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Hariharan S, Rogers N, Naesens M, Pestana JM, Ferreira GF, Requião-Moura LR, Foresto RD, Kim SJ, Sullivan K, Helanterä I, Goutaudier V, Loupy A, Kute VB, Cardillo M, Tanabe K, Åsberg A, Jensen T, Mahillo B, Jeong JC, Anantharaman V, Callaghan C, Ravanan R, Manas D, Israni AK, Mehta RB. Long-term Kidney Transplant Survival Across the Globe. Transplantation 2024; 108:e254-e263. [PMID: 38499511 DOI: 10.1097/tp.0000000000004977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The outcomes after kidney transplantation (KT), including access, wait time, and other issues around the globe, have been studied. However, issues do vary from one country to another. METHODS We obtained data from several countries from North America, South America, Europe, Asia, and Australia, including the number of patients awaiting KT from 2015, transplant rate per million population (pmp), proportion of living donor and deceased donor (LD/DD) KT, and posttransplant survival. We also sought opinions on key difficulties faced by each of these countries with respect to KT and long-term survival. RESULTS Variation in access to KT across the globe was noted. Countries with the highest rates of KT pmp included the United States (79%) and Spain (71%). A higher proportion of LD transplants was noted in Japan (93%), India (85%), Singapore (63%), and South Korea (63%). A higher proportion of DD KTs was noted in Spain (90%), Brazil (90%), France (85%), Italy (85%), Finland (85%), Australia-New Zealand (80%), and the United States (77%). The 5-y graft survival for LD was highest in South Korea (95%), Singapore (94%), Italy (93%), Finland (93%), and Japan (93%), whereas for DD, it was South Korea (93%), Italy (88%), Japan (86%), and Singapore (86%). The common issues surrounding KTs are access and a limited number of LDs and DDs. Key issues identified for long-term survival were increasing age of donors and recipients, higher recipient comorbidity, and posttransplant events, such as alloimmune injury to the kidney, infection, cancer, and suboptimal adherence to therapy. CONCLUSIONS A unified approach is necessary to improve issues surrounding KT as the demand continues to increase.
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Affiliation(s)
- Sundaram Hariharan
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Natasha Rogers
- Division of Nephrology and Transplantation, Department of Nephrology and Transplantation Medicine, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Maarten Naesens
- Department of Medicine and Nephrology, University of KU Leuven, Leuven, Belgium
| | - J Medina Pestana
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo F Ferreira
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucio R Requião-Moura
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato D Foresto
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Joseph Kim
- Department of Medicine (Nephrology), University of Toronto, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | | | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Valentin Goutaudier
- Université Paris Cité, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Alexandre Loupy
- Department of Nephrology and Transplantation, Université Paris Cité, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Vivek B Kute
- Department of Nephology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India
| | - Massimo Cardillo
- Centro Nazionale per i Trapianti, Istituto Superiore di Sanità, Roma, Italy
| | - Kazunari Tanabe
- Kidney Transplant/Robotic Surgery Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Anders Åsberg
- Section of Pharmacology and Pharmaceutical Bioscience, University of Oslo, Oslo, Norway
| | - Trond Jensen
- Department of Nephrology, University of Oslo, Oslo, Norway
| | | | - Jong Cheol Jeong
- Department of Medicine and Nephrology, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Vathsala Anantharaman
- National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Derek Manas
- Newcastle Hospitals NHS Trust and Newcastle University, New Castle, United Kingdom
| | - Ajay K Israni
- Department of Medicine, Adjunct Faculty School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rajil B Mehta
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Sadayandi K, Madhavan D, Murugesan P, Mathavan B, Narayanasamy K, Baranikumar P, Murugesan A, Balasundaram S, Sengottayan V, Vasanthan R, Jeevithan S. Deceased donor renal transplant outcome in a south Indian tertiary care hospital with zonal allocation model - An observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_112_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Pal D, Chaudhury A, Verma A, Jana D. Factors influencing survival outcome in deceased renal transplant recipients: A single-center study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kute VB, Patel HV, Modi PR, Rizvi SJ, Shah PR, Engineer DP, Banerjee S, Butala BP, Gandhi S, Mishra VV. Two Decades of Deceased Donor Kidney Transplantation at Ahmedabad, India. EXP CLIN TRANSPLANT 2020; 18:549-556. [PMID: 33143600 DOI: 10.6002/ect.2020.0318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mohamed M, Ghonim MA, Abouzeid MM, Salas MAP. Does rabbit anti-thymocyte globulin dose and antiviral prophylaxis alter the risk of the development of PTLD in renal transplant population? Ren Fail 2020; 42:673-674. [PMID: 32662315 PMCID: PMC7470055 DOI: 10.1080/0886022x.2020.1792927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mahmoud Mohamed
