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   2015| January-March  | Volume 9 | Issue 1  
    Online since December 1, 2017

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Pre transplant PRA (penal reactive antibody) and DSA (donor specific antibody) screening status and outcome after renal transplantation
S Mehrotra, RK Sharma, M Mayya, Amit Gupta, Narayan Prasad, A Kaul, DS Bhadauria
January-March 2015, 9(1):7-12
Background: Forty six renal transplant recipients were evaluated by pre-transplant PRA screening (Class I and Class II) by luminex assay (Lifecodes Life-screen Deluxe (LMX) by Gen-Probe). PRA screening results and DSA positivity were correlated with development of rejection episodes. Single Antigen (SA) solid phase antibody assay (One-lambda) was also correlated with rejection episodes. Method: All the 46 kidney transplant recipients were complement dependant cytotoxicity (CDC) crossmatch negative at room, warm, and cold temperatures pretransplant. PRA and Donor Specific Antibody (DSA) (Lifecode) assays were done by luminex. SA antibody assay was done by One-lambda kit by luminex system. Results: All the 46 kidney transplant recipients had PRA screening done on luminex platform. They were divided in to two groups: Group (Gr)-I (PRA negative) n = 30, 65% of patients studied. Group (Gr)-II (PRA Positive) n = 16, 35% of patients. In PRA negative group, only 3 of 30 patients (10%) were DSA positive; one against class I and two recipients had antibody against class-II HLA antigens. Of the PRA negative group, 16 patients received kidney transplantation. Induction with Basiliximab (BSA) was given in 9 and by anti-thymocyte globulin (ATG) in 7 recipients. Two of 16 (12.5%) PRA negative patients developed acute rejection (AR) episodes. Of PRA positive group (16 recipients) only one was DSA positive (6.2%) of PRA positive group, only 6 were transplanted (4 were given induction with BSA, two recipients got ATG induction. Two recipients out of 6 (33%) from PRA positive group who were transplanted had acute rejection (one had evidence of acute cellular rejection and another had glomerulitis on allograft histology) despite being CDC cross match negative. PRA positivity was associated with increased acute rejection episodes. On SA antibody assay, three recipients showed antibody against donor class-II antigens by single bead Luminex assay. All these three patients with single antigen DSA positivity developed acute rejection. All these three recipients showed no donor specific antibody pre transplant and CDC cross match against donor was also negative at the time of kidney transplantation. Conclusion: There was no correlation between DSA positivity and PRA screen positivity. PRA screen negative group had lesser no of acute rejection episodes. PRA positive patients had higher acute rejection episodes despite no evidence of DSA. Single Antigen (SA) antibody positivity was associated with increased episodes of acute rejection (AR).
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  850 97 1
Distribution of HLA genes and disease predisposition in Bengali speaking people from India
Leenam Dedhia, Manasi Vijapukar-Valluri, Shruti Gadekar, Pooja Mehta, Sunil Parekh, Kanjaksha Ghosh
January-March 2015, 9(1):2-6
Background: Knowledge of allele and haplotype frequencies of the HLA system is not only important in the search for unrelated bone marrow donors but it also provides useful insights to the probable susceptibility and resistance to disease as well as drug tolerance and toxicity in the Bengali population. Methods: In this study, 322 Bengali speaking donors registered with MDRI were analyzed for the HLA ABDRB1 alleles using Luminex and SSP techniques. The haplotype analysis and HW test was performed using arlequin 3.5 software. Results: The most prevalent HLA A alleles are A*33(20%), A*24(19%), A*11(16%), A*02(14%), A*01(11%), which are known to be associated with increased risk of pulmonary tuberculosis, leprosy, cytomegalovirus and enterovirus 71 infections. The common B alleles B*15 (15%), B*35, B*40, B*44 (11%), B*52 (9%) and B*57 (6%) are associated with increased risk to cervical cancer and vasculitis. The most prevalent DRB1*15 (29%), DRB1*07 (21%), DRB1*04 (11%) and DRB1*12 (9%) are associated with Rheumatoid arthritis, bronchial asthma and inflammatory bowel disease. The most common haplotype A*33-B*44-DRB1*07 with the haplotype frequency of 6.4% was prevalent Bengali population from India. Many other common haplotypes seen in Bengali are present in other parts of the world like Asian population in USA, China, Brazil and neighboring Bangladesh and Pakistan. Conclusion: This study shows presence of common Bengali haplotypes across many countries. This will enable sharing of donors stem cells to the needy patients worldwide.
