Epidemiology of systemic mycoses among renal-transplant recipients in India

John, George T.; Shankar, Viswanathan; Talaulikar, Girish; Mathews, Mary S.; Abraham, Mookanottle Abraham; Thomas, Paulose P.; Jacob, C. K.

doi:10.1097/01.tp.0000061610.34110.04

Cited by 53 publications

(22 citation statements)

References 19 publications

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“…Over the course of 13 years, 0.8% of renal transplant recipients developed cryptococcosis, and most occurred a long time after transplantation. The incidence of cryptococcosis in renal transplant recipients observed in this study was similar to the low incidence rates reported by other groups (0.3%‐5.5%), but with high mortality . Among these 47 patients, the majority had received AMBd (87.2%) as first‐line therapy.…”

Section: Discussionsupporting

confidence: 88%

Outcomes of cryptococcosis in renal transplant recipients in a less‐resourced health care system

Ponzio

Camargo

Medina-Pestana

et al. 2018

Transplant Infectious Dis

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Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients.

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Section: Discussionsupporting

confidence: 88%

Outcomes of cryptococcosis in renal transplant recipients in a less‐resourced health care system

Ponzio

Camargo

Medina-Pestana

et al. 2018

Transplant Infectious Dis

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“…Surgical complications following commercial transplantations have been described as the major cause of morbidity and mortality in both the early and late post-transplant periods. [8][9][10][11][12][13][14]15,17,20,[28][29][30] Consistent with those reports, our current series shows that the rate of surgical complications was quite high. Chugh and Jha reported that it is likely that some of these living-unrelated donor transplantations are performed by questionably qualified physicians in mushrooming private back-street clinics with minimal sanitary facilities.…”

Section: Discussionsupporting

confidence: 81%

“…Chugh and Jha reported that it is likely that some of these living-unrelated donor transplantations are performed by questionably qualified physicians in mushrooming private back-street clinics with minimal sanitary facilities. 20,29,30 It has been reported that commercial living-unrelated transplantations in the Third World have higher rates of serious post-transplantation complications, morbidity and mortality. 1,[8][9][10][11][12][13][14][15][16][17]28,30 Over half of all renal transplant recipients in tropical countries develop serious infection at some point in the post-transplant period and 20% to 40% of them succumb to these infections.…”

Section: Discussionmentioning

confidence: 99%

Commercial renal transplantation: A risky venture? A single Canadian centre experience

Kapoor

Kwan

Whelan

2013

CUAJ

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Background: Canada, akin to other developed nations, faces thegrowing challenges of end-stage renal disease (ESRD). Even withexpanded donor criteria for renal transplantation (the treatment ofchoice for ESRD), the supply of kidneys is outpaced by the escalatingdemand. Remuneration for kidney donation is proscribedin Canada. Without an option of living-related transplantation(biological or emotional donors), patients often struggle with longwaiting lists for deceased donor transplantation. Accordingly, manypatients are now opting for more expedient avenues to obtaininga renal transplant. Through commercial organ retrieval programs,from living and deceased donors, patients are travelling outsideCanada to have the procedure performed.Methods: Between September 2001 and July 2007, 10 patients (7males, 3 females) underwent commercial renal transplantation outsideCanada. We describe the clinical outcomes of these patientsmanaged postoperatively at our single Canadian transplant centre.Results: Six living unrelated and 4 deceased donor renal transplantationswere performed on these 10 patients (mean age49.5 years). All procedures were performed in developing countriesand the postoperative complications were subsequently treatedat our centre. The mean post-transplant serum creatinine was142 mmol/L. The average follow-up time was 29.8 months (range:3 to 73 months). One patient required a transplant nephrectomysecondary to fungemia and subsequently died. One patient had afailed transplant and has currently resumed hemodialysis. Acuterejection was seen in 5 patients with 3 of these patients requiringre-initiation of hemodialysis. Only 1 patient had an uncomplicatedcourse after surgery.Discussion: Despite the kidney trade being a milieu of corruptionand commercialization, and the high risk of unconventionalcomplications, patients returning to Canada after commercial renaltransplantation are the new reality. Patients are often arriving withoutany documentation; therefore, timely, goal-directed therapy forsurgical and infectious complications is frequently delayed becauseof the time taken to establish an accurate diagnosis. Refuting theexistence of commercial renal transplantation may not be a practicalsolution; more consistent communication and documentationwith transplant teams may be more pragmatic. In the current climate,patients considering the option of overseas commercial renaltransplantation should be advised of the potential increased risks.

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“…Longer time on HD (due to immunosuppressive effects of ESRD and HD) [22–24], pretransplant diabetes mellitus, and chronic liver disease [6, 25] have been pointed as risk factors for developing post-transplant TB. Opportunistic infections (such as caused by CMV, Pneumocystis jiroveci, and Nocardia ) [6, 26] after RT and the presence [22, 25] and number [23] of acute rejection episodes (with IS augmentation) were also associated with increased risk of TB.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

Azevedo

Freitas

Silva

et al. 2013

Case Reports in Nephrology

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Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.

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Epidemiology of systemic mycoses among renal-transplant recipients in India

Cited by 53 publications

References 19 publications

Outcomes of cryptococcosis in renal transplant recipients in a less‐resourced health care system

Outcomes of cryptococcosis in renal transplant recipients in a less‐resourced health care system

Commercial renal transplantation: A risky venture? A single Canadian centre experience

A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

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