act recognizes the importance of quality assurance and standardized practices in testing laboratories involved in organ and tissue transplantation.[2] The ISO1589 standard was first published in 2003 (ISO15189:2003) then revised in 2007 (ISO15189:2007), again in 2012 (ISO15189:2012),[3,4] and now an updated version of ISO1589 (ISO15189:2022) requirements for quality and competence was released by ISO in December 2022. This updated version includes fresh subjects (such as Point of Care Testing [POCT]), incorporates changes in the medical laboratory business, and significantly clarifies a variety of matters from the 2012 edition. This is an attempt to summarize the major key differences between ISO15189:2012 and ISO15189:2022 for an improved medical laboratory quality service and additionally, may also help the laboratory in preparation for the transition from the 2012 version to the 2022 version of ISO15189. ISO15189:2022 is based on ISO/International Electrotechnical Commission 17025:2017.[5] In this revised standard, many requirements have been combined, separated, elaborated, or highlighted further. Priority is given to technical requirements. The total number of clauses ends at 5.10.3 in ISO15189:2012, whereas in the updated version (ISO15189:2022), it ends at 8.9.3. Hence, there is a significant addition in the updated version for the betterment of the medical laboratory services. For the first time, a detailed list of POCT testing requirements has been added in ISO15189. POCT was only briefly discussed (in one reference) in the 2012 edition of ISO15189. POCT requirements are covered by a separate standard (ISO 22870:2016), which will be removed following the release of this document. Although ISO 1589:2012 incorporated risk management requirements, during the revision process, a greater emphasis is placed on risk management and assessment in medical laboratories in the 2022 version. There are five requirements instead of one concerning risk analysis compared to the previous edition. So over all the rights, requirements, and safety of patients are more strongly emphasized in this updated version of ISO15189. In the updated edition of ISO15189, the standards for external quality control are enhanced in addition to those for internal quality control. Now, seven different alternative ways can be used when an external quality program is not suitable or not available. ","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135801989","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":"Spectrum of Infections in Kidney Transplant Recipients: A Single Centre Retrospective Cohort Study","authors":"Chandani Bhagat, Rajendra Prasad Mathur, Neha Sharma","doi":"10.4103/ijot.ijot_84_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_84_22","url":null,"abstract":"Export Introduction: Kidney transplant recipients (KTRs) have to receive lifelong immunosuppressive therapy. Consequently, they are predisposed to life-threatening infections. A detailed review regarding the spectrum of infections is necessary for adequate management. Materials and Methods: In this single high-volume center, we present data of 100 KTRs, who presented to us with signs of infections. Results: The majority of the patients were male with a median age of 47 years and the median duration of follow-up was 41 months. Comorbidities were present in the majority of patients in the form of hypertension, diabetes, and heart disease. Among infections before kidney transplant, tuberculosis (28%), hepatitis C virus (11%), and hepatitis B virus (1%) were the predominant ones. During follow-up, 57% of patients presented to us with at least one episode of infection. The first episode of infection occurred after a median duration of 127 days. The most common infections were urinary tract infection, acute gastroenteritis, cytomegalovirus infections, pneumonia, pyelonephritis, surgical site infections, protozoal infections, and viral and other infections. Most of the infections were managed successfully; however, 7% of patients had graft dysfunction and are on maintenance hemodialysis. Conclusion: Infections in KTRs are a predominant cause of mortality. Prompt and aggressive treatment is warranted for patient survival.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838188","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":"Salvage of Renal Allograft Rupture in a COVID-19-Positive Patient with Buttressing Rectus Sheath: An Innovative Approach","authors":"Nripesh Sadasukhi, Ashish Sharma, Sandeep Malik, T. C. Sadasukhi, H. L. Gupta, Manish Gupta","doi":"10.4103/ijot.ijot_17_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_17_21","url":null,"abstract":"Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. Mostly graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. The exact pathogenesis of RAR is still not clear. Acute cellular rejection causes inflammatory reaction that leads to interstitial edema. Capsule tension due to edema leads to tension and tearing and may lead to RAR. COVID-19 infection in patient on immunosuppression like post-renal transplant is a worrisome disease with high morbidity and mortality. This posttransplant patient developed fever and decreased urine output, for which biopsy was done. On exploration, the graft was found to be ruptured. Graft salvage was tried with argon beam laser, surgical glue, and pressure but failed. The renal graft was then salvaged using buttressing rectus sheath graft in this COVID-19 patient.