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  Citation statistics : Table of Contents
   2014| April-June  | Volume 8 | Issue 2  
    Online since December 4, 2017

 
 
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CASE REPORTS
Successful thrombolysis of renal allograft venous thrombosis – A case report
Sampath Kumar Krishnaswamy, Mukuntha Rajan, Arunachalam Prabahar
April-June 2014, 8(2):57-59
DOI:10.1016/j.ijt.2014.05.003  
Renal allograft venous thrombosis is a rare but catastrophic complication resulting in graft failure. A 55-year-old male underwent live related renal transplantation. Donor's right kidney was placed in recipient's left iliac fossa. Graft renal artery was anastomosed to the left internal iliac artery. Graft renal vein was anastomosed to the left external iliac vein in a side to side fashion. He was discharged with a serum creatinine of 0.9 mg. Four weeks after transplantation patient was readmitted with anuria for 6 h and swelling of left leg for 1 day. Doppler study showed extensive venous thrombosis extending from left femoral, external iliac veins with total occlusion of allograft vein. Renal arterial diastolic flow was absent. Blood urea was 36 mg/dl and creatinine was 2.2 mg/dl. A fogarty's catheter was inserted in the popliteal vein and venogram was performed to outline the extent of thrombus. Thrombosuction followed by In situ thrombolysis with streptokinase and heparin were carried out. His renal parameters and urine output dramatically improved following our intervention. He was discharged with the creatinine of 0.8 mg/dl. Salvage of the allograft in renal vein thrombosis is possible if early diagnosis and aggressive thrombolytic therapy are instituted.
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ORIGINAL ARTICLES
Outcomes of living donor renal transplant recipients with and without basiliximab induction: A long-term follow-up study
Harsh Vardhan, Narayan Prasad, Akhilesh Jaiswal, Brijesh Yadav, Shashi Kumar, Dharmendra Bhadauria, Anupama Kaul, Amit Gupta, Anees Srivartava, Raj Kumar Sharma
April-June 2014, 8(2):44-50
DOI:10.1016/j.ijt.2014.06.001  
Objectives: To compare the outcomes of renal allograft recipients with and without basiliximab Induction in living donor renal transplantation. Methods: We included 296 renal allograft recipients, 148 patients with basiliximab induction and 148 without induction (controls) therapy from 1st Jan 2003 to 31st December 2011 and followed up till end of study period December 2013. The control patients were next renal transplant recipients who were age and gender matched with similar ratio of HLA mismatch. The acute rejection episodes, delayed graft function, patient survival; and the death censored and death non-censored graft survival was compared between the two groups of patients with and without induction therapy. Results: The demographic profile and characteristics of the patients were similar in both groups of patients. The proportion of patients with HLA mismatches, and the immunosuppression protocols other than basiliximab induction was also similar in both groups. The number of biopsy proven acute rejection at 6 months was 10 (6.7%) in patients with induction and 22 (14.8%), (p = 0.028) in patients without induction. Delayed graft function was observed in 9 (6%) patients with induction and 14 (9%), (p = 0.39) patients without induction. Graft failure was observed in 5 (3.38% patients with induction and 14 (9.4%), (p = 0.05) patients without induction at end of follow up. The overall cumulative survival of all patients at 1, 2, 5 and 10 years was 95%, 92%, 85% and 80%, respectively. The mean cumulative patient survival with induction was 120 (95% CI 114–126) months; and without induction was 102 (95% CI 94–110) months (p = 0.001). The 1, 2, 5, and 10 years patient survival; death censored and death non censored graft survival was superior in patients with induction compared to the patients without induction therapy on long term follow up. Conclusion: Acute rejection was significantly less in patients with induction compared to that of patients without induction. The cumulative short and long term patients and graft survival was significantly better in patients with induction compared to that of patients without induction.
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  1 317 55
CASE REPORTS
External iliac artery dissection after renal transplant
V.L.N Murthy Pisapati, Ch Ramreddy, Ramakrishna Pinjala, RC Mishra
April-June 2014, 8(2):51-53
DOI:10.1016/j.ijt.2014.04.001  
Dissection of the external iliac artery is rare but a serious complication after renal allograft transplantation endangering the graft and the lower limb as well. We report a case of right external iliac artery dissection in a diabetic and hypertensive patient immediately after transplant resulting in cessation of blood supply to the graft and lower limb. The dissected segment was resected and replaced by a synthetic graft there by restoring the blood supply to the lower limb. The renal graft was removed, re-perfused with cold saline and anastomosed to the internal iliac artery and the arterial blood flow was immediately restored. The postoperative course was uneventful and soon after transplantation the graft functioned well. The patient completed 6-month follow-up with a serum creatinine of 1.0 mg%. We suspect that the vascular clamps might have injured the intima of the external iliac artery, so one should be careful while applying clamps in diseased arteries, which may look apparently normal on Doppler. Occlusion of these diseased arteries by a snare technique during anastomosis is safer in such situations.
