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Kute V, Ray DS, Dalal S, Hegde U, Godara S, Pathak V, Bahadur M, Khullar D, Guleria S, Vishwanath S, Singhare A, Yadav D, Bansal SB, Chauhan S, Meshram HS. A Multicenter Cohort Study From India of ABO-Incompatible Kidney Transplantation in Post-COVID-19 Patients. Transplant Proc 2022; 54:2652-2657. [PMID: 35995711 PMCID: PMC9300716 DOI: 10.1016/j.transproceed.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a dearth of data regarding the consequences of ABO-incompatible kidney transplant (ABOiKTx) among post-COVID-19 candidates. METHODS The study was designed as a retrospective, multicentric cohort study across 11 sites in India, from August 2020 to December 2021. The data for ABOiKTx conducted for post-COVID-19 candidates were investigated. The primary outcome of biopsy-proven acute rejection was compared with the ABO protocol implemented through Kaplan-Meier analysis. The secondary outcomes were graft loss, patient survival, and infections. RESULTS A total of 38 ABOiKTx with candidates of median (interquartile range) age of 38.5 (31.25-47.5) years were performed. Nineteen cases had mild COVID-19 severity, while 9 cases (23.6%) had an oxygen requirement. Six (15.7%) donors also were post-COVID-19. The most common ABO incompatibility reported was A to O in 14 (36.8%) pairs followed by B to O in 10 (26.3%) pairs. The maximum isoagglutinin titer cutoff was 1:2048 and 1:64 for baseline and pretransplant levels, respectively. The median time from COVID-19 infection to surgery was 130 (63.2-183) days. Biopsy-proven acute rejection, graft loss, and mortality were 13.1%, 2.6%, and 2.6%, respectively. The Breslow-Wilcoxon's P value in Kaplan-Meier plots were 0.57 and 0.93 for thymoglobulin-based induction and high dose rituximab-based regimen, respectively. The incidence of reinfection was 2.6%. Two (5.2%) urinary tract infections were reported. No cytomegalovirus or BK polyomavirus infection was reported. The median serum creatinine at 1 year of follow-up was 1.1 (0.8-1.3) mg/dL. CONCLUSIONS Our report implies that ABOiKTx in post-COVID-19 candidates can be successfully performed with no major deviation from standard ABO protocol.
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Affiliation(s)
- Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Deepak Shankar Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India,Address correspondence to Deep Shankar Ray, Department of Nephrology, Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India. Tel.: (+91) 9831824751
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - M.M. Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Dinesh Khullar
- Department of Nephrology, Max Saket Complex, Max Super Specialty Hospital, Saket, Delhi
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - S Vishwanath
- Department of Nephrology, Manipal Hospital, Bangalore, India
| | - Ashay Singhare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Dinesh Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta, The Medicity, Gurugram, Haryana, India
| | - Shyam Bihari Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta, The Medicity, Gurugram, Haryana, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Kute VB, Guleria S, Bhalla AK, Sharma A, Agarwal SK, Sahay M, Varughese S, Prasad N, Varma PP, Shroff S, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P, Prakash J. ISOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19. Indian J Nephrol 2022; 32:288-290. [PMID: 35967531 PMCID: PMC9365002 DOI: 10.4103/ijn.ijn_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Sharma
- Department of Transplantation Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - P P Varma
- Department of Nephrology, Primus Super Speciality Hospital, Delhi, New Delhi, India
| | | | - Harsh Vardhan
- Department of Nephrology, Patna Medical College, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shruti Dave
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Dhamendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - Manish Rathi
- Department of Nephrology, PostgraduateInstitute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pankaj Shah
- Department of Nephrology Gujarat University of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Jai Prakash
- President, Indian Society of Organ Transplantation, Former Professor and Head Nephology Banaras Hindu University, Varanasi, Utter Pradesh, India
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Jensen A, Guleria S, Albieri V, Nøhr B, Frederiksen K, Kjær S. P-783 Fertility treatment and risk of ovarian cancer in a large nationwide cohort of 151,821 infertile Danish women. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do use of fertility drugs increase the risk of ovarian cancer among infertile women
Summary answer
Use certain types of fertility drugs may modify the risk of ovarian cancer among infertile women, primarily for serous ovarian tumors and among parous women.
What is known already
Even though most previous studies on the association between fertility treatment and ovarian cancer have not been able to show a convincing association, some studies have found an increased risk of this malignancy among women undergoing fertility treatment. However, many of the previous studies have had methodological limitations including selection bias and potential confounding due to missing information of important factors, such as parity status and hormonal contraceptive use, small sample size as well as short- and incomplete follow-up time. Furthermore, only few studies have assessed the association between fertility treatment and ovarian cancer according to histological type.
Study design, size, duration
This retrospective register-based cohort study included virtually all 20-45 year old infertile women in Denmark between 1971 and 2017 as identified in the Danish Infertility Cohort. All women were followed from entry in the cohort (i.e. the date of first infertility diagnosis) to occurrence of ovarian cancer, any other cancer (except non-melanoma skin cancer), death, emigration, bilateral oophorectomy or end of follow-up (December 31, 2017), whichever occurred first. The median follow-up length was 10.3 years
Participants/materials, setting, methods
In total, 332 women were diagnosed with ovarian cancer during the follow-up period. Information on the use of specific fertility drugs (clomiphene citrate, gonadotropins, hCGs, GnRH receptor modulators and progesterone), ovarian cancer, covariates and vital status was obtained from the Danish Infertility Cohort and various Danish national registers. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% CIs for ovarian cancer overall and for serous ovarian tumors.
Main results and the role of chance
After adjustment for attained age (as the underlying time scale), calendar year of study entry, highest obtained level of education, maternal age at first childbirth, number of childbirths, hormonal contraceptive use as well as mutual adjustment for treatment with any other specific fertility drugs, ever use of hCG (HR 0.62, 95% CI 0.44-0.89) and GnRH receptor modulators (HR 0.63, 95% CI 0.40-1.00) were associated with a decreased risk of overall ovarian cancer. In contrast, ever use of gonadotropins (HR 1.43; 95% CI 0.91-2.24) and especially progesterone (HR 1.81; 95% CI 1.18-2.78) increased the risk of overall ovarian cancer. No marked association was observed for clomiphene citrate (HR 1.07, 95% CI 0.80-1.44)). The rates for serous ovarian cancer generally resembled those observed for overall ovarian cancer; however only the association for progesterone reached statistical significance (HR 2.89; 95% CI 1.67-4.99). The observed associations existed mainly among parous women and did not vary with time since first use of the fertility drug in question and no statistically significant associations were observed with cumulative dose of the specific fertility drugs.