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Hemophilic donor used for sibling HSCT in aplastic anemia
Sandip Shah, Shreeniwas Raut, Amit Jetani
January-March 2015, 9(1):39-40
We report a case of 19 year old female (carrier of hemophilia) with severe aplastic anemia who underwent Hematopoetic stem cell transplantation. Sibling donor was 13 year male suffering from hemophilia A, with factor VIII levels of 3 units per liter. Recipient's factor VIII level was maintained after HSCT. She is transfusion independent and without symptoms of hemophilia after a follow up of 24 months.
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Brain MR imaging in neurologic complications of post living donor liver transplant recipients
N Soni, R Gupta, S Kumar
January-March 2015, 9(1):13-29
Liver transplantation (LT) is a complex medical–surgical procedure, accepted as the best treatment for end-stage liver disease of various etiologies. Relatively common occurrence of neurologic complications in post LT patients as compared to other solid organ transplantation is probably due to the poorer clinical condition of these patients (malnutrition, coagulopathy and electrolyte imbalance), pre-transplant encephalopathy and the highly complex and lengthy surgical procedure with major hemodynamic changes. Neuroimaging especially MRI plays an important role in localising and characterising the abnormalities to reach a presumptive diagnosis of these complications which helps in timely intervention. Hence, it is important to be familiar with the imaging spectrum of various cerebral complications in these patients to guide the treatment. In this review, we summarize the MR imaging spectrum of the common neurological complications in post LT patients.
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Extramedullary plasmocytoma: A rare malignancy in renal transplant recipient
Keyur Dave, Madan M Bahadur, Ganapathi M Bhat, Samir Shah
January-March 2015, 9(1):30-33
Extramedullary plasmacytoma in a post renal transplant recipient is an extremely rare type of post transplant lymphoproliferative disorder (PTLD) which warrants significant reduction in immunosuppressive therapy leading to increased risk of rejections and even graft loss. We describe a 49 year old male patient who after 14 years of renal transplant presented with extramedullary plasmacytomas in pancreas, gums, subcutaneous tissue and transplant kidney. He was treated with high dose melphalan followed by rescue autologous hematopoetic stem cell transplant and concurrent reduction in immunosuppression following which he achieved complete remission maintained on 5 years of follow up with astable allograft function. This case, to best of our knowledge is first case to be successfully managed with a rescue autologous hematopoetic stem cell transplant in a renal transplant patient with multifocal extramedullary plasmacytomas.
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  283 43 -
H shape renal vein anomaly encountered during living donor nephrectomy
Datteswar Hota, Sanjay Choudhuri, Jeevanjyoti Mishra, Sabyasachi Panda
January-March 2015, 9(1):37-38
Presence of renal vein anomalies can create technical difficulties especially during donor nephrectomy. Three common anomaly are described. These are supernumerary renal vein, retroaortic renal vein and circumaortic renal vein, but there is no literature depicting H-Shaped anomaly of renal vein. To the best of our knowledge, we present the first case report of H-Shaped renal vein anomaly found during open donor nephrectomy.
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  283 37 1
Renal transplantation in inherited thrombophilias
Dhananjai Agrawal, Kunal Gandhi, Dharmendra Prasad
January-March 2015, 9(1):43-45
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Spontaneous renal allograft rupture due to iliac vein thrombophlebitis
Sanjay Kolte, Sameer Choube, Jitendra Hazare, Bhau Rajurkar, Meenal Kolte
January-March 2015, 9(1):34-36
Renal allograft rupture is one of the most dreaded complications in patients of kidney transplantation. It has a dramatic and stormy course and may be life threatening for the patient. Although rare, it has to be recognised early and surgical correction and or graft nephrectomy may often be required to salvage the patient. It is usually observed in the first two weeks after transplant. We herein report a case of spontaneous renal allograft rupture in a 50 years old female patient who had undergone a live donor kidney transplantation from her spouse. The patient had a renal rupture on ninth day of surgery. She was re-explored and the rupture was repaired using 2-0 vicryl mattress sutures over surgicell. Her graft recovered completely by day 3 after the repair. However she had pulmonary embolism a day prior to discharge and she succumbed with a functioning graft.
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  257 34 -
RK Sharma
January-March 2015, 9(1):1-1
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  248 37 -
An interesting case of renal allograft dysfunction with multiple renal arteries of the transplanted kidney
Kunal Gandhi, Piyush Kimmatkar, Amith D'souza, Pankaj Beniwal, Vinay Malhotra, Dhananjai Agrawal
January-March 2015, 9(1):41-42
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