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An unusual case of post-renal transplant anemia induced by Parvovirus B19
Pragya Varshney, Varun Verma, Neena Verma, Alok Kumar Gupta, Manoj Kumar Singhal
April-June 2014, 8(2):54-56
DOI:10.1016/j.ijt.2014.04.003  
We report a 43-year-old man, a known case of Autosomal dominant polycystic kidney disease, who underwent a pre-emptive renal transplant with antithymocyte globulin (ATG) induction (3 mg/kg) and triple immunosuppression. Six months after transplant, he developed severe anemia requiring blood transfusions. Bone marrow aspirate revealed maturation arrest of the erythroid series at the stage of proerythroblasts and basophilic erythroblasts, and presence of giant proerythroblasts with viral inclusions. IgM antibodies against Parvovirus B19 (PVB19) were positive. We concluded that this was a case of PVB19 induced anemia. It is an extremely rare disease and should be suspected in the setting of chronic anemia with reticulocytopenia in an immunocompromised host.
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Spontaneous rupture of splenic abscess in post renal transplant
Sridhar N Reddy, Pradeep Rangappa, Sundar Shankaran, Karthik Rao
April-June 2014, 8(2):60-62
DOI:10.1016/j.ijt.2014.05.002  
We report a rare case of spontaneous rupture of splenic abscess in a patient who was on immuno-suppressants following renal transplant. She was incidentally found to have this rupture when an ultrasound abdomen was done to rule out hypersplenism. Diagnosis requires a high index of suspicion and early intervention produces good outcomes.
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Fatal strongyloides hyperinfection syndrome in a renal allograft recipient: A case report and review of literature
Amit Kumar Mahapatra, Narayan Prasad
April-June 2014, 8(2):63-66
DOI:10.1016/j.ijt.2014.05.004  
Strongyloidiasis stercoralis, is an intestinal nematode and endemic in tropical and subtropical countries. It usually presents as a long term, asymptomatic infection in immunocompetent human hosts. But in immunocompromised hosts, it may produce a more fatal form of disease. We report a case of severe fatal strongyloides stercoralis in renal transplant recipients and review of literature in this regard.
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Imaging and endovascular management in allograft renal artery stenosis: Case report
Hiralal , Manas Ranjan Jena, Puja Keshwani, Abhishek Jha, Anuj Thakral, RV Phadke, Narayan Prasad, Anupama Kaul, RK Sharma
April-June 2014, 8(2):67-70
DOI:10.1016/j.ijt.2014.06.002  
Transplant renal artery stenosis (TRAS) is a relatively frequent, potentially curable cause of refractory hypertension and allograft dysfunction and usually becomes apparent between 2 months and 2 years after renal transplantation. Depending on the hemodynamic significance of stenosis it can be treated conservatively or by revascularization. Here we describe a case of TRAS which was treated successfully with angioplasty with a brief review of its etiology, natural history, diagnosis and therapy.
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IMAGES IN TRANSPLANTATION
Images in transplantation
Shivanand Gamanagatti, Hiralal , Narayan Prasad
April-June 2014, 8(2):71-72
DOI:10.1016/j.ijt.2014.04.002  
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ORIGINAL ARTICLES
The use of CT angiography in the evaluation of living donors for kidney transplantation
Pankaj Beniwal, Sant Pandey, Rajesh Kumar Garsa, Mohit Mathur, Vinay Malhotra, Dhanajai Agarwal
April-June 2014, 8(2):39-43
DOI:10.1016/j.ijt.2014.05.001  
Objective: To study the prevalence of renal vascular and other abnormalities by CT angiography in kidney donors at our center. Material and methods: A hundred potential kidney donors underwent CT angiogram as a part of their preoperative workup between December 2009 and May 2013. We retrospectively studied the CT angiogram and compared the findings with the surgical findings. Results: We studied 100 patients with mean age of 46.8 years. The incidence of renal accessory artery in our patients was 27%. Also, renal accessory vein was detected in 17% of subjects. Early branching of renal artery was identified in 7% of cases. Amongst, the abnormalities of renal parenchyma, most common were simple renal cysts which were seen in 9% of the subjects. In addition, 4% of donors had nephrolithiasis, 3% had duplication of renal system and 1 donor had horseshoe kidney. CT angiographic findings were concordant with intra-operative findings in 93% of the cases, missing small renal vein in 2 cases, 2 small veins in 1 case and 1 accessory artery. Two cases of early branching were reported as accessory artery. Conclusion: In the majority of cases, there was good correlation between preoperative CT renal angiography and operative findings. CT angiography is one of the most important exams in the preoperative evaluation of renal donor candidates.
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