Limitations, reasons for caution
The median age at the end of follow-up was only 42.5 years, which is markedly lower than the usual peak age for ovarian cancer in Denmark (mid 60s). Hence, we were not able to capture the true, potential long-term association between use of fertility drugs and ovarian cancer.
Wider implications of the findings
Use of certain specific types of fertility drugs in fertility treatment may modify the risk of ovarian cancer among subgroups of women. However, although this study is by far the largest to date, additional large epidemiological studies with longer follow-up time are needed to further clarify the observed associations.
Trial registration number
Not applicable.
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Affiliation(s)
- A Jensen
- Danish Cancer Society Research Center, Lifestyle- Reproduction and Cancer , Copenhagen O, Denmark
| | - S Guleria
- Danish Cancer Society Research Center, Lifestyle- Reproduction and Cancer , Copenhagen O, Denmark
| | - V Albieri
- Danish Cancer Society Research Center, Statistics and Data Analysis , Copenhagen O, Denmark
| | - B Nøhr
- University Hospital of Herlev and Gentofte, Department of Obstetrics and Gynecology , Herlev, Denmark
| | - K Frederiksen
- Danish Cancer Society Research Center, Statistics and Data Analysis , Copenhagen O, Denmark
| | - S.K Kjær
- Danish Cancer Society Research Center, Virus- Lifestyle and Genes , Copenhagen O, Denmark
- University of Copenhagen, Department of Gynecology- Rigshospitalet , Copenhagen O, Denmark
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Kute VB, Ray DS, Aziz F, Godara SM, Hegde U, KumarBT A, Bhalla AK, Yadav DK, Singh S, Pathak V, Dalal S, Bahadur MM, Anandh U, Abraham M A, Siddini V, Das SS, Thukral S, Krishnakumar A, Sharma A, Kher V, Bansal SB, Shingare A, Narayanan R, Patel H, Gulati S, Kakde S, Bansal D, Guleria S, Khullar D, Gumber MR, Varyani U, Guditi S, Khetan P, Dave R, Mishra VV, Tullius SG, Chauhan S, Meshram HS. Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study. EClinicalMedicine 2022; 46:101359. [PMID: 35350707 PMCID: PMC8948372 DOI: 10.1016/j.eclinm.2022.101359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding Sanofi.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Deepak S. Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Feroz Aziz
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Suraj M. Godara
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Anil KumarBT
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Pathak
- Department of nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Madan M. Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Abi Abraham M
- Department of Nephrology, VPS Lakeshore Hospital, Kochi, India
| | | | - Sushree Sashmita Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arvind Krishnakumar
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Shyam B. Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ranjit Narayanan
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis Group of Hospitals, New Delhi, India
| | | | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Dinesh Khullar
- Department of Nephrology, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Manoj R. Gumber
- Department of Nephrology, Indraprastha Apollo Hospital, Ahmedabad, Gujarat, India
| | - Umesh Varyani
- Department of Nephrology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Swarnalatha Guditi
- Department of Nephrology, Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, India
| | - Prakash Khetan
- Department of Nephrology, Kingsway Hospitals, Nagpur, India
| | - Rutul Dave
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Vineet V. Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Stefan G. Tullius
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
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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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Singh P, Garg HK, Hota JK, Guleria S, Vohra S, Khanna S, Singh A, Ghonge NP. Type Va Duplication of the Common Bile Duct With Type IIIa Intrahepatic Bile Duct Anatomy: A Rare Combination of Dual Biliary Ductal Anomaly With Difficulty to Extract Common Bile Duct Stone. J Clin Exp Hepatol 2022; 12:225-229. [PMID: 35068805 PMCID: PMC8766532 DOI: 10.1016/j.jceh.2021.02.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/09/2021] [Indexed: 01/03/2023] Open
Abstract
Extrahepatic duplication of the common bile duct (CBD) is an extremely rare anatomic variation seen in the biliary tract. It represents failure of regression of the primitive duplicated biliary ductal system, resulting in five different subtypes of the duplicated CBD as described by Choi et al. To date, only few such cases have been reported in the literature. Associated variation in branching of intrahepatic bile ducts presenting as combined dual ductal anomaly is even rarer phenomena to be seen. We report a case of a 67-year-old man with chronic kidney disease and obstructive jaundice resulting from choledocholithiasis. Evaluation revealed type IIIa branching of intrahepatic bile ducts with type Va duplication of the CBD.
