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  Citation statistics : Table of Contents
   2015| July-September  | Volume 9 | Issue 3  
    Online since December 7, 2017

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Oligospermia secondary to sirolimus
Syed Sajad Hussain, Samina Farhat, Imtiyaz Wani
July-September 2015, 9(3):119-121
Sirolimus, one of the leading drugs of the mammalian target of rapamycin inhibitor (mTORi) family, is a promising immunosuppressive drug being used after solid organ transplantation. The introduction of sirolimus in renal transplantation has increased the repertoire of immunosuppressive protocols substantially. It has a different mode of action and a different side effect profile (i.e. lower nephrotoxicity, less hypertension and less neoplastic potential) than the calcineurin inhibitors, the other commonly used post transplant immunosuppressive drugs. Here we present a case report of a 40-year-old patient who presented with oligospermia after consuming the sirolimus for three years.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Kidney transplantation: Hemodialysis and surrounding are they informed enough?
Béfa Noto Kadou Kaza, Kossi Akomola Sabi, Eyram Yoan Makafui Amekoudi, Ghislain Imangue, Mays Hadi Al-Torayhi, Claude Mawufemo Tsevi, Mohamed Zamd, Ghislaine Medkouri, Mohamed Gharbi Benghanem, Benyounes Ramdani
July-September 2015, 9(3):101-104
Kidney transplantation is the best treatment for chronic renal failure. However there is less donors compared to recipients whose number continues to increase. Ignorance of transplantation by hemodialysis patients and their families could be one of the causes. We aim to assess the knowledge and opinions of hemodialysis patient and his surrounding on renal transplantation. The survey conducted in August 2013 included 83 hemodialysis patients of our center and 70 members of their surroundings. They underwent a questionnaire about usual aspects of kidney transplantation. Out of 83 hemodialysis patients we noted 49.4% of women with an average age of 41.4 ± 12 years; 66.7% had a low economic status. There was a lack of information among 62.7%. Only 41% reported to be transplant candidate with 12% noted on the transplant list. Transplantation was estimated to be more expensive by 50.6% of the patients and 71.1% think that it allowed a better life. For 20.5% of the patients, Islam is against the cadaveric donation. Out of 70 members of the surrounding questioned there were 56.8% of women with an average age of 44.4 ± 10.5 years. The low economic status represented 52.3%; 61.4% lacked information. 56.8% think that life is impossible with only one kidney, 13.6% were noted on the donation register. For 45.5% Islam is against the cadaveric donation. It is important to increase awareness of hemodialysis patients and their families about kidney transplantation.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Renal transplant: Tacrolimus use and two weeks post-transplant serum creatinine levels predict early acute rejections
Sonam Bedi, Chandra Mani Pandey, Amit Gupta, Narayan Prasad, Anupama Kaul, Dharmendra Bhadauria, Uttam Singh, Raj Kumar Sharma
July-September 2015, 9(3):90-94
Aim: Improved results have made renal transplantation the favored option for treating patients with end stage renal disease. Although the risk of allograft rejection still remains a major concern for short- and long-term grafts survival, serum creatinine is the most successful biomarker to predict acute renal rejection. Methods: Present analysis was carried out to assess the extent of additional risk of acute renal rejection with elevated baseline serum creatinine. Data were observed from December 2009 to April 2013 on various factors on 307 patients, who underwent renal transplant at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS, Lucknow). Follow-up data of 90 days post-transplant were analyzed. Cox Proportional Hazards model was applied to identify the determinants of graft rejection. Survival curves for various contributing factors were obtained. Results: Patients treated with cyclosporine were 3.83 times more prone to have acute rejection at 3 months than those treated with tacrolimus. Compared to those with creatinine <1.10 mg/dl, hazards of acute rejection at 3 months were similar in those with creatinine between 1.10 and 1.50 mg/dl (HR = 1.73), while 16.01 times higher in those with creatinine ≥1.50 mg/dl. Conclusions: Renal transplant cases with elevated creatinine at two weeks post-transplant and those on cyclosporine-based immunosuppression are at higher risk of acute rejection and would require more frequent follow-ups and monitoring to diagnose early acute rejection episodes.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Mucormycosis in the post renal transplant surgical scar
Ashish Parikh, Amit Tuli, Francis K Sridhar, Kim Mammen
July-September 2015, 9(3):116-118
Cutaneous mucormycosis is a rare entity related to kidney transplantation, which usually presents with ecthyma-like lesions and black necrotic cellulitis. Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema nodosum-like lesions with panniculitis or discharging sinus.We report an unusual case of primary cutaneous mucormycosis in a post-renal transplant patient, presenting as pus discharging sinus from the surgical incision site.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Evaluation of immunological barriers in transplantation: Role of transplant immunology lab
S Mehrotra, P Rishishwar, RK Sharma
July-September 2015, 9(3):83-85
Full text not available  [PDF] [CITATIONS]
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Management of acute anastomotic transplant renal artery stenosis in orthotopic renal transplantation by percutaneous angioplasty and stenting in the early post-operative period
V Murali, J Vyas, R Sabnis, M Desai
July-September 2015, 9(3):122-124
Despite recent advances, post-renal transplant vascular complication rate remains stable. We report a case of a 55-year-old male, chronic smoker with extensive atherosclerotic disease who underwent right orthotopic live related renal transplantation. On 6th post-operative day, the patient had sudden drop in urine output and graft site pain and found to have acute anastomotic transplant renal artery stenosis (TRAS), which was managed successfully with percutaneous angioplasty (PA) and stenting. His post-operative course was uneventful and has normal renal functions at 6 months post-transplant period.
