Kidney paired donation is the most cost-effective approach in incompatible donor-recipient pairs. Incompatibility may be due to blood group, human leucocyte antigen crossmatch or both. In many cases of a living donor kidney transplant, there is only one potential donor who becomes unsuitable due to any of the above mentioned factors. In kidney paired donation, donor-recipient pairs are exchanged to sort out the incompatibility. We report our first successful three-way kidney exchange transplantation from North India. As deceased donor program is still in evolving stage in most parts of our country and transplant with desensitization protocol is associated with financial constraints, infections, and lack of availability in many centers, kidney paired donation is a valuable approach to expand the donor pool.
Vascular complications arise in uremic patients in the absence of clinically significant atherosclerotic disease. Elevated serum parathyroid hormone (PTH) and abnormal calcium (Ca) and phosphorus (P) balance have been implicated in vascular damage in chronic kidney disease (CKD) patients, but there is lack of histo-pathological studies. Patients with CKD stage 5 and 5D who underwent arterio-venous fistula were included in this study. Baseline and laboratory parameters including assessment of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, albumin, calcium, phosphorus, intact PTH (iPTH) and vitamin D level were documented. The specimens of the arterial wall were obtained during the procedure and were analyzed. Patients were divided into two groups iPTH <400 (Group A) and iPTH >400 (Group B). Mean intimal thickness (IT) was significantly high in patients of Group B (60.4 ± 24.1 μ m) as compared with patients of Group A (37.8 ± 14.9 μm) (P = 0.003). Vascular calcification was comparable in both groups. The iPTH level was found to be an independent risk factor for high intima thickness (correlation coefficient 0.653) (P-value <0.01). Patients with high (≥ 400 pg/mL) iPTH have 8.93 times the risk of developing intimal thickness of ≥ 60 μ m as compared with patients with low (<400 pg/mL) iPTH (P-value <0.05), with 95% confidence interval of 1.27, 62.61. The mean IT of the radial artery significantly correlated with the iPTH level, while vascular calcification was independent of the iPTH level. Hyperparathyroidism is an important cause of ongoing vascular damage and may contribute to higher vascular events in CKD patients.
Introduction: Large-scale Indian data on the use of anti-T-lymphocyte globulin (ATLG) (Grafalon Ò ) as induction therapy in kidney transplantation (KT) patients is lacking. The aim of this study was to determine the 1-year patient and graft survival outcomes with the use of ATLG as induction regimen in KT. Methods: In a prospective, multicentric, observational study, adult patients who underwent ABO-compatible KT and had received ATLG as a part of induction were included in the study. The primary outcome measure was overall survival and death-censored graft survival at 12 months. The primary safety outcome was assessed by development of infectious complications and graft rejection. Results: In total, 359 patients were included in this study. The mean age was
Introduction: Urinary tract infection (UTI) is a common complication after kidney transplant,prevalence ranging from 35 to 79%,associated with graft loss and increased healthcare cost 1. Beta-lactam antibiotics are the most frequently prescribed antimicrobial in the United States and worldwide 2. Nowadays ESBL(Extended-spectrum beta-lactamases) producing organism has become a major cause of concern causing antibiotic resistance 3,4 Very little data is available for antibiotic resistance pattern in developing world & further studies are needed in this area.The aim of this study is to determine the incidence of UTI and causative organisms,antibiotic susceptibility and resistance pattern over last four years. Methods: This is a retrospective observational-single center study conducted at PSRI Hospital, New Delhi.Post renal transplant patients between January 2015-July 2018 who had symptomatic UTI and urine culture positive were taken as subjects.The minimum follow up period of 3 months post transplant was taken as inclusion criteria.All the patients after transplant received triple immmunosuppression which included Tacrolimus, Mycophenolate and Steroids according to center protocol.Urine culture was performed with manual semi-quantitative technique & further identification & antimicrobial susceptibility testing was done using VITEK2.0 compact (Biomerieux,France).Antibiotics were prescribed according to their sensitivity report. ESBL positive organisms were defined as resistance to 3rd generation cephalosporins including ceftazidime.The data was entered in MS EXCEL spreadsheet & analysis was done using SPSS version 21.0.Statistical tests applied are Chi-Square test & Kaplan-Meier survival analysis curve.p value of < 0.05 was considered statistically significant. Results: A total of 91 episodes of UTI were identified in 66 subjects out of 211 urine samples processed.Incidence of infections were more common in initial 3 months(41.7%) following transplant possibly due to higher immunosuppression during this period.Growth of Gram Negative in 87(95.60%) & Gram positive in 4(4.40%) patients with Escherichia coli(57.1%) being the commonest followed by Klebsiella pneumoniae(28.5%),Pseudomonas(6.5%),Enterococcus spp.(3.3%) and Enterobacter (1.1%)(Table 1).Incidence of ESBL positive infection increased from 19.23% in 2015 to 34.62% in 2018.Resistance to antibiotics increased over last four years Example Amikacin(from 23% to 43%),Levofloxacin(from 61% to 82%),Ceftazidime(from 18% to 21%) & Meropenem(from 28% to 51%)(Picture).Even resistance to higher antibiotics such as Colistin which was not there in 2015 but was present in 2018(10%)(Picture).Kaplan-Meier curve showed that Infection free survival rates were better in 2015(66%) when compared with 2018(57%)
Diabetic myonecrosis or muscle infarction (DMI), a clinicoradiological entity is an underdiagnosed complication of diabetes mellitus. It refers to spontaneous aseptic necrosis of skeletal muscles commonly of the lower limb without evidence of any large vessel disease. It presents as painful swollen limb without any external insult in patients with long-standing diabetes mellitus with other microvascular complications especially nephropathy. We present four instances of DMI in our patients who had end-stage renal disease with a varied course.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.