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Affiliation(s)
- Pankaj Singh
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Hitendra K. Garg
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Jayant K. Hota
- Department of Nephrology, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Sandeep Guleria
- Department of Surgery, GI Surgery and Renal Transplantation, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Sudeep Khanna
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Anvita Singh
- Department of Paediatrics, Jaypee Hospital, Noida 201304, India
| | - Nitin P. Ghonge
- Department of Radiology, Indraprastha Apollo Hospitals, New Delhi 110076, India
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7
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Kute V, Kher V, Sahariah S, Ray D, Khullar D, Guleria S, Bansal S, Gang S, Bhalla A, Prakash J, Abraham A, Shroff S, Bahadur M, Das P, Anandh U, Chaudhury A, Singhal M, Kothari J, Raju S, Pahari D, Siddini GV, Sudhakar G, Varughese S, Saha T. Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_28_21] [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: 11/04/2022] Open
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8
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Shroff S, Asthana S, Kute V, Shah U, Mohanka R, Sahay M, Chinnadurai R, Rajagopal S, Patwardhan S, Prasad N, Guleria S, Bansal S, Choudhary A, Ray D, Kolte S, Gulati S, Seth S, Agarwal S, Ojha J, Varma PP. Consensus statement on organ donation from COVID-Positive deceased donors indian society of organ transplantation liver transplant society of India Indian society for heart and lung transplantation. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_29_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Meshram HS, Kute VB, Swarnalatha G, Hegde U, Sharma A, Sahay M, Guleria S, Raju SB, Eapen JJ, Ray DS, Chaudhury AR, Patel HV, Siddini V, Pathak V, Agarwal D, Bahadur MM, Verma PP, Anandh U, Krishna A, Abraham A, Mishra V. Effect of Coronavirus Disease 2019 on Transplantation and Nephrology in India: A Nationwide Report From India. Transplant Proc 2021; 54:1429-1433. [PMID: 34706823 PMCID: PMC8486646 DOI: 10.1016/j.transproceed.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effect of coronavirus disease 2019 (COVID-19) on a developing nation is sparsely reported and, more importantly, the discrepancies in public and private sectors are underexplored. METHODS We retrospectively investigated the data on the effect of COVID-19 on renal transplantation between 2019 and 2020 in a nationwide analysis from 8 public and 10 private sector hospitals of India. RESULTS On comparing the yearly data, the number of living-related transplants and deceased donor transplants declined by 48% (2610 vs 1370) and 49% (194 vs 99), respectively. The outpatient numbers and in-center admissions decreased by 40.4% (616,741 vs 367,962) and 30.8 % (73,190 vs 49,918). respectively. There was no increase in the number of renal or graft biopsies in the COVID-19 era. The number of waitlisted patients on hemodialysis was higher in public (304,898 vs 338,343) when compared with private (163,096 vs 150,292) in the last 2 years. Similarly, the number of waitlisted patients on peritoneal dialysis (4655 vs 3526) was higher in the public sector compared with private sector (932 vs 745). The decline in living transplants during the pandemic was higher in public sectors (58%) compared with the private (49%). However, the decline in deceased donation was higher in private (57.9%) relative to public (50.6%). CONCLUSIONS COVID-19 has adversely affected the transplantation activities across the Indian transplantation centers, with a disproportionately higher impact on waitlisted patients in public sector programs. A sound prioritization of health care resources is mandated to safeguard the most deprived and high-risk waitlisted patients during the pandemic.
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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, India
| | - Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
| | - G Swarnalatha
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Jeethu Joseph Eapen
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arpita Ray Chaudhury
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | | | - Vivek Pathak
- Department of Nephrology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | | | | | - Prem P Verma
- Department of Nephrology, Venkateshwar Hospital, New Delhi, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Abi Abraham
- Department of Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Vineet Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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10
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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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11
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Kute VB, Ray DS, Yadav DK, Pathak V, Bhalla AK, Godara S, Kumar A, Guleria S, Khullar D, Thukral S, Mondal RRS, Jain M, Jha PK, Hegde U, Abraham M A, Dalal S, Patel H, Bahadur MM, Shingare A, Sharma A, Kumar Sharma R, Anandh U, Gulati S, Gumber M, Siddini V, Deshpande R, Kaswan K, Varyani U, Kakde S, Kenwar DB, Shankar Meshram H, Kher V. A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19. Transplantation 2021; 105:1423-1432. [PMID: 33724246 DOI: 10.1097/tp.0000000000003740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil Kumar
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Dinesh Khullar
- Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Raj Kumar Sharma
- Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | | | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kamal Kaswan
- Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India
| | - Umesh Varyani
- Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Deepesh B Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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12
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Kakkar B, Makroo RN, Agrawal S, Chowdhry M, Nayak S, Jasuja S, Sagar G, Guleria S. Role of therapeutic plasma exchange in acute humoral rejection patients undergoing live-related renal transplantation: A single-center experience. Asian J Transfus Sci 2021; 15:62-67. [PMID: 34349459 PMCID: PMC8294439 DOI: 10.4103/ajts.ajts_5_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIM: Renal transplantation (RT) is the most successful and ideal renal replacement therapy for end-stage renal disease patients. Renal allograft rejection has always been one of the major barriers in successful RT. Our aim was to report the role of therapeutic plasma exchange (TPE) in acute humoral rejection (AHR) patients who underwent live-related RT (LRRT) and their renal allograft outcome at our center. MATERIALS AND METHODS: A prospective observational study was conducted from July 1, 2014, to December 31, 2016. Patients with biopsy-proven AHR and treated with TPE along with other lines of treatment after undergoing LRRT were included in the study. ABO-incompatible individuals, pediatric patients, and patients undergoing second transplants were excluded from the study. Clinical history, donor and graft details, management, and patient and graft survival were noted. RESULTS: Of the 1608 patients who underwent LRRT, 49 (37 males, 76%; 12 females, 24%; mean age 39.5 ± 13.3 years) had biopsy-proven AHR (3.04%) and were treated with TPE. A total of 281 TPEs were performed with an average of 5.7 TPE/patient (range 2–12). Of the 49 patients, 38 patients (78%) with favorable response underwent 213 (75.8%) TPEs (average of 5.6 TPE/patient; range: 2–12), whereas 11 patients (22%) with unfavorable response underwent 68 (24.2%) TPEs (average of 6.2 TPE/patient; range: 3–8). Blood urea (P = 0.012) and serum creatinine (P = 0.038) levels at the time of rejection were significant predictors of response to TPE therapy. The average length of stay in our study population was 33 ± 22 days. Six months posttransplant, the patient and graft survival were 93.3% and 89.5%, whereas at 12 months, they were 89.3% and 81.5%, respectively. CONCLUSION: TPE is a safe and effective adjunct therapy for treating AHR patients.
