Indian Journal of Transplantation最新文献

{"title":"Microfilaria Infection Associated with Hemophagocytic Lymphohistiocytosis in a Renal Transplant Patient","authors":"Shuvam Roy, Narayan Prasad","doi":"10.4103/ijot.ijot_117_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_117_23","url":null,"abstract":"TRANSPLANTATION IMAGE A 27-year-old male live-related renal allograft recipient, on triple maintenance immunosuppression therapy with tacrolimus, azathioprine, and prednisolone, presented 7 years after transplant with complaints of dysuria and fever for 2 weeks. Urine culture showed Pseudomonas infection. He had bi-cytopenia initially in the form of anemia and leukopenia, which worsened to pancytopenia subsequently. Azathioprine was stopped. He had been treated with sensitive antibiotics without any clinical response and the fever persisted. In view of febrile neutropenia, he had been given antifungal liposomal amphotericin-B. During evaluation, bone marrow aspirates demonstrated hypocellular marrow with increased number of histiocytes, with many showing hemophagocytosis [Figure 1a], suggesting the diagnosis of hemophagocytic lymphohistiocytosis (HLH), which was also supported by the high-level of serum ferritin 1100 ng/ml and high triglyceride level (600 mg/dl). There was also evidence of microfilaria in bone marrow [Figure 1b] and peripheral blood. He was started on diethylcarbamazine citrate.Figure 1: (a) May Grunwald Giemsa stain of bone marrow aspirate showing histiocytes and hemophagocytosis (black arrow), and (b) Grunwald Giemsa stain demonstrating microfilaria in bone marrow (black arrow)HLH is a rare, life-threatening condition caused by excessive immune system activation. It can be triggered by infection, malignancy, autoimmune diseases, and immunosuppression associated with solid organ transplantation. It can occur in renal transplant recipients at risk of opportunistic infections. Our patient had a pseudomonal urinary tract infection, which can trigger HLH. However, the patient was on a sensitive antibiotic, ceftazidime-sulbactam plus polymyxin. Most parasitic infections in transplant recipients produce morbidities, not mortality. Parasitic infections such as malaria, toxoplasmosis, leishmaniasis, and strongyloidiasis rarely cause HLH. This patient resides in the endemic zone of filaria; microfilaria was detected in our patient’s peripheral blood and bone marrow. Renal transplant recipients may have multiple infections simultaneously, and the index patient remains unresponsive to anti-pseudomonal antibiotics, suggesting that microfilariae may be responsible for HLH in this patient, resulting in the patient’s casualty. To the best of our knowledge, filariasis has not been implicated so far in the causation of HLH, and it may be an incidental finding in our patient. However, there is an alarm for renal transplant patients living in the endemic zone of filariasis and adherence to the National Filaria Control Program needs to be encouraged. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be pu","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"284 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":"135839651","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":"“Kidney First” Retrieval: A Viable Concept for Emerging Transplant Centers","authors":"Sanjay P. Kolte, Akshay Mahesh Kriplani, Rahul Saxena","doi":"10.4103/ijot.ijot_34_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_34_23","url":null,"abstract":"To increase deceased donation in an organ-depleted country like India, improved understanding of the mechanisms influencing donor yield is important. Certain technical and emotional modifications in approach and methods can help in increasing donations. “Kidney first” retrieval in situations such as delay in heart/liver team’s arrival, diagnostic dilemma for quality of organ, or single surgeon for both kidney transplants can prove useful in optimizing donor maintenance quality and cost and minimizing cold ischemia time of the other kidney, without altering the structural viability of other organs. Early handover of the deceased body for cremation adds a positive perspective to the grieving family’s decision for consent. This approach can be safely suggested for emerging transplant centers yearning to increase their scope of organ transplantation amidst the constraints of time, expertise, logistics, and infrastructure.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"167 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":"135839897","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":"Every Rash is Important – A Rare Case of Neurosyphilis in Renal Transplant Patient","authors":"Madhav Hande, Mohammed Fahad Khan, Ravi Jangamani, Vishwanath Siddini, H. Sudarshan Ballal","doi":"10.4103/ijot.ijot_48_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_48_23","url":null,"abstract":"In immunocompromised conditions, latent syphilitic infection can lead to secondary syphilis. We present here a case of neurosyphilis (syphilitic meningomyelitis) in a kidney transplant recipient. Atypical presentation, the typical maculopapular rash, and a serological test all pointed to secondary syphilis. The scenario illustrates a crucial point: infections can go undetected, whereas a patient is on immunosuppressive therapy.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"71 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":"135839903","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 prospective observational study to compare abo isoagglutinin titer by conventional test tube and column agglutination technique after heat inactivation of plasma in O blood group individuals","authors":"P. Pandey, S. Ranjan, D. Setya, Supriya Kumari","doi":"10.4103/ijot.ijot_62_21","DOIUrl":"https://doi.org/10.4103/ijot.ijot_62_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":"70756274","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":"Rabbit Anti-thymocyte Globulin (rATG) as Induction Immunosuppression Therapy in Patients Undergoing Renal Transplantation: Clinical Experience from RISE Registry","authors":"Deepak Shankar Ray, Sishir Gang, Dinesh Khullar, Anil Kumar Bhalla, Ashish Sharma, Abi Abraham, Sree Bhushan Raju, Vishwanath Siddhi, Arup R. Dutta, Georgie Abraham, M Soma Shekar, Bharat V. Shah, Jatin Kothari, Madan Bahadur, Ishtiaque Ahmed, Ajit Singh Narula, Sarvanan Margabandhu, Sujatha Shetty, Deepa Chodankar, Aniket Mandrekar, Vaibhav Shrikant Salvi","doi":"10.4103/ijot.ijot_81_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_81_22","url":null,"abstract":"Export Introduction: Induction immunosuppression therapy plays a significant role in the prevention of acute rejection in renal transplantation. This study aimed to