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   2013| July-September  | Volume 7 | Issue 3  
    Online since December 4, 2017

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Nutritional management of renal transplant patients
Uma Chitra, K Sunitha Premalatha
July-September 2013, 7(3):88-93
Transplantation is a major operation complicated by metabolic complications of pre-existing medical conditions and administration of immunosuppressive medications to prevent rejection. Even though the major causes of post-transplant metabolic abnormalities are not necessarily diet related, results from a number of studies have shown that these complications can be significantly improved through dietary intervention. An adequate nutritional status may improve outcomes after transplantation. Nutritional status is an important determinant of clinical outcome in patients with chronic renal disease. Post-transplant nutritional goals include providing adequate nutrients to treat catabolism and promote healing, monitoring and treating electrolyte abnormalities, and achieving optimal blood glucose control. The weight gain experienced by a large percentage of long-term renal recipients, is accompanied by a significant increase in body fat, which is partially explained by the immunosuppressive therapy and by a sedentary lifestyle. However, up to approximately 1 year after renal transplant, serum albumin levels may still be below normal, suggesting that protein malnutrition may persist after the transplant. A successful renal transplant allows greater dietary freedom and resultant weight gain. Dietary advice should be an important part of post-transplant treatment. This article reviews the effects of renal transplantation and the guidelines for nutritional management.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  293 71 1
Initial experience of pediatric liver transplantation – An Indian prospective
Kapileshwer Vijay, Rajesh Godara, CS Naidu, Pankaj Rao, Sanjay Sharma, Varunika Vijayvergia
July-September 2013, 7(3):74-77
Background: Liver transplantation is well established treatment modality worldwide as an effective treatment for end-stage liver disease with only chance of long-term survival. Over the years survival following liver transplantation in pediatric group of patients has improved significantly because of improved diagnostic tools, technical refinements at operation and improved perioperative intensive care management. Aim: To assess feasibility and outcome of pediatric liver transplant in India. Materials and methods: From Apr 2007 to June 2011, total 15 children underwent liver transplant at our institution and 11 were died while on work up, 6 had Acute Liver Failure (ALF) and rest 5 had Chronic liver disease (CLD). Results: Biliary atresia was the commonest indication (n = 8). Twelve children had living donor transplants, mothers being the donors in a majority of these. Common surgical complications were vascular problems (n = 3) and bowel perforation (n = 2). Common medical complications included pulmonary sepsis. Overall 1-year survival was 73.4%. All survivors are doing well, have caught up with physical and developmental milestones and are engaged in age appropriate activities. Conclusions: Optimization of patients, nutritional improvement and control of sepsis with early transplant is important predictor of outcome in pediatric population.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  226 49 1
Incidence of lymphoceles in patients undergoing renal transplantation and the effect of povidone–iodine in treatment
Birkan Bozkurt, Ersin Gürkan Dumlu, Mehmet Tokaç, Mehmet Kılıç, M Deniz Ayli
July-September 2013, 7(3):70-73
Background: We aimed to determine the incidence of lymphoceles in patients undergoing renal transplantation and the effect of povidone–iodine on lymphoceles. Material and methods: The study included a total of 26 cases (12 females, 14 males; mean age, 40.0 ± 10.1 years) treated with dialysis due to end-stage renal failure and underwent renal transplantation in our hospital between December 2010 and February 2012. Transplantation was performed using a cadaveric donor in 17 of the 26 patients, and a living donor in 9 patients. Post-operative ultrasound examination was performed in all patients on the first and seventh days, and repeated when indicated. Small and asymptomatic collections were followed. Large and symptomatic lesions underwent percutaneous catheter drainage, and daily injections of 10% povidone–iodine (30 mL) were applied for 30 min. Results: Lymphoceles were detected in 6 (23%) of the 26 transplant patients, all of which were treated with povidone–iodine effectively (100% success rate). There was no complications or lymphocele recurrence during three months follow-up. Conclusions: In spite of recent advances in renal transplantation surgery, lymphocele is still a common post-operative complication. Percutaneous sclerotherapy of lymphoceles with povidone–iodine is an easy to perform and effective treatment method without any complications or recurrence.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  193 32 3
A fulminant malignant hyperthermia episode during laparoscopic donor nephrectomy – Case report
Chinnamuthu Murugesan, Bandlapally Ramanjaneya Gupta Harish, Surjya Kanta Mohanty, Prashanth Kulkarni
July-September 2013, 7(3):94-96
Malignant hyperthermia (MH) is a rare life threatening complication during general anaesthesia using volatile anaesthetic agents. We report a case of fulminant MH episode during laparoscopic donor nephrectomy. The early clinical manifestations include rapid rise of ETCO2, respiratory acidosis and tachycardia, later fever, generalized muscle rigidity, hyperkalemia and severe rhabdomyolysis were noted. An acute MH was diagnosed and prompt resuscitative measures were initiated. No intravenous dantrolene was available for administration. Our patient survived of this acute fulminant MH due to early diagnosis, coordinated teamwork and availability of other resuscitative modalities only possible in a large tertiary care centre.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  201 23 1