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Affiliation(s)
- Brinda Kakkar
- Department of Immunohematology and Blood Transfusion, Bharati Vidyapeeth University Medical College and Hospital, Pune, Maharashtra, India
| | - Raj Nath Makroo
- Department of Transfusion Medicine, VPS Rockland Hospital, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine and Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine and Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sweta Nayak
- Department of Transfusion Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Sanjiv Jasuja
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Gaurav Sagar
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Guleria
- Department of Transplant Surgery, Indraprastha Apollo Hospital, New Delhi, India
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13
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Kute VB, Bhalla AK, Guleria S, Ray DS, Bahadur MM, Shingare A, Hegde U, Gang S, Raju S, Patel HV, Jain S, Godara S, Modi P, Gumber M, Engineer DP, Dalal S, Darji P, Balwani M, Patel AH, Mishra VV. Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India. Transplantation 2021; 105:851-860. [PMID: 33350674 PMCID: PMC7993652 DOI: 10.1097/tp.0000000000003593] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a scarcity of data on the consequences of coronavirus disease-19 (COVID-19) infections in kidney transplant recipients (KTRs) from emerging countries. METHODS Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donors) with polymerase chain reaction-confirmed COVID-19 positivity from March 23, 2020, until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment, and outcomes. RESULTS Median age of transplant recipients was 43 years, and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%) and diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%), and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), and moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age; dyspnea; severe disease; obesity; allograft dysfunction before COVID-19 infection; acute kidney injury; higher levels of inflammatory markers including C-reactive protein, interleukin-6 level, and procalcitonin; chest X-ray abnormality, and intensive care unit/ventilator requirements. Overall patient mortality was 11.6% (29 of 250), 14.5% (29 of 200) in hospitalized patients, 47% (25 of 53) in intensive care unit patients, and 96.7% (29 of 30) in patients requiring ventilation. KTRs with mild COVID-19 symptoms (n = 50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic. CONCLUSIONS Mortality rates in COVID-19-positive KTR appear to be higher than those in nonimmunosuppressed patients, and high mortality was noted among those requiring intensive care and those on ventilator.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujrat, India
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Deepak S. Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Madan M. Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Sreebhushan Raju
- Department of Nephrology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Himanshu V. Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujrat, India
| | - Siddharth Jain
- Department of Nephrology, Kidney Care Clinic, Surat, Gujarat, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Pranjal Modi
- Department of Transplantation Surgery, IKDRC-ITS, Ahmedabad, Gujrat, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | - Divyesh P. Engineer
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujrat, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Prakash Darji
- Department of Nephrology, Zydus Hospitals, Ahmedabad, Gujarat, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Ansy H. Patel
- BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India
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14
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Kute VB, Godara S, Guleria S, Ray DS, Aziz F, Hegde U, Sharma A, Nayak KS, Siddini V, Sarkar P, Thukral S, Mondal RRS, Goswami J, Patel HV, Abraham M A, Pathak V, Anandh U, Jha PK, Bavikar S, Bonu RS, Gulati S, B T AK, Yadav DK. Is it Safe to Be Transplanted From Living Donors Who Recovered From COVID-19? Experience of 31 Kidney Transplants in a Multicenter Cohort Study From India. Transplantation 2021; 105:842-850. [PMID: 33394992 PMCID: PMC7993648 DOI: 10.1097/tp.0000000000003609] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is lack of data on feasibility and safety of kidney transplants from living donors who recovered from COVID-19. METHODS Here, we present a retrospective cohort study of 31 kidney transplant recipients (KTR) from living donors who recovered from polymerase chain reaction confirmed COVID-19 across 19 transplant centers in India from July 3, 2020, to December 5, 2020. We detailed demographics, clinical manifestations, immunosuppression regimen, treatment, and outcomes. Donors with a previous diagnosis of COVID-19 were accepted after documenting 2 negative polymerase chain reaction tests with complete symptom resolution for at least 28 days and significant social distancing for 14 days before surgery. RESULTS COVID-19 clinical severity in donors ranged from completely asymptomatic (71%, n = 22) to mild infection (29%, n = 9). None progressed to moderate or severe stages of the disease in the entire clinical course of home treatment. Patient and graft survival was 100%, respectively, with acute cellular rejection being reported in 6.4% (n = 2) recipient. All recipients and donors were asymptomatic with normal creatinine at median follow-up of 44 days after surgery without any complications relating to surgery and COVID-19. CONCLUSIONS Our data support safety of proceeding with living donation for asymptomatic individuals with comprehensive donor, recipients screening before surgery, using a combination of clinical, radiologic, and laboratory criteria. It could provide new insights into the management of KTR from living donors who have recovered from COVID-19 in India. To the best of our knowledge, this remains the largest cohort of KTR from living donors who recovered from COVID-19.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Deepak S Ray
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Aster MIMS Hospital, Kozhikode, Kerala, India
| | - Feroz Aziz
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ashish Sharma
- Department of Transplantation Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - K S Nayak
- Department of Nephrology, Virinchi Hospitals, Hyderabad, Telangana, India
| | | | - Piyali Sarkar
- Department of Nephrology, Charnock Hospital, Kolkata, West Bengal, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | | | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Urmila Anandh
- Institute of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Suhas Bavikar
- Department of Nephrology, MIT Hospital and Research Institute, Aurangabad, India
| | - Ravi Shankar Bonu
- Department of Nephrology, Manipal Hospital Whitefield, Bangalore, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant, Fortis Group of Hospitals, New Delhi, India
| | - Anil Kumar B T
- Department of Nephrology, BGS Global Hospital, Bengaluru, Karnataka, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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Kute VB, Agarwal SK, Prakash J, Guleria S, Shroff S, Sharma A, Varma P, Prasad N, Sahay M, Gupta S, Sudhindran S, Krishan K, Ramesh V, Kumar S. NOTTO COVID-19 Vaccine Guidelines for Transplant Recipients. Indian J Nephrol 2021; 31:89-91. [PMID: 34267426 PMCID: PMC8240933 DOI: 10.4103/ijn.ijn_64_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/19/2022] Open
Abstract
In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sanjay K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Delhi, India