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135839637","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":"Unusual delay in Kidney Transplant due to COVID-19 Pandemic Just Before Transplant Surgery","authors":"Pritpal Singh, A. Krishna, C. Kumar, O. Kumar","doi":"10.4103/ijot.ijot_115_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_115_21","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70754804","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 descriptive cross-sectional study to assess knowledge regarding brain death among health professionals in India","authors":"V. Bharambe, K. Vijayakumar, VK Arunprasad, Supriya Methepatil, Sunita Jadhav, Mandar Ambike","doi":"10.4103/ijot.ijot_126_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_126_21","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70754880","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 child with vacterl association for deceased donor renal transplantation: Perioperative anesthetic management concerns","authors":"Nilesh Vaniya, Virali Trivedi, K. Vora, Amrita Singh","doi":"10.4103/ijot.ijot_76_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_76_22","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70758230","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":"Rare Presentation of Acute Abdomen in a Posttransplant Patient","authors":"Akila Viswanathan, Vidyashankar Panchangam, Govardhan Reddy, Shashank Shetty, Vinay Bhat, Naresh Bhat, Tripti Kaur","doi":"10.4103/ijot.ijot_71_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_71_23","url":null,"abstract":"Infective complications continue to be a big hurdle to patient and graft survival after transplantation. Fungal infections can occur anytime posttransplant. They often present with nonspecific symptoms leading to a delay in diagnosis and treatment. Pain abdomen in a posttransplant patient should always be evaluated in detail to rule out invasive fungal infections. Here, we present a case of gastric mucormycosis presenting as acute abdomen in a diabetic patient who was a 1-month posttransplant.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"283 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135801991","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":"Tac(hy)rolimus: A Case of Tacrolimus-induced Tachycardia","authors":"Madhav Hande, Mohammed Fahad Khan, Sudarshan Ballal, Sundar Sankaran","doi":"10.4103/ijot.ijot_64_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_64_23","url":null,"abstract":"The Editor, The case involves a 35-year-old female patient who had end-stage renal disease due to IgA nephropathy and was planned for a kidney transplant with her mother as the donor. She was started on tacrolimus 4 mg/day on postoperative day-2 (POD-2) as a part of the pretransplant regimen. Approximately 1 h after receiving the medication, she developed palpitations, and her heart rate increased to 134/min from the baseline of 78/min. The symptoms resolved spontaneously after 5–6 h, and further doses of tacrolimus were not given pretransplant. However, again, after the introduction of tacrolimus posttransplant on the first POD, the patient developed tachycardia [Figure 1], palpitations, and shortness of breath 45 min later. An electrocardiogram revealed sinus tachycardia, and echocardiogram was normal. The patient’s troponin I levels remained normal, and there were no serial ST-T changes observed. Her serum electrolytes such as sodium, potassium, calcium, and magnesium were also normal. Tacrolimus was stopped; however, the levels were not checked, and the patient continued with cyclosporine, mycophenolate mofetil, and steroid. Holter monitoring was conducted, which was normal. No active bleeding, fever, or other offending drugs were found. The patient was doing well at 5 months posttransplant, with a creatinine level of 1.2 mg/dl. The tachycardia was presumed to be a side effect of tacrolimus due to the temporal relationship and reproducibility with rechallenges.Figure 1: Electrocardiogram showing sinus tachycardiaTacrolimus is an immunosuppressive agent that is used to prevent organ rejection after transplantation. However, its use has been associated with various cardiovascular complications, including tachycardia and arrhythmias. In a case report by Erdoğan et al., a 13-year-old boy who underwent kidney transplantation developed sinus tachycardia after receiving tacrolimus.[1] The authors noted that tacrolimus-induced sinus tachycardia is a common finding in kidney transplant recipients, particularly in the early posttransplant period. However, the exact mechanism of tacrolimus-induced tachycardia is not clear. It is believed to be related to the drug’s effect on the autonomic nervous system, leading to sympathetic activation and increased heart rate. The authors suggested that careful monitoring of heart rate and blood pressure is essential in patients receiving tacrolimus.[1] In another case report by Kim et al., a 36-year-old male who underwent kidney transplantation developed supraventricular arrhythmia after receiving tacrolimus.[2] The authors noted that tacrolimus-induced arrhythmias are rare but can be life-threatening. Finally, Hodak et al. reported a case of QT prolongation and near-fatal cardiac arrhythmia after intravenous administration of tacrolimus in a liver transplant recipient. The authors suggested that tacrolimus-induced QT prolongation may be related to the drug’s effect on ion channels in cardiac myocytes.[3] In conclus","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135839652","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}