Better knowledge and awareness will help in promoting organ donation. Effective campaign needs to be driven to educate people with relevant information with the involvement of media, doctors and religious scholars.

Treatment of patients with amlodipine overdose remains challenging. We describe a case of successful treatment of refractory hypotension, noncardiogenic pulmonary edema and acute kidney injury after an intoxication with 250 mg of amlodipine. Marked improvement in all hemodynamic parameters was noted with combination of fluids, inotropes, low-dose calcium, low dose insulin, mechanical ventilation and hemodialysis. All available information on overdose of amlodipine is limited to case reports and series. Prospective trial on the use of these agents is required to define its role as the first-line treatment in amlodipine, a calcium channel blockers overdose.

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Background. The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods. We administered an electronic survey to staff at transplant centers outside the United States (10/14/21-0½8/22) addressing the reasons cited by transplant centers for or against implementing a vaccine mandate. Each responding center was represented once in the analysis. Results. Respondents (n=90) represented 27 countries on 5 continents. Half (51%) of responding transplant center representatives reported implementing a vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pre-transplant vaccination versus post-transplant, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status, and regardless of pre-vaccination spike-protein antibody titer or other markers or prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure to transplant candidates, insufficient evidence to support vaccine mandate, equity, and legal considerations. Conclusions. The approach to pre-transplant COVID-19 vaccination mandate policies in centers outside the United States is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.

Background We aimed to analyze the humoral and cellular response to standard and booster (additional doses) COVID‐19 vaccination in solid organ transplantation (SOT) and the risk factors involved for an impaired response. Methods We did a systematic review and meta‐analysis of studies published up until January 11, 2022, that reported immunogenicity of COVID‐19 vaccine among SOT. The study is registered with PROSPERO, number CRD42022300547. Results Of the 1527 studies, 112 studies, which involved 15391 SOT and 2844 healthy controls, were included. SOT showed a low humoral response (effect size [ES]: 0.44 [0.40–0.48]) in overall and in control studies (log‐Odds‐ratio [OR]: −4.46 [−8.10 to −2.35]). The humoral response was highest in liver (ES: 0.67 [0.61–0.74]) followed by heart (ES: 0.45 [0.32–0.59]), kidney (ES: 0.40 [0.36–0.45]), kidney‐pancreas (ES: 0.33 [0.13–0.53]), and lung (0.27 [0.17–0.37]). The meta‐analysis for standard and booster dose (ES: 0.43 [0.39–0.47] vs. 0.51 [0.43–0.54]) showed a marginal increase of 18% efficacy. SOT with prior infection had higher response (ES: 0.94 [0.92–0.96] vs. ES: 0.40 [0.39–0.41]; p ‐value < .01). The seroresponse with mRNA‐12723 mRNA was highest 0.52 (0.40–0.64). Mycophenolic acid (OR: 1.42 [1.21–1.63]) and Belatacept (OR: 1.89 [1.3–2.49]) had highest risk for nonresponse. SOT had a parallelly decreased cellular response (ES: 0.42 [0.32–0.52]) in overall and control studies (OR: −3.12 [−0.4.12 to −2.13]). Interpretation Overall, SOT develops a suboptimal response compared to the general population. Immunosuppression including mycophenolic acid, belatacept, and tacrolimus is associated with decreased response. Booster doses increase the immune response, but further upgradation in vaccination strategy for SOT is required.

Prevalence of ARAS among the patients in routine cardiac catheterization was 5.7 %. Hypertension is closely associated with significant ARAS. Significant CAD in the form of triple-vessel disease and altered renal function tests are closely associated with ARAS. They predict the presence of significant renal artery stenosis in patients undergoing routine peripheral and coronary angiography. Moreover, hypertension and altered renal functions predict bilateral ARAS.