[ABSTRACT]   Full text not available  [PDF]
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Cortical laminar necrosis due to refractory status epilepticus in a kidney transplant patient with cryptococcal meningitis
Zaheer Virani, Prashant Rajput, Pankaj Agarwal, Rashmi Badhe
July-September 2015, 9(3):105-108
A 56-year-old diabetic male underwent kidney transplant in 2010. He was brought to the hospital with complaints of vomiting and altered sensorium of 10 days duration. Lumbar puncture revealed cryptococcal meningitis. He was promptly initiated on liposomal amphotericin B and flucytosine. Immunosuppressive agents tacrolimus and mycophenolate mofetil were discontinued. There was an initial improvement in his sensorium but a few days later, he developed super-refractory status epilepticus. Despite early and aggressive management of seizures with multiple anti-epileptic drugs including intravenous anesthesia with thiopentone, his seizures persisted. This unfortunately led to cortical laminar necrosis, a condition in which there is severe brain injury. This condition is commonly a consequence of hypoxic ischemic encephalopathy, hypoglycaemic encephalopathy, status epilepticus, or ischemic stroke, and most patients either progress to brain death or remain in a persistent vegetative state.
[ABSTRACT]   Full text not available  [PDF]
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Complete recovery of acute kidney injury in native kidney following heart kidney transplantation
Vanji Karthikeyan, KK Venkat
July-September 2015, 9(3):109-112
We report the case of a 23-year-old female who developed severe acute kidney injury (AKI) in the setting of recent onset congestive heart failure secondary to viral cardiomyopathy, cardiogenic shock unresponsive to placement of a biventricular assist device with continued requirement of multiple intravenous pressors, recurrent ventricular tachycardia/fibrillation, and rhabdomyolysis secondary to ischemic necrosis of left leg muscles. Daily slow, low-efficiency dialysis was instituted shortly after admission. Given the possibility of irreversible AKI and the inferior outcomes following heart transplantation alone in patients with perioperative renal dysfunction, she was listed for urgent combined heart-kidney transplantation. Dual transplantation was performed after 9 days of AKI and 7 days on dialysis. Both organs functioned well soon after transplantation. One month post-transplant, recovery of native kidney function with nearly equal contribution to renal function by the native kidneys and the allograft was documented by radioisotopic renography. This case report highlights the difficulty in deciding which patients with severe AKI in the setting of acute heart failure may recover renal function with heart transplantation alone and the need for developing guidelines to help in choosing between heart versus heart-kidney transplantation in such patients.
[ABSTRACT]   Full text not available  [PDF]
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Spontaneous clearance of HCV infection in a renal allograft recipient
Vishal V Ramteke, Bhupendra V Gandhi, Ajay Jhaveri, Parijat Gupte
July-September 2015, 9(3):113-115
Spontaneous clearance of hepatitis C virus occurs exclusively after acute infection with an associated robust cellular immune response. In immune compromised patients like renal transplant recipient, this is rarely seen. Although it has been reported in recipients who have received interferon in the past, very few cases of spontaneous clearance of hepatitis C virus (HCV) have been described in interferon naive patients. We report a case of a 43-year-old renal transplant recipient who had spontaneous clearance of HCV infection with reduction of immunosuppression to minimum without antiviral therapy. To the best of our knowledge, this is the first reported case in Indian literature.
