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Meshram HS, Kute VB, Yadav DK, Godara S, Dalal S, Guleria S, Bhalla AK, Pathak V, Anandh U, Bansal S, Patel H, Hegde U, Dave R, Chauhan S, Dave R, Kumar D, Jamale T, Bajpai D, Kenwar D, Sil K, Vardhan H, Balwani M, Patil M, Deshpande R, Nandwani A, Jha PK, Jain M, Das P, Mishra V, Segev DL, Kher V. Impact of COVID-19-associated Mucormycosis in Kidney Transplant Recipients: A Multicenter Cohort Study. Transplant Direct 2022; 8:e1255. [PMID: 34912944 PMCID: PMC8670583 DOI: 10.1097/txd.0000000000001255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19-associated mucormycosis (CAM) is a recently emerging entity. There is a lack of reports of CAM in organ transplant recipients. METHODS We conducted a multicenter (n = 18) retrospective research in India during November 2020 to July 2021. The purpose of this study was to explore the clinical spectrum, outcome and risk factors for mortality of CAM in kidney transplant recipients (KTRs). RESULTS The incidence of CAM was 4.4% (61/1382 COVID-19-positive KTRs) with 26.2% mortality. The median age of the cohort was 45 (38-54) y. Twenty (32%) were not hospitalized and 14 (22.9%) were on room air during COVID-19. The proportion of postdischarge CAM was 59.1%, while concurrent CAM was reported in 40.9%. The presentation of CAM was 91.8% rhino-orbital-cerebral mucormycosis and 8.2% pulmonary with 19.6% and 100% mortality, respectively. In the univariable analysis, older age, obesity, difficulty of breathing, high-flow oxygen requirement, and delay in starting therapy were significantly associated with mortality. In the multivariable logistic regression analysis, patients requiring high-flow oxygen therapy [odds ratio (95% confidence interval) = 9.3 (1.6-51); P = 0.01] and obesity [odds ratio (95% confidence interval) = 5.2 (1-28); P = 0.05] was associated with mortality. The median follow-up of the study was 60 (35-60) d. CONCLUSIONS We describe the largest case series of CAM in KTRs. Morality in pulmonary CAM is extremely high. Severe COVID-19 pose extra risk for the development of CAM and associated mortality. Our report will help in better understanding the conundrum and management of CAM.
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Affiliation(s)
- Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta—The Medicity, Gurugram, Haryana, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Vivek Pathak
- Department of nephrology, Kovai Medical Center and hospital, Coimbatore, Tamil Nadu, India
| | - Urmila Anandh
- Department of Nephrology, Centre Yashoda Hospitals, Secunderabad, India
| | - Shyam Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta—The Medicity, Gurugram, Haryana, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Umapati Hegde
- Department of Nephrology; Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ruchir Dave
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Rutul Dave
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Deepak Kumar
- Department of Nephrology, Paras Hospital, Patna, Bihar, India
| | - Tukaram Jamale
- Department of Nephrology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Divya Bajpai
- Department of Nephrology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Deepesh Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshab Sil
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Harsh Vardhan
- Department of Nephrology, Patna Medical College, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Mayur Patil
- Department of Nephrology, Care Institute of medical sciences, Ahmedabad, Gujarat, India
| | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Ashish Nandwani
- Department of Nephrology, Manipal Hospital, New Delhi, Delhi, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta—The Medicity, Gurugram, Haryana, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta—The Medicity, Gurugram, Haryana, India
| | - Pratik Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Vineet Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta—The Medicity, Gurugram, Haryana, India
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Meshram HS, Kute VB, Patel HV, Hegde U, Das P, Sil K, Sahay M, Raju SB, Chaudhury AR, Siddini V, Pathak V, Bahadur M, Anand U, Krishna A, Abraham A, Patel AH, Mishra V, Chauhan S. Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India. Transplant Proc 2021; 53:2468-2475. [PMID: 34556343 PMCID: PMC8403672 DOI: 10.1016/j.transproceed.2021.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited data exist on the incidence and outcome of early coronavirus disease 2019 (COVID-19) in kidney transplantation recipients (KTR). METHODS A retrospective multicenter research study was conducted across 12 centers in India. We explored the symptomatology, demographic, laboratory findings, and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. RESULTS The incidence of early COVID-19 was 2.6% (n = 22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 until May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43 (31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%), and severe (13.6%). Among clinical symptoms, dyspnea and anosmia were frequent, and in laboratory parameters, neutrophil lymphocyte ratio, high-sensitivity C-reactive protein, and D-dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; P = 1). COVID-19 severity (23.9% vs 15.7%; P = .0001) and mortality (15.5% vs 8.5%; P = .001) among waitlisted patients (n = 1703) were higher compared with overall KTR. CONCLUSIONS We report higher burden of COVID-19 in waitlisted patients compared with KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.
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Affiliation(s)
- Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India,Address correspondence to Vivek B. Kute, MD, DM, FCPS, FASN, FISOT, FISN, FRCP, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India. Tel.: +91 9099927543
| | - Himanshu V. Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Pratik Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal
| | - Keshab Sil
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Arpita Ray Chaudhury
- Department of Nephrology, Institute of Post-Graduate Medical Education & Research, Kolkata, India
| | | | - Vivek Pathak
- Department of Nephrology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - M.M. Bahadur
- Department of Nephrology, Jaslok Hospitals, Mumbai, India
| | - Urmila Anand
- Departmentt of Nephrology, Centre Yashoda Hospitals, Secunderabad, India
| | - Amresh Krishna
- Department of Nephrology and Renal Transplantation, Indira Gandhi Institute of Medical Science, Patna, India
| | | | - Ansy H. Patel
- B. J. Medical Hospital, Civil Hospital, Ahmedabad, Gujarat, India
| | - Vineet Mishra
- Department of Gynecology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Kute VB, Hegde U, Das P, Sharma A, Bahadur MM, Sil K, Guleria S, Varma PP, Jamale T, Meshram HS. A Multicenter Cohort Study of Indian Centers on Reoccurring SARS-CoV-2 Infections in Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2021; 19:1023-1031. [PMID: 34498549 DOI: 10.6002/ect.2021.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. MATERIALS AND METHODS We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. RESULTS COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19-positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically significant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. CONCLUSIONS To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.