| | - Jai Prakash
- Department of Nephrology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Apollo Hospital, Delhi, India
| | - Sunil Shroff
- Managing, Trustee, MOHAN Foundation, Chennai, Tamil Nadu, India
| | - Ashish Sharma
- Department of Transplant Surgery, The Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prem Varma
- Department of Nephrology, Venkateshwar Hospital, Delhi, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Subhash Gupta
- Department of Liver Transplant Surgery, Max Center of Liver and Biliary Sciences at Max Hospital, Saket, Delhi, India
| | - S Sudhindran
- Clinical Professor in Transplantation and Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Kewal Krishan
- Department of Cardiovascular Surgery Max super specialty Hospital Saket, New Delhi, India
| | - Vasanthi Ramesh
- National Organ and Tissue Transplant Organization, New Delhi, India
| | - Sunil Kumar
- Director General of Health Services, New Delhi, India
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16
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Kute V, Ramesh V, Shroff S, Prasad N, Guleria S, Prakash J, Sahay M, Modi P, Cantarovich M, Haberal M. Benefit to Few Versus Risk to Many: An Ethical Dilemma During Coronavirus Disease 2019 Pandemic for Deceased-Donor Organ Transplant in a Resource-Limited Developing Country. EXP CLIN TRANSPLANT 2021; 19:1-7. [PMID: 32778012 DOI: 10.6002/ect.2020.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Kute V, Guleria S, Bhalla A, Sharma A, Agarwal S, Sahay M, Varughese S, Prasad N, Varma P, Shroff S, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agrawal D, Shah P, Prakash J. ISOT consensus statement for the kidney transplant recipient and living donor with a previous diagnosis of COVID-19. Indian J Transplant 2021. [DOI: 10.4103/ijot.ijot_26_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Ramesh V, Kute V, Agarwal S, Prakash J, Guleria S, Shroff S, Sharma A, Varma P, Prasad N, Sahay M, Gupta S, Sudhindran S, Krishan K, Kumar S. NOTTO COVID-19 vaccine guidelines for transplant recipients. Indian J Transplant 2021. [DOI: 10.4103/ijot.ijot_2_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Chowdhry M, Agrawal S, Thakur Y, Guleria S, Sharma V. Implication of a positive virtual crossmatch with negative flow crossmatch: A mind-boggler. Asian J Transfus Sci 2020; 14:79-82. [PMID: 33162714 PMCID: PMC7607997 DOI: 10.4103/ajts.ajts_159_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 12/20/2018] [Accepted: 10/16/2019] [Indexed: 01/09/2023] Open
Abstract
There are occasions when tests performed before considering a patient for transplant are ambiguous and require further workup. One such condition is the presence of a positive virtual crossmatch (VXm) (anti-human leukocyte antigen [HLA-A]*26: 01 antibody in this case) with a negative complement-dependent cytotoxicity, Luminex, and flow crossmatch. To ascertain the nature of the antibody, the beads used in single-antigen bead assay (SAB) were treated by acid to denature the antigens and retested with the control and test sample. The mean fluorescence intensities (MFIs) from the patient sera with acid-treated beads increased considerably as compared to the regularly untreated SAB indicating additional antigen epitopes become available by the denaturation process. The MFIs of the antibodies from that of the control sera were reduced to half on testing with the acid-treated SAB assay, indicating that HLA antigen HLA-A*26 was susceptible to acid treatment. Therefore, results of VXm should be interpreted with caution.
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Affiliation(s)
- Mohit Chowdhry
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Yogita Thakur
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Guleria
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vandana Sharma
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, New Delhi, India
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Kute V, Guleria S, Prakash J, Shroff S, Prasad N, Agarwal SK, Varughese S, Gupta S, K Gokhale AG, Sahay M, Sharma A, Varma P, Bhalla A, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P, Ramesh V, Garg R. NOTTO Transplant Specific Guidelines with Reference to COVID-19. Indian J Nephrol 2020; 30:215-220. [PMID: 33273783 PMCID: PMC7699665 DOI: 10.4103/ijn.ijn_299_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Apollo Hospital, New Delhi, India
| | - Jai Prakash
- Banaras Hindu University, Varanasi, Utter Pradesh, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Sanjay K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subhash Gupta
- Department of liver transplant surgery, Max Center of Liver and Biliary Sciences at Max Hospital, Saket, New Delhi, India
| | - A G K Gokhale
- Department of Heart & Lung Transplant Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Ashish Sharma
- Department of Transplant Surgery, The Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prem Varma
- Department of Nephrology, Venkateshwar Hospital, New Delhi, India
| | - Anil Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Harsh Vardhan
- Department of Nephrology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shruti Dave
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | | | - Manish Rathi
- Department of Nephrology, PGIMER, Chandigarh, India
| | | | - Pankaj Shah
- Department of Nephrology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Vasanthi Ramesh
- National Organ and Tissue Transplant Organization, Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Rajiv Garg
- Director General Health Services, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India
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21
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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: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Reinholdt K, Kjaer SK, Guleria S, Frederiksen K, Mellemkjær L, Munk C, Jensen A. Risk of endometrial cancer among women with benign ovarian tumors - A Danish nationwide cohort study. Gynecol Oncol 2020; 157:549-554. [PMID: 32139149 DOI: 10.1016/j.ygyno.2020.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The few studies on the association between benign ovarian tumors and endometrial cancer have been inconclusive. Using data from a large Danish register-based cohort study, we assessed the overall and type-specific risk of endometrial cancer among women with a benign ovarian tumor. METHODS We identified all Danish women diagnosed with a benign ovarian tumor during 1978-2016 in the Danish National Patient Register (n = 149,807). The study population was followed for subsequent development of endometrial cancer by linkage to the Danish Cancer Register and standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs) were calculated after correction for hysterectomy. RESULTS After a one-year delayed study entry, women with benign ovarian tumors had a decreased incidence of endometrial cancer (SIR = 0.74, 95% CI: 0.68-0.81) compared with women in the general Danish population. Both solid benign ovarian tumors (SIR = 0.79, 95% CI 0.70-0.88) and cystic benign ovarian tumors (SIR = 0.68, 95% CI 0.58-0.78) were associated with decreased incidences of endometrial cancer. Likewise, women with benign ovarian tumors had decreased incidences of both type I and type II endometrial cancer. The incidence of endometrial cancer was decreased to virtually the same magnitude irrespective of the age at diagnosis of a benign ovarian tumor and the reduction persisted throughout the follow-up period. CONCLUSIONS The risk of endometrial cancer was decreased beyond the first year after a benign ovarian tumor and the decrease persisted for 20 or more years. The possible underlying mechanisms are not known and should be investigated further.