evaluate the effectiveness and safety of rabbit anti-thymocyte globulin (rATG) used as induction immunosuppression in Indian patients undergoing renal transplantation. Patients and Methods: RISE was a multicenter (n = 20), prospective observational cohort study of patients aged ≥ 18 years undergoing a first or repeat renal transplant and receiving rATG as part of the routine management practice. Twelve-month acute rejection was evaluated as a primary endpoint. Results: A total of 325 patients were enrolled, of which 313 patients received at least one dose of rATG with a mean (standard deviation [SD]) duration of induction therapy of 2.07 (1.33) days. The mean (SD) cumulative rATG induction dose was 2.6 (1.5) mg/kg. The mean (SD) glomerular filtration rate was 64.59 (19.57) mL/min/1.73 m2 at 6 months and 64.93 (20.26) mL/min/1.73 m2 at 1 year. The incidence of acute rejection at 1 year was 7.7% (n = 23). Graft rejection at 6 months was observed in 6.7% (n = 20) patients and an average time to first graft rejection of 5.4 and 10.3 months at 6 and 12 months, respectively. In total, 342 adverse events (AEs) were reported (n = 154, 49.2%) after 12 months, of which 11 events were related to the rATG treatment. Pyrexia was the most commonly reported serious adverse event (n = 10, 3.2%). Seven deaths were reported during the study. Conclusions: The study revealed the effectiveness and safety of rATG induction therapy in the Indian context as expected based on the data from randomized clinical trials. Trial Registration Number: CTRI/2017/09/009/009700.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"42 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":"135801987","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":"Health-related Quality of Life with Emotional and Behavioral Outcomes in Renal Transplant Recipients: A Study from a Tertiary Center in North India","authors":"Anant Giri, Nripesh Sadasukhi, Trilok Chand Sadasukhi, Manish Gupta, Hotilal Gupta, Ashish Sharma, Sonia Goswami, Ankit Modi","doi":"10.4103/ijot.ijot_86_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_86_22","url":null,"abstract":"Export Introduction: Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease and health-related quality of life (HRQoL) is routinely used for measuring the outcome. Although the generic HRQoL questionnaire provides useful information on multiple dimensions, they fail to capture emotional and behavioral components of well-being, which is supplemented by the Transplant Effects Questionnaire (TxEQ). The present research studies the impact of these two questionnaires on various parameters affecting the health of kidney transplant recipients. Methodology: This cross-sectional study included 500 postrenal transplant patients within 5 years of transplant (18–70 years) evaluating HRQoL using a Short Form Survey-36 Questionnaire and emotional/behavioral outcomes using a TxEQ. Results: Mean age of participants was 44.92 ± 5.86 years and males constituted the majority (>75%). The mean physical component score (PCS) was 41.3 ± 9.2 and the mental component score (MCS) was 48.1 ± 8.4. The highest score was observed for bodily pain, followed by role limitations attributable to emotional problems (RE). The PCS was significantly higher among younger participants, among males, among participants who have got a transplant >24 months ago, and among participants who had serum creatinine levels <2 mg/dl (*P < 0.05). However, the mental component score did not differ significantly in any of the matched variables. In TxEQ, medication adherence had the highest mean score, followed by perceived responsibility toward others. Conclusion: In our study, we concluded that reduced physical functioning among female gender, illiterate patients, with increasing age, in employed section, and with associated comorbidities such as hypertension and with a history of rehospitalization.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"9 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":"135838497","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 Rare Case of Cladophialophora Isolated in a Renal Transplant Patient after Rejection Therapy","authors":"Mehvish Khan, Pratik Tripathi, Shaurya Mehta, Gaurav Khandelwal","doi":"10.4103/ijot.ijot_46_23","DOIUrl":"https://doi.org/10.4103/ijot.ijot_46_23","url":null,"abstract":"Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis. A case of live-related renal allograft recipient complained of high-grade continuous fever on the 5 th postoperative day (POD). No organism was isolated on cultures and no foci were found on chest X-ray. He was started on broad-spectrum antibiotics. The patient thereafter developed acute antibody-mediated plus acute cellular rejection on the 7 th POD. He received a high dose methylprednisolone with plasmapheresis. On the 18 th POD, the patient was diagnosed with right frontotemporal and basal ganglionic region abscess on magnetic resonance imaging of the brain. Urgent neurosurgical intervention was done and the sample was sent for investigation. Initially, there was suspicion of Aspergillus on culture. Injection of liposomal amphotericin B was given for 14 days, after which oral voriconazole was started. The patient improved initially but multiple abscesses recurred on the 46 th POD. Abscess was drained. On the final culture report, C. bantiana was isolated. 5-flucytosine was added to voriconazole as dual antifungal therapy.","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"80 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":"135839650","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":"Posttransplant cortical necrosis in a kidney transplant recipient","authors":"P. Etta, T. Madhavi, R. Panjwani","doi":"10.4103/ijot.ijot_24_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_24_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":"70755315","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":"Subcapsular hematoma in postrenal transplant patients: A report of three cases","authors":"Shivakumar S. Patil, Milind Mandwar, Vivek Thakur, D. Kenwar","doi":"10.4103/ijot.ijot_26_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_26_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":"70755419","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":"Duplicated inferior vena cava in live-related renal transplant donor nephrectomy","authors":"K. Kamath, S. Vasudevan, H. Pandey","doi":"10.4103/ijot.ijot_51_22","DOIUrl":"https://doi.org/10.4103/ijot.ijot_51_22","url":null,"abstract":"","PeriodicalId":37455,"journal":{"name":"Indian Journal of Transplantation","volume":"65 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70756217","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}