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   2016| January-March  | Volume 10 | Issue 1  
    Online since December 1, 2017

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Utility of quantitative real time PCR in detection and monitoring of viral infections in post renal transplant recipients
P Shivanesan, Mukut Minz, Ranjana Walker Minz, Yashwant Kumar, Ashish Sharma, Deepesh B Kanwar, Sarabpreet Singh, HS Kohli, Shashi Anand, Ritambhra Nada
January-March 2016, 10(1):9-14
Background: Viral infections cause significant morbidity and mortality in post-transplant period. A highly sensitive and specific detection tool if used may help in early diagnosis and better management in these patients. The study aimed to assess the utility of quantitative real-time polymerase chain reaction (qRT-PCR) as a diagnostic and monitoring tool for viral infections in post renal transplant patients. Methods: A quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect EBV and CMV infection in 50 patients on 1st, 2nd, 3rd, and after 6 months of renal transplantation. Results: CMV infection was found in 34%, EBV in 28% of recipients, and 17% showed dual infection. Viruses were detectable after the first month of transplantation followed by symptomatic infections within first three months of follow-up, with diarrhea being the commonest symptom. These patients were also at high risk for developing other infections. Anti-thymocyte globulin (ATG) induction was a definitive risk factor for CMV/EBV infection in post operative period. Conclusion: Renal transplant patients frequently develop one or more viral infections at a time. Regular monitoring with qRT-PCR and prompt antiviral therapy with reduction in immunosuppression may be an ideal approach for management of these patients.
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Fibroblast growth factor-23, vitamin D and mineral metabolism in renal transplant recipients
Sonia Mehrotra, Raj K Sharma, Manas R Patel, Narayan Prasad, Amit Gupta, Dharmendra S Bhadauria, Anupama Kaul
January-March 2016, 10(1):1-4
In CKD patients various disturbances in vitamin D metabolism in addition to their classical effects on mineral bone disorder (MBD), also can have important effects on innate or adaptive immunity through various signaling pathways. Vitamin D deficiency could be a factor for triggering rejection, chronic allograft nephropathy and infections in post-transplant period. Patients with CKD are known to be both 25-hydroxyvitamin D (25OHD3) and 1,25-dihydroxyvitamin D (1,25[OH]2D3) deficient. Several observational studies have shown that treatment of ESRD patients with vitamin D analogues is associated with improved survival. 1,25(OH)2-D3 has long been recognized to have an immune regulatory function besides its role in calcium homeostasis. There is evidence in literature that indicates that 1,25(OH)2-D3 could have an important role in the regulation of immune function. This could have important clinical implications. Transplant physicians and surgeons should understand that vitamin D has a variety of immunological actions which can have important effect on patient and graft survival after transplantation.
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The importance of donor-specific anti-HLA antibodies (DSA) identification in renal transplant patients with C4d-negative biopsies
S Mehrotra, RK Sharma, N Prasad, A Gupta, DS Bhadauria, A Kaul, M Jain, P Rishishwar
January-March 2016, 10(1):15-21
Two index cases of living-related donor renal allografts patients developed C4d-negative rejection. Both cases had negative cytotoxic crossmatch and negative flow crossmatch before transplantation. The serum creatinine levels were tabulated. Both cases experienced augmented anti-T cell therapy (intravenous methyl prednisolone) at the time of rejection, which failed to improve renal function. Meantime, our HLA lab identified circulating anti-class I and/or II HLA antibodies towards donor mismatched antigens by Luminex multiplex bead array. Additional therapy included high-dose IVIg and plasma exchange. The renal function improved significantly. Furthermore, the donor-specific antibody strength decreased after combined plasmapheresis and IVIG therapy. These cases highlight the importance of donor-specific antibody detection by sensitive solid phase assays in the context of C4d-negative ABMR.
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Salvage of renal allograft in mycotic pseudoaneurysm of the transplant renal artery
Mukut Minz, Sunil Kumar, Sarbpreet Singh, Ashish Sharma, Deepesh B Kenwar
January-March 2016, 10(1):25-27
Mycotic pseudoaneurysm of transplant renal artery is a rare complication and warrants allograft nephrectomy. We report a 54-year-old renal allograft recipient who presented with 9.2 cm × 5.9 cm × 5.7 cm sized pseudoaneurysm of transplant renal artery. Blood culture grew Pseudomonas aeruginosa. The allograft was explanted, aneurysm was excised, and the allograft was reimplanted to right internal iliac artery with interposition of autogenous arterial graft. Microbiological examination of the aneurysm wall did not reveal active infection. The patient did well and at four years maintains normal renal function. Salvage of renal allograft is possible in selected patients with mycotic pseudoaneurysm of transplant renal artery.