Combining kidney paired donation with desensitization increases renal transplantation rate in highly sensitized patients
Vivek B Kute, Aruna V Vanikar, Himanshu V Patel, Pankaj R Shah, Manoj R Gumber, Divyesh P Engineer, Hargovind L Trivedi
July-September 2013, 7(3):109-111
When a desensitization protocol is unsuccessful, a look-back into kidney paired donation (KPD) pool may facilitate transplantation. A 53-year male developed end stage renal disease (ESRD) due to chronic glomerulonephritis. His immunological profile remained unacceptable for transplantation with wife as potential donor even after desensitization protocol. Lymphocytotoxicity crossmatch, flow crossmatch and donor specific antibodies [DSA] were favorable for transplantation with rescue swap donor. Two-way KPD exchange was performed with steroid and rabbit anti-thymoglobulin induction under triple immunosuppressive regimen. Both recipients were discharged with stable allograft function. This case suggests that in case of an unsuccessful attempt at desensitization, rescue KPD can be used for salvaging failed desensitization treatment and increase the transplantation rate.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  178 39 2
The current state and key issues of pediatric heart transplantation
Ching Kit Chen, Anne I Dipchand
July-September 2013, 7(3):78-87
Pediatric heart transplantation has now been established as standard of care for infants and children with end-stage heart disease. Initial experience with transplantation of the heart in children was met with high mortality owing primarily to the lack of effective immunosuppressive medications. However, interest in pediatric heart transplantation had its resurgence in the late 1970s and early 1980s with the discovery and introduction of cyclosporine-based immunosuppression regimens. Outcomes have consistently improved with improved selection of candidates and donors, enhanced preservation of the donor heart, refinements in surgical technique, the development of endomyocardial biopsy for surveillance of rejection, and the histopathologic standardization of rejection. The last 10 years have shown exponential growth in knowledge affecting the clinical course and outcomes of these patients, contributing to the length of patient survival and improved quality of life. Significant limitations still exist including the need for lifelong immunosuppressive medications and toxicities associated with these drugs, the development of post-transplant lymphoproliferative disease, and chronic rejection or allograft vasculopathy. In this review, we will summarize some of the many lessons learned over the last 10 years, highlight recent advances in our knowledge, and describe some of the key issues and future trends of pediatric heart transplantation.
[ABSTRACT]   Full text not available  [PDF]
  170 26 -
Interventional management of iliopsoas abscess in a post renal transplant patient
Hiralal , Madhvi , Anuj Thakral, Narayan Prasad, Anupama Kaul, Dharmendera Bhadauria, Amit Gupta, RK Sharma
July-September 2013, 7(3):101-103
Various types of collections can occur around the transplanted kidney. We present one such rare complication of psoas abscess underneath the transplanted kidney. Patient was on immunosuppression therapy post transplant and already had pulmonary tuberculosis treated with anti-tubercular treatment. Psoas abscess was diagnosed on subsequent follow up and managed successfully with ultrasound guided placement of percutaneous drainage catheter along with antibiotic therapy based on the culture report. Percutaneous drainage in combination with antibiotics is a viable alternative to more invasive surgical drainage for management of psoas abscess in post transplant patients.
[ABSTRACT]   Full text not available  [PDF]
  152 32 -
Double drug abuse in renal transplant patient – A case report
Anal Trivedi, Neeta Bhavsar, Bimal Jathal
July-September 2013, 7(3):104-108
In Renal transplant patients prevalence of gingival enlargement due to cyclosporine along with calcium channel blockers are increasing, as calcium channel blockers are drug of choice in cases with cyclosporine induced renal hypertension. As the treatment part in most of the cases to reduce gingival overgrowth, tacrolimus substitution to cyclosporine, is sufficient. But, as per present case report, patient is intolerant to tacrolimus. So, periodontal therapy is an only alternative to this patient. Thus, trying to understand and correlate internal mechanism of action of cyclosporine & amlodipine, with histopathologic & clinical picture of gingival enlargement; and decide corrective periodontal treatment is a humble aim of present case report, but the present case report invites lots of further research work in this direction. A case is presented to illustrate adverse effects of both the drugs in under treatment renal transplant patient clinically as well as histopathologically & its periodontal management.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  150 34 1
Recurrence of focal segmental glomerulosclerosis in a renal allograft recipient
Zachariah P Polachirackal, Vavullipathy N Unni, Seethalekshmy N Vijayan, Anil Mathew, Rajesh R Nair, George Kurian
July-September 2013, 7(3):97-100
A 22-year girl, diagnosed to have primary focal segmental glomerulosclerosis in 2009, underwent live related donor renal transplantation in May 2011. Her immunosuppressive regimen included Tacrolimus, Mycophenolate Mofetil and Prednisolone. For next three months graft function remained normal. In August 2011 she developed massive proteinuria with mild graft dysfunction and graft biopsy showed recurrence of focal segmental glomerulosclerosis. She underwent nine sessions of plasmapheresis followed by two doses of Rituximab. She attained remission of proteinuria and normal graft function after treatment. She continues to be in remission at one year and six months.
[ABSTRACT]   Full text not available  [PDF]
  124 28 -
RK Sharma
July-September 2013, 7(3):69-69
Full text not available  [PDF]
  108 36 -
A case of post renal transplant with swelling on forearm
Narayan Prasad, Vinita Agarwal, Tejender Singh Chauhan
July-September 2013, 7(3):112-112
Full text not available  [PDF]
  88 36 -