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Affiliation(s)
- K Reinholdt
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Guleria
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Frederiksen
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Mellemkjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Munk
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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23
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Vasanthi R, Kute V, Guleria S, Prakash J, Shroff S, Prasad N, Agarwal S, Varughese S, Gupta S, Gokhale AGK, Sahay M, Sharma A, Varma P, Bhalla A, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P. NOTTO transplant specific guidelines with reference to COVID-19. Indian J Transplant 2020. [DOI: 10.4103/ijot.ijot_62_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Kute V, Agarwal S, Sahay M, Kumar A, Rathi M, Prasad N, Sharma R, Gupta K, Shroff S, Saxena S, Shah P, Modi P, Billa V, Tripathi L, Raju S, Bhadauria D, Jeloka T, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees M. Kidney-Paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017. Indian J Transplant 2018. [DOI: 10.4103/ijot.ijot_7_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-Paired Donation to Increase Living Donor Kidney Transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017. Indian J Nephrol 2018. [PMID: 29515294 PMCID: PMC5830802 DOI: 10.4103/ijn.ijn_365_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanjay K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Artemis Hospital, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Anant Kumar
- Department of Transplantation Surgery, Max Group of Hospital, New Delhi, India
| | - Manish Rathi
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajkumar K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishan L Gupta
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Shroff
- Department of Transplantation Surgery, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Sandip K Saxena
- Department of Nephrology, Apollo Hospital, Indore, Madhya Pradesh, India
| | - Pankaj R Shah
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Pranjal R Modi
- Department of Transplantation Surgery Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vishwanath Billa
- Department of Nephrology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dhamedndra S Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tarun K Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | | | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Rajshekhar Perumalla
- Department of Transplantation Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India
| | - Manoj Jain
- Department of Renal Pathology Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael A Rees
- Department of Transplantation Surgery, University of Toledo Medical Center, Toledo, Ohio.,CEO, Alliance for Paired Donation, USA
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:1783-1792. [PMID: 28737659 PMCID: PMC5542788 DOI: 10.1097/tp.0000000000001770] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 02/07/2023]
Abstract
Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many "ungraded" expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate's profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Philip Kam-Tao Li
- Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Dorry L. Segev
- Johns Hopkins University School of Medicine, Baltimore, MD
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27
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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28
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Bhowmik D, Gupta A, Kumar R, Lakshmy R, Guleria S, Agarwal S. SP088EVALUATION OF PHYSIOLOGICAL AND BIOCHEMICAL PARAMETERS IN LIVING KIDNEY DONORS - PRE AND POST DONATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx140.sp088] [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: 11/14/2022] Open
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29
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Yadav K, Aggarwal S, Guleria S, Kumar R. Comparative study of laparoscopic and mini-incision open donor nephrectomy: have we heard the last word in the debate? Clin Transplant 2016; 30:328-34. [DOI: 10.1111/ctr.12700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kunal Yadav
- Department of Surgical Disciplines; All India Institute of Medical Sciences (AIIMS); New Delhi India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines; All India Institute of Medical Sciences (AIIMS); New Delhi India
| | - Sandeep Guleria
- Department of Surgical Disciplines; All India Institute of Medical Sciences (AIIMS); New Delhi India
| | - Rajeev Kumar
- Department of Urology; All India Institute of Medical Sciences (AIIMS); New Delhi India
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30
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Pushkar P, Agarwal A, Kumar S, Guleria S. Endourological management of live donors with urolithiasis at the time of donor nephrectomy: a single center experience. Int Urol Nephrol 2015; 47:1123-7. [DOI: 10.1007/s11255-015-1007-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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31
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Affiliation(s)
- S Kumar
- Department of Renal Transplantation, Indraprastha Apollo Hospital, New Delhi, India
| | - D K Agarwal
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - S Guleria
- Department of Renal Transplantation, Indraprastha Apollo Hospital, New Delhi, India
| | - P Pushkar
- Department of Urology, Indraprastha Apollo Hospital, New Delhi, India
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Aggarwal S, Guleria S, Sharma S, Gulati G, Priyadarshini P. Short-term effects of renal transplantation on coronary artery calcification: A prospective study. Saudi J Kidney Dis Transpl 2015; 26:536-43. [DOI: 10.4103/1319-2442.157359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sibal A, Malhotra S, Guru FR, Bhatia V, Kapoor A, Seth S, Jerath N, Jasuja S, Rajkumari V, Wadhawan M, Aggarwal DK, Guleria S, Shrivastava RN, Gupta S. Experience of 100 solid organ transplants over a five-yr period from the first successful pediatric multi-organ transplant program in India. Pediatr Transplant 2014; 18:740-5. [PMID: 25092050 DOI: 10.1111/petr.12324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/28/2022]
Abstract
To analyze the clinical profile and outcome of pediatric patients who had undergone a liver and/or RT at our center over a five yr period, case records of all the patients who had undergone a liver or RT were analyzed retrospectively. One hundred solid organ transplants were performed at our center between January 2007 and January 2012. These included 50 liver, 44 renal, one sequential liver and renal, and two CLKT. BA was the most common indication for an LT (38%). At a median follow-up of two yr three months, the patient survival was 88%. The most common indication for an RT was chronic glomerulonephritis (54.5%). At a median follow-up of three yr, the survival was 91%. The CLKT were performed for hyperoxaluria. Two yr post LT, a sequential RT was performed for ESRD resulting from transplant associated microangiopathy. All patients received a living related graft. The common post-operative complications were infections, vascular complications, and graft dysfunction. Survival rates for liver and RT at our center are comparable to those in the established centers in the West.
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Affiliation(s)
- Anupam Sibal
- Apollo Centre of Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, India
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Patro ARK, Dar L, Pati SK, Agarwal SK, Guleria S, Broor S, Boppana SB. Human cytomegalovirus glycoprotein N polymorphisms among renal transplant recipients in India. BMC Infect Dis 2014. [PMCID: PMC4080332 DOI: 10.1186/1471-2334-14-s3-p66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.