- Nephrology Division, Department of Medicine.,University of Tennessee Health Science Center.,Memphis, TN, USA
| | - Mohamed A Ghonim
- St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Immunology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Mai M Abouzeid
- Louisiana State University Health Sciences Center.,New Orleans, LA, USA
| | - Maria Aurora Posadas Salas
- Division of Nephrology and Hypertension, Department of Medicine.,Medical University of South Carolina.,Charleston, SC, USA
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Kute V, Ramesh V, Shroff S, Guleria S, Prakash J. Deceased-Donor Organ Transplantation in India: Current Status, Challenges, and Solutions. EXP CLIN TRANSPLANT 2020; 18:31-42. [PMID: 32758118 DOI: 10.6002/ect.rlgnsymp2020.l6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wang Z, Durai P, Tiong HY. Expanded criteria donors in deceased donor kidney transplantation - An Asian perspective. Indian J Urol 2020; 36:89-94. [PMID: 32549658 PMCID: PMC7279103 DOI: 10.4103/iju.iju_269_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/29/2023] Open
Abstract
There is an increasing gulf between demand and supply for kidneys in end-stage renal failure patients worldwide, especially Asia. Renal transplantation is often the treatment of choice for long-suffering patients who have to undergo dialysis on a regular basis. The utilization of expanded criteria donors (ECDs) to address the donor pool shortage has been proven to be a legitimate solution. Metzger first described the classification of standard criteria donor and ECD in 2002. Since then, the criterion has undergone various modifications, with the key aims of optimizing organ procurement rate while minimizing discard and rejection rates. We review the methods to improve selection, characterization of risks, and surgical techniques. Although the ECD kidneys have a higher risk of impaired donor and recipient outcome than the "standard criteria" transplants, it may be justified by the improved overall survival of these patients compared to those who remained on dialysis. It is, therefore, crucial that we perform meticulous selection, along with state of the art surgical techniques to maximize the use of this scarce resource. In this article, we review the pre-procurement and post-procurement processes implemented to preserve outcomes.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Hospital, Singapore
| | - Pradeep Durai
- Department of Urology, National University Hospital, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore
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Mukherjee D, Nair RK, Sharma S, Datt B, Rao A, Prakash S. Cadaveric renal transplantation: Our experience at a tertiary care centre in India. Med J Armed Forces India 2020; 76:58-62. [PMID: 32020970 PMCID: PMC6994763 DOI: 10.1016/j.mjafi.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Renal transplantation in developing countries like India is largely live donor transplantation. Cadaveric transplantation comprises <2% of all transplants in India. METHODS Ninety-two cadaveric renal transplantations were included. Various donor and recipient characteristics were analysed along with graft and patient survival, using Kaplan-Meier method. RESULTS The mean age of the recipients was 35.5 ± 10.9 years while that of cadaver was 43.9 ± 17.0 years. Proportion of females among recipients was 47.8% while that of donors was 34.8%. The most common underlying pathology was chronic glomerulonephritis (44.6%). Antithymocyte globulin was used as induction in 84.8% of cases. Tacrolimus-based triple-drug regimen was most commonly used as maintenance (80.4%). The mean follow-up time was 39.02 ± 28.24 months. The most common cause of death was sepsis (47%). More than 50% deaths (9/17) occurred within first 3 years, while 61.5% of graft loss occurred 5 years after transplantation. The mean graft survival time was 81.6 months (95% confidence interval [CI]: 72.8-90.4). Cumulative proportion of graft survival was 91.6% at 3 years and 77.1% at 5 years. Although females have better mean graft survival time (91.6 vs 73.5 months), it was not a significant difference as shown by log-rank test (p value = 0.062). Pretransplant haemodialysis has no significant effect on graft loss, but patients on peritoneal dialysis have significantly higher odds of graft loss (odds: 4.86, p value < 0.05 [0.018]). The mean patient survival time was 99.5 months (95% CI: 84.0-114.9). Cumulative proportion of patient survival was 83.3% at 3 years and 70.8% at 5 years. CONCLUSION Graft and patient survival rate of cadaveric transplant at our centre was satisfactory. There is need to sensitise and augment the rate of cadaveric transplantation to increase the donor pool.