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Massive hemorrhage due to external iliac artery laceration in kidney transplantation: A case report of an uncommon complication after CT guided drainage
Francesco Buia, Andrea Casadei, Camilla Sportoletti, Maurizio Zompatori
January-March 2016, 10(1):28-29
We report a case of a 56-year-old male with a kidney transplantation and a symptomatic peritransplant deep fluid collection who underwent a computed tomography (CT) guided drainage. Nine days after the procedure the patient had to be submitted to the surgical removal of the renal graft due to a massive bleeding caused by the position of the pigtail catheter lying on the wall of the external iliac artery.
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Hepatic artery thrombosis versus neurological complications – Role of antiplatelet medications in adult living donor liver transplantation
Naganathan Selvakumar, Subash Gupta, Neerav Goyal
January-March 2016, 10(1):5-8
Aspirin used in the post-operative period as prophylaxis for hepatic artery thrombosis (HAT) increases the risk of neurological complications (NC) in adult living donor liver transplantation (LDLT) recipients was the hypothesis. Case control study was done on 1400 cases operated in our institute. Pediatric transplants, combined liver kidney, cadaver transplants, dual lobe transplants, preexisting organic neurological dysfunction and patients whose records were missing were excluded from the study. There were effectively 880 cases in non-aspirin group (NAG) and 440 cases in aspirin group (AG). The groups were matched for various factors. There were more alcoholics in AG and more ALFs in NAG. On subgroup analysis these two etiological factors were found to be statistically insignificant P > 0.05. So the prophylactic protocol was aspirin 75 mg once daily in all adults (age >12 years) once the platelet counts have reached 50,000 and there is no evidence of bleeding elsewhere. In pediatric population our protocol is use of aspirin 75 mg and clopidogrel 75 mg once daily once the platelet counts have reached 50,000 and there is no evidence of bleeding anywhere else.
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A de novo Randall disease in a kidney transplant recipient: A case report
Amina Izem, Béfa Noto-Kadou-Kaza, Kawtar Mabrouk, Naoufal Mtiou, Kossi Akomola Sabi, Selma El Khayat, Mohamed Zamd, Ghislaine Medkouri, Mohamed Gharbi Bengahanem, Benyounes Ramdani
January-March 2016, 10(1):30-32
Introduction: Randall disease called “monoclonal immunoglobulin deposition disease (MIDD)” and is defined histologically by the presence of deposits immunoglobulin (Ig) monoclonal, diffuse and continuous linear, non-organized within the tubular basement membranes, and frequently glomerular basement and vascular, often associated with accumulation of extracellular matrix. Only 11 cases of de novo Randall disease post-renal transplantation have been reported in the literature. Case presentation: We report a case of de novo Randall kidney and liver disease associated with myeloma diagnosed in the 20th month post-renal transplant in a woman of 49 years. The treatment had consisted of a decrease of immunosuppression and put on chemotherapy. The evolution was marked by graft loss with return to dialysis. The death occurred in a context of septic shock after the first cure of chemotherapy. Conclusion: A de novo Randall disease post-renal transplantation is not only very rare, but also there is no consensus of it is a management.
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Percutaneous drainage of splenic abscess in a renal transplant recipient – A case report
ND Srinivasaprasad, K Manokaran, R Vivekpraveen, M Edwin Fernando
January-March 2016, 10(1):22-24
Splenic abscess is a rare clinical entity with an incidence of 0.2–0.7% in autopsy-based studies.[1],[2] Moreover, abscess of the spleen is a very rare entity in post-renal transplant recipients. We encountered a rare case of this life-threatening infection in a 32-year-old gentleman who had undergone live related renal transplant 8 months ago. He presented with fever, malaise, left upper quadrant pain and non-productive cough. Computed tomography (CT) of the chest taken to assess the lower chest signs and ultrasound abdomen taken to assess the left upper quadrant pain revealed a large thick walled abscess (8 cm × 7 cm × 7.5 cm) in the spleen. He made a complete recovery after percutaneous pig tail catheter drainage of splenic abscess and intravenous antibiotics for 3 weeks.
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