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Affiliation(s)
| | | | - Sandeep Guleria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Yashwant R, Guleria S, Khattar N, Kumar R, Kumar S. Leak from the surface of a decapsulated renal allograft: urine or lymph? Excellent response to povidone iodine instillation. Saudi J Kidney Dis Transpl 2014; 25:105-8. [PMID: 24434391 DOI: 10.4103/1319-2442.124512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Sandeep Guleria
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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Reddy VSK, Guleria S, Abdullah SM, Bansal R. A kink in transplantation: a rare cause of early graft dysfunction. Saudi J Kidney Dis Transpl 2013; 24:965-968. [PMID: 24029262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Kink of the transplant renal artery is a rare yet correctable cause of early graft dysfunction. We describe a 35-year-old male patient with end-stage renal disease who underwent live, related renal transplantation with end-to-side anastomosis of the graft vessels with the external iliac vessels. He had oliguria and uncontrolled hypertension in the post-operative course and was found to have a parvus tardus waveform on Doppler ultrasound and an acute angled kink of the renal artery on angiography. After failure of initial attempts at per cutaneous transluminal renal angioplasty, the patient was re-explored and the graft renal artery was anastomosed with the internal iliac artery. The patient had a steady recovery and was discharged with a good renal function. A kinking of the renal artery should be excluded when early graft dysfunction is associated with a parvus tardus waveform.
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Affiliation(s)
- Vemuru Sunil K Reddy
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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Guleria S, Jain S, Dinda AK, Mahajan S, Gupta S, Mehra NK. The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression. Indian J Nephrol 2013; 23:253-8. [PMID: 23960339 PMCID: PMC3741967 DOI: 10.4103/0971-4065.114474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/04/2022] Open
Abstract
The aim of the study was to assess the impact of protocol biopsies in a live-related renal transplant program using tacrolimus-based immunosuppression in the short term. Eighty-three live-related transplant recipients were randomly allocated to protocol biopsy group (Group I, n = 40) and a control group (Group II, n = 43). Other immunosuppressants in these groups consisted of either mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at 1, 6, and 12 months post-transplant. The non-biopsy group was followed by serial serum creatinine and biopsies in them were conducted as and when clinically indicated. Both groups were analyzed at 12 months with respect to graft function and survival. The two groups were similar with respect to age, number of dialysis pre-operatively, tacrolimus levels, induction therapy, donor age, and donor glomerular filtration rate. Forty protocol biopsies were conducted at 1 month, 31 at 6 months, and 26 at 12 months. The prevalence of sub-clinical rejection at 1, 6, and 12 months in these biopsies was 17.5%, 11.2%, and 10.3%, respectively. The prevalence of calcineurin inhibitor toxicity during same period was 15%, 15.5%, and 14.4%, respectively. The cumulative rejection rate in Group I and Group II at 12-month follow-up was 10.3% and 11.3% (P = 0.78), respectively, and cumulative calcineurin inhibitor toxicity at 12 months was 14.4% and 9.3% (P = 0.59), respectively, were not statistically significant. There was no difference in graft survival and function at 1 year. Protocol biopsies have a limited role in a well-matched renal transplant program with tacrolimus-based immunosuppression in the short term. However, the long-term impact of protocol biopsies needs further evaluation.
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Affiliation(s)
- S Guleria
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Guleria S, Kelly T, Maheshwari M, Segall H. An Atypical Case of Chiari II Malformation Mimicking Partial Rhombencephalosynapsis. Neuroradiol J 2012; 25:528-32. [DOI: 10.1177/197140091202500505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/18/2012] [Indexed: 11/16/2022] Open
Abstract
Partial rhombencephalosynapsis in the presence of Chiari II malformation has been proposed as a “new abnormality of the hindbrain and spine“. We describe a case of Chiari II malformation with imaging features mimicking partial rhombencephalosynapsis. Our case demonstrates how the imaging findings of Chiari II malformation can be confused with the above entity and highlights the differentiating features to help radiologists make an accurate diagnosis.
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Affiliation(s)
- S. Guleria
- Pediatric Radiology, Children's Hospital of Wisconsin; Milwaukee, Wisconsin, USA
| | - T.G. Kelly
- Pediatric Radiology, Children's Hospital of Wisconsin; Milwaukee, Wisconsin, USA
| | - M. Maheshwari
- Pediatric Radiology, Children's Hospital of Wisconsin; Milwaukee, Wisconsin, USA
| | - H.D. Segall
- Pediatric Radiology, Children's Hospital of Wisconsin; Milwaukee, Wisconsin, USA
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Kumar S, Kumar A, Guleria S. Primary leiomyosarcoma of the juxtarenal inferior vena cava: a case report. Indian J Surg 2012; 75:313-5. [PMID: 24426602 DOI: 10.1007/s12262-012-0634-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 06/12/2012] [Indexed: 12/01/2022] Open
Abstract
Primary juxtrarenal leiomyosarcoma of the inferior vena cava (IVC) is a rare disease and is invariably malignant. Prognosis depends on early patient diagnosis and management. We report a case of a primary IVC tumor in a 66-year-old woman which was managed successfully by surgical resection of involved IVC along with right nephrectomy. IVC reconstruction was done using a Dacron interposition graft, and the left renal vein was anastomosed end to side to the Dacron graft.
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Affiliation(s)
- Surjeet Kumar
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Anil Kumar
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Sandeep Guleria
- C-291, Sarita Vihar, New Delhi 110076 India ; Indraprastha Apollo Hospital, Mathura Road, Sarita Vihar, New Delhi 110076 India
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Sarangi SC, Reeta KH, Agarwal SK, Kaleekal T, Guleria S, Gupta YK. A pilot study on area under curve of mycophenolic acid as a guide for its optimal use in renal transplant recipients. Indian J Med Res 2012. [PMID: 22382188 PMCID: PMC3307190 DOI: 10.4103/0971-5916.93429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & objectives: The immunosuppressants administered to renal transplant subjects are usually monitored therapeutically to prevent graft rejection and drug toxicity. Mycophenolic acid (MPA) is an immunosuppressant. The present prospective study was undertaken to establish the utility of plasma level monitoring of MPA and to correlate it with clinical outcomes in renal transplant receipients. Methods: MPA plasma level at 2, 4 and 9 h and the area under concentration-time curve (AUC) were estimated using high performance liquid chromatography in 24 renal transplant recipients receiving immunosuppressant MPA plus tacrolimus and steroid. Results: There was wide inter-individual variation in MPA plasma level and the AUC. The incidences of gastrointestinal adverse drug events (diarrhoea and acidity) were significantly more in the high MPA AUC patients. Though biopsy proven acute rejection was not found, of the six subjects with lower MPA AUC (<30 mg.h/l), three were clinically diagnosed to develop tacrolimus nephrotoxicity. The Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) scores represented better health related quality of life in lower MPA AUC than in the higher MPA AUC (>60 mg.h/l). Interpretation & conclusions: The present findings suggest the MPA AUC of 30 - 60 mg.h/l in the maintenance stage of renal transplant patients to have optimum clinical benefit and relegated adverse events profile indicating the usefulness of AUC of MPA with limited sampling strategy in optimizing its use.