[ABSTRACT]   Full text not available  [PDF]
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High prevalence of rare hla alleles in parsi population from india: Marrow donor registry data
Leenam Dedhia, Sunil Parekh, Kanjaksha Ghosh
July-September 2015, 9(3):125-126
Full text not available  [PDF]
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Study of the outcome of renal transplants with single versus multiple renal arteries in obese recipients
Siddalinga Swamy
July-September 2015, 9(3):86-89
As we all know, donor nephrectomy of multiple renal arteries (MRA) is not a contraindication, either by open or laparoscopic method. But the study of the effect on the recipients is still going on, and in obese patients, it is very less studied. Here we have made an attempt to study the outcome of single versus multiple renal arteries in obese patients. Graft survival and vascular and urological complications were studied and compared among the single versus multiple renal artery recipients and in obese and nonobese patients. Methods and material: Retrospectively, all the transplants done in the Department of Urology, CARE Hospital during the period of 2004–2015 were analyzed. All the patients underwent renal transplant as per hospital protocol. Statistical analysis used: Data were analyzed using SPSS for Windows version 20 with relative risk calculated using stat pages software. Fisher's exact test and Kendall's tau-b were used to compare categorical data between the body mass index (BMI) and anatomical subgroups. Results: Over all, 320 transplants were done; 224 were single renal artery (SRA) and 96 were multiple arteries. 286 had BMI <30 and 34 patients had BMI more than 30. Delayed graft function (DGF) was seen in 20 (6.25%), vascular complications in 10 (3.12%), urological complications in 15 (4.6%), wound infection in 20 (6.25%), and lymphocele in 16 (5%) was observed. Between single and multiple renal arteries, cold ischemia time, DGF, vascular complications, and one-year graft survival were suggestive of better results in SRA group. Compared to obese and nonobese single artery groups, nonobese group had better graft survival and lesser vascular complications. In multiple renal arteries also, obese patients with multiple vessel anastomosis had poor graft survival and increased vascular complications. Conclusions: Even though obesity is not a contraindication for renal transplant surgery, we need to be conscious while selecting patients with multiple renal arteries for obese recipients.
[ABSTRACT]   Full text not available  [PDF]
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Experience of hematopoietic stem cell transplantation (HSCT) in the patients infected with either hepatitis B or hepatitis C virus
Gaurang Modi, Irappa Madabhavi, Sandip Shah, Kamlesh Shah, Kinnari Patel, Asha Anand, Harsha Panchal, Apurva Patel, Sonia Parikh
July-September 2015, 9(3):95-100
Background: Hematopoietic stem cell transplantation (HSCT) is challenging in Hbs-Ag positive or HCV-Ab positive patients due to fear of delaying engraftment and transplant-related mortality (TRM). Very few data are published internationally till date. We had done HSCT (allogenic/autologus) of 19 hepatitis B and hepatitis C positive malignant and nonmalignant patients at our institute during the years 1999–2013. Design and methods: We performed a retrospective analysis of the patients who were either hepatitis B or hepatitis C virus seropositive at the time of HSCT (n = 19). All the positive patients (Hbs-Ag positive or HCV-Ab positive) who underwent HSCT for malignant or nonmalignant causes during 1999–2013 were selected. A total of 13 patients underwent autologus HSCT and 6 patients underwent allogenic HSCT. All the included patients had performance score 1, normal liver function test, and noninfectious state of Hbe antigen before HSCT. Results: The median age of the seropositive patients was 25 years (range 7–54); 16 patients were Hbs-Ag positive and 3 were HCV-Ab positive. Most common indication of HSCT was lymphoma (n = 12), in which 7 patients were of Hodgkin disease and 5 patients were of non-Hodgkin disease (NHL). Three patients were acute myeloid leukemia, 2 patients of thalassemia major, 1 patient was of chronic myeloid leukemia-chronic phase, and 1 of multiple myeloma. We had used high-dose chemotherapy for induction with carmustine, etoposide, cytarabine, and melphalan (BEAM) for autologus HSCT and busulfan, cyclophosphamide (BUCY), busulfan, cyclophosphamide-thymoglobulin (BUCY-THYMO), and reduced intensity HSCT (RIST) for allogenic HSCT. All the patients underwent successful engraftment except one NHL patient. The median duration of neutropenia was 14 and 11 days in the allogenic HSCT and autologus HSCT, respectively. Median duration for engraftment of neutrophils was achieved on +Day 17 with 3 consecutive absolute neutrophil counts of more than 500 cumm/dL. Median duration for engraftment of platelets was achieved on +Day 19 with 3 consecutive platelet counts of more than 50,000 cumm/dL without any component support. Out of 6 allogenic HSCT patients, 4 developed graft versus host disease (GVHD) (2 – liver, 1 – colon, 1 – both skin and liver). Three patients died due to liver GVHD (2 – acute, 1 – chronic). Grades of GVHD in allogeneic HSCT patients are as follows, for liver (grade 3 in 2, grade 4 in 1), colon (grade 2 in 1), and skin (grade 2 in 1). Out of the 8 patients, one patient developed grade 3 veno-occlusive disease. Median at 100 days, 1-year overall survival (OS), and 5-year OS were 89.4%, 94.1%, and 81.1%, respectively. Conclusions: HSCT is a rugged job in Hbs-Ag positive or HCV-Ab positive patients due to more complications in the form of more neutropenia, GVHD, drug toxicity of chemotherapy, acute fulminant liver failure, fear of delaying of engraftment, and TRM. Careful evaluation before embarking on HSCT and intensive assessment against complications are warranted in Hbs-Ag positive and HCV-Ab positive recipients.
[ABSTRACT]   Full text not available  [PDF]
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