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Affiliation(s)
- Debabrata Mukherjee
- Senior Advisor (Nephrology), Army Hospital (Research & Referral), Delhi, India
| | - Ranjith K. Nair
- Senior Advisor (Nephrology), Army Hospital (Research & Referral), Delhi, India
| | - Sourabh Sharma
- Senior Resident (Nephrology), Army Hospital (Research & Referral), Delhi, India
| | - Bhaskar Datt
- Classified Specialist, (Nephrology), Army Hospital (Research & Referral), Delhi, India
| | - Ananth Rao
- Senior Resident (Nephrology), Army Hospital (Research & Referral), Delhi, India
| | - Sudeep Prakash
- Senior Resident (Nephrology), Army Hospital (Research & Referral), Delhi, India
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Shah PS, Modi MP, Butala BP, Wakhare PS, Varyani UT, Shinde SG, Ghodela VA, Kasat GS, Patil MV, Patel JC, Kumar DP, Trivedi VB, Patel MH, Trivedi HL. Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study. Transpl Int 2017; 30:679-688. [PMID: 28319288 DOI: 10.1111/tri.12956] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n = 222), positive cross-match (n = 59) and better matching (n = 19). A total of 124 two-way (n = 248), 14 three-way (n = 42), one four-way (n = 4) and one six-way exchange (n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n = 288) and 83.3% (n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Pranjal R Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Veena R Shah
- Department of Anesthesia, IKDRC-ITS, Ahmedabad, India
| | - Sayyed J Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Bipin C Pal
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Priyadarshini S Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | | | | | - Pavan S Wakhare
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Umesh T Varyani
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Saiprasad G Shinde
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Vijay A Ghodela
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Govind S Kasat
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Mayur V Patil
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Jaydeep C Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Deepk P Kumar
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Varsha B Trivedi
- Laboratory Medicine, Transfusion Services and Immunohematology, Department of Pathology, IKDRC-ITS, Ahmedabad, India
| | - Minaxi H Patel
- Laboratory Medicine, Transfusion Services and Immunohematology, Department of Pathology, IKDRC-ITS, Ahmedabad, India
| | - Hargovind L Trivedi
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
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Gopalakrishnan N, Dineshkumar T, Dhanapriya J, Sakthirajan R, Balasubramaniyan T, Srinivasa Prasad ND, Thirumalvalavan K, Murugananth S, Kawaskar K. Deceased donor renal transplantation: A single center experience. Indian J Nephrol 2017; 27:4-8. [PMID: 28182043 PMCID: PMC5255989 DOI: 10.4103/0971-4065.179206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Deceased donor renal transplantation (DDRT) constitutes less than 5% of all kidney transplantats in India. A retrospective analysis of 173 deceased donor renal transplants performed in a public funded government hospital was done. Mean age of the recipients was 36 years (male:female ratio 2.4:1), and that of the donors was 32.3 years (male:female ratio 6:1). The cold ischemic time was 340 ± 170 minutes. Mean follow-up period was 36 months. Forty one patients died, 75% of them in the first post - transplant year. Sepsis and cardiovascular disease were the most common causes of death. Twenty two percent had acute rejection. There was no significant difference in the incidence in the rate of acute rejection, bacterial, fungal infections and death rate between the cohorts of induction and non induction immunosuppression. The patient and death censored graft survival at 1 year were 80 and 82.6% and at 5 years were 76 and 80% respectively.
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Affiliation(s)
- N Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Dineshkumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - J Dhanapriya
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - R Sakthirajan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Balasubramaniyan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - N D Srinivasa Prasad
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - K Thirumalvalavan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - S Murugananth
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - K Kawaskar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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Gupta V, Chandra A, Rahul, Singh M, Shrivastava PK, Singhai A, Ojha BK, Chandra G, Khan MP, Pandey S, Kant R. Establishing a deceased donor program in north Indian region: lessons learnt. Clin Transplant 2016; 30:633-40. [PMID: 27087634 DOI: 10.1111/ctr.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Living-related donors are the source of almost all organ transplants in India. However, these donations fall far short of current needs, and there remains a huge disparity between demand and supply of organs. In the last five yr, a consistent increase in deceased donor transplant activity has been observed in some southern Indian states. This report describes our experience of establishing a new deceased donor program in the state of Uttar Pradesh in north India. METHODS We describe our experience on counseling families of all brain-dead patients admitted to our center from October 2013 to September 2014 and data on retrieving and transplanting organs. RESULTS A total of 99 brain-dead patients were identified, of which 67 were medically eligible as donors. Fourteen patients developed cardiac arrest before the counseling could begin. Only eight families agreed for multi-organ donation. CONCLUSION Lack of consensus among the family members, mistrust of the medical system, fear of mutilation of the body, and delay in the funeral were identified as the main reasons behind negative consent. Conversely, mass media campaign, proper ICU care of brain-dead patients, rapport with the family and streamlining all medico legal processes were associated with positive consent.
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Affiliation(s)
- Vivek Gupta
- Department of Human Organ Transplant, KGMU, Luknow, India
| | | | - Rahul
- Surgical Gastroenterology, KGMU, Luknow, India
| | - Manmeet Singh
- Department of Human Organ Transplant, KGMU, Luknow, India
| | | | | | | | | | | | - Sant Pandey
- Department of Human Organ Transplant, KGMU, Luknow, India
| | - Ravi Kant
- Department of Human Organ Transplant, KGMU, Luknow, India
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