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Affiliation(s)
- S C Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Chatterjee P, Mathur SR, Dinda AK, Guleria S, Mahajan S, Iyer V, Arora V. Analysis of urine sediment for cytology and antigen expression in acute renal allograft rejection: an alternative to renal biopsy. Am J Clin Pathol 2012; 137:816-24. [PMID: 22523222 DOI: 10.1309/ajcpqfz0gelh5zpn] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Acute rejection in renal transplant recipients is diagnosed by renal biopsy at an advanced disease stage. There is no modality for sequential monitoring of graft status. We studied the role of urine cytology in predicting acute cellular rejection (ACR) and its ability to correctly diagnose ACR and differentiate it from drug toxicity (DT). Urine samples from 203 renal transplant recipients were studied to determine the cellular composition using cytology and immunocytochemistry for HLA-DR, intercellular adhesion molecule (ICAM)-1, and interleukin (IL)-2R. In a 3-month follow-up period, there were 36 episodes of graft dysfunction, of which 28 occurred due to ACR and 8 due to DT. The cytology results showed a significantly increased percentage of lymphocytes and polymorphonuclear cells in samples obtained before and during the clinical manifestations of ACR. A greater level of expression of antigens was observed before and during ACR. The use of IL2-R-, ICAM-1-, and HLA class II-specific monoclonal antibodies gave very high specificity, sensitivity, and positive predictive values in diagnosing rejection through urine cytology, suggesting that routine cytology along with immunocytochemistry of urine sediment has clinical potential for early diagnosis and management of ACR and DT.
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Reddy VSK, Guleria S, Bora GS. Donors with renal artery stenosis: fit to donate. Saudi J Kidney Dis Transpl 2012; 23:577-580. [PMID: 22569449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Kidney donation from hypertensive donors is now an accepted norm in live related kidney transplantation. The use of hypertensive donors with renal artery stenosis due to atherosclerosis and fibromuscular dysplasia is still debated. The prime concern is about the deleterious effect of hypertension on the donor and the risk of recurrence of such lesions in the solitary kidney. Even as the response of atherosclerotic renal artery stenosis to revascularisation is unpredictable, there is an improvement in blood pressure following revascularisation of kidneys with fibro-muscular dysplasia. The first use of such kidney donors was reported in 1984 and, since then, there have been a few reports of successful use of kidneys from donors with renal artery stenosis. We report here two interesting cases of successful transplantation of kidneys from live related kidney donors with hypertension due to renal artery stenosis who became normotensive with good graft function in the recipient. We conclude that moderately hypertensive donors with renal artery stenosis are fit to donate.
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Affiliation(s)
- Vemuru Sunil K Reddy
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Guleria S. Editorial. Apollo Medicine 2012. [DOI: 10.1016/s0976-0016(12)60112-4] [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: 11/29/2022] Open
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Guleria S, Khattar N, Sharma S. Hepatorenal bypass using autogenous, free internal iliac artery graft: An attractive alternative to revascularize the right kidney in Takayasu′s disease. Indian J Urol 2012; 28:199-201. [PMID: 22919139 PMCID: PMC3424900 DOI: 10.4103/0970-1591.98466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonspecific aortoarteritis or Takayasu's disease (TD) is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28–75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu's arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.
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Gupta P, Guleria S, Mathur SR, Ghosh R. Port site tuberculosis: a case report and review of literature. Indian J Tuberc 2012; 59:32-35. [PMID: 22670509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A rare case of port site tubercular infection is reported. A young male patient presented, one month after laparoscopic inguinal hernia repair with discharging sinuses at the port sites. Biopsy of the sinus tract showed features of tuberculosis. Excision of sinus tract was done and the patient was started on anti-tubercular therapy, sinuses healed. Probably, the source of tubercular infection was laparoscopic instruments. Proper sterilization of laparoscopic instruments is necessary.
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Affiliation(s)
- Pankaj Gupta
- Department of Surgical Disciplines, All India Institute of Medical Sciences, 55 floor, Teaching Block, Ansari Nagar, New-Delhi, India-110029
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Guleria S, Reddy VSK, Bora GS, Sagar R, Bhowmik D, Mahajan S. The quality of life of women volunteering as live-related kidney donors in India. Natl Med J India 2011; 24:342-344. [PMID: 22680258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Women outnumber men 6:1 as live-related donors in our renal transplant programme. Women donors in developing regions are often illiterate and unemployed. This study was done to assess the change in quality of life of women who donate kidneys. METHODS We prospectively studied 73 consecutive women volunteering as live-related kidney donors over a 6-month period using the World Health Organization Quality of Life Brief (WHO QoL Bref) Questionnaire and Hospital Anxiety and Depression Scale (HADS). Each woman was interviewed 2 weeks before and 6 months after kidney donation. RESULTS There was a significant improvement in all the domains, namely physical (p=0.0001), psychological (p<0.0001), social relationship (p=0.037) and environment (p<0.0001) of the WHO QoL Bref questionnaire. Donors who were mothers had a greater improvement in all 4 domains than donors with other relationships. There was a significant decrease in the depression score (p<0.0001), but no change in the anxiety scores (p=0.065) following kidney donation. All donors would donate again, if possible. CONCLUSION In live-related women kidney donors, quality of life improves and depression scores decline after kidney donation.
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Affiliation(s)
- S Guleria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
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Siddiqui JA, Kaur G, Bhowmik DM, Guleria S, Agarwal SK, Mehra NK. 112-P Clinical relevance of cytokine gene polymorphism on post transplant renal allograft survival. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.137] [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: 10/17/2022]
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