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Affiliation(s)
- Vivek B Kute
- From the Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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Banerjee S, Engineer D, Hirpara J, Shah N, Dave R, Sil K, Kute V, Patel H, Shah PR. Dialysis Vascular Access: Where do Tunneled Catheters Stand? - A Single-Center Experience. Indian J Nephrol 2021; 31:235-239. [PMID: 34376936 PMCID: PMC8330648 DOI: 10.4103/ijn.ijn_266_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/07/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Tunneled cuffed catheters (TCC) provides a short and intermediate-term access solution for dialysis patients who fail to get an arteriovenous fistula (AVF). They are associated with high morbidity and mortality along with high rates of infectious complications. Methods We present a single-center prospective cohort of 159 TCCs inserted over one year. Patients were dialyzed in-hospital and in various peripheral dialysis units attached to the institute. The primary endpoint was catheter drop-out. Results The mean age of patients was 41.8 ± 16.9 years. The right internal jugular vein was the commonest site of TCC insertion (66%). The absence of suitable veins was the predominant reason for TCC insertion. The mean time to catheter drop-out was 134.4 ± 83.3 days (5-399 days). Death with a working catheter was the most common cause of catheter drop-out (22.6%). About 25% of catheters were lost to catheter-related bloodstream infections (CRBSI), either alone or as overlap with poor flow. CRBSI rates were 3.74 episodes per 1000 catheter-days. No difference in survival between the staggered tip and split-tip catheters was found. Conclusions With the advent of the "hub and spoke" model for dialysis in the public sector healthcare, TCCs are suboptimal with regards to patient and catheter survival, with high infection rates. It must be regarded as a temporary solution and AVF creation should be prioritized.
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Affiliation(s)
- Subho Banerjee
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Divyesh Engineer
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Jaydeep Hirpara
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Nilav Shah
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Rutul Dave
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Keshab Sil
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Pankaj R Shah
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
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Banerjee S, Patel HV, Shah NM, Dave RM, Sil K, Engineer DP, Kute VB. Outpatient High-Dose Urokinase Lock: A Quick Answer to Blocked Tunneled Cuffed Catheters. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/44595.13756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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De B, Mandal S, Sau D, Mani S, Chatterjee S, Mondal S, Bhattacharya K, Sil K, Bhattacharya R. Pentoxifylline Plus Prednisolone versus Pentoxifylline Only for Severe Alcoholic Hepatitis: A Randomized Controlled Clinical Trial. Ann Med Health Sci Res 2014; 4:810-6. [PMID: 25328799 PMCID: PMC4199180 DOI: 10.4103/2141-9248.141562] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Prednisolone and pentoxifylline (PTX) have been shown to be individually useful in severe alcoholic hepatitis with Maddrey discriminant function (MDF) score ≥32. Previous report suggests that PTX is probably superior to prednisolone alone. However the efficacy of PTX and prednisolone combination over PTX alone in the management of acute alcoholic hepatitis (MDF score ≥32) is yet unrevealed. Aim: The present study was initiated to find out the efficacy of combined pentoxifylline and prednisolone versus PTX alone in acute alcoholic hepatitis in respect of short and intermediate term outcomes. Subjects and Methods: A total of 124 patients with severe alcoholic hepatitis (MDF score ≥ 32) initially were evaluated. 62 patients who fulfilled the inclusion and exclusion criteria were randomized and divided into 2 groups. Group 1 received PTX only, whereas Group 2 received PTX plus Prednisolone. The total duration of follow-up was 12 months. Student's t-test, Chi-square test, the Kaplan-Meier methods were used for statistical analysis. Results: A total of 60 patients, 30 in each group were available for final analysis. In Group-1, 6 patients expired at the end of 1 year (5 within 3 months and another after 3 months). In Group 2, 10 patients expired at the end of 1 year (9 within 3 months and another after 3 months). Though survival probability is higher among Group 1 patients but the difference is not statistically significant. Conclusion: The combination of PTX plus Prednisolone yields no additional benefit in terms of mortality and morbidity from that of PTX monotherapy.
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Affiliation(s)
- Bk De
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - Sk Mandal
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - D Sau
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - S Mani
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - S Chatterjee
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - Ss Mondal
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - K Bhattacharya
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - K Sil
- Department of Medicine, Medical College, Kolkata, West Bengal, India
| | - R Bhattacharya
- Department of Medicine, Medical College, Kolkata, West Bengal, India
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Abstract
Repair of ultraviolet-light-induced DNA damage in a highly pathogenic Gram-negative bacterium, Vibrio cholerae, has been examined. All three strains of V. cholerae belonging to two serotypes, Inaba and Ogawa, are very sensitive to ultraviolet irradiation, having inactivation cross-sections ranging from 0.18 to 0.24 m2/J. Although these cells are proficient in repairing the DNA damage by a photoreactivation mechanism, they do not possess efficient dark repair systems. The mild toxinogenic strain 154 of classical Vibrios presumably lacks any excision repair mechanism and studies of irradiated cell DNA indicate that the ultraviolet-induced pyrimidine dimers may not be excised. Ultraviolet-irradiated cells after saturation of dark repair can be further photoreactivated.
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