Cadaveric Renal Transplantation Research Articles

Salvage of a Transplanted Kidney following Immediate Renal Artery Narrowing

Renal transplantation is considered the preferred treatment method for chronic renal failure. Early graft failure caused by transplant renal artery narrowing/stenosis is a common vascular complication after kidney transplantation. The classic symptoms include refractory hypertension, a decline in graft function, and fluid retention. Color Doppler sonography plays an important role in the diagnosis of renal artery narrowing; however, allograft artery angiography remains the gold standard. We report on a case of cadaveric donor renal transplantation, wherein the urine output markedly decreased within 7 h of transplantation due to renal arterial narrowing and the efforts that were made to salvage the kidney.

A Case of Listeria Monocytogenes Brain Abscess with a Clinical Presentation Mimicking Stroke

Purpose: Kidney transplant recipients are at a high risk of both stroke and infection. We report this case to inform readers of the possibility of the occurrence of Listeria monocytogenes brain abscess despite treatment with low dose trimethoprim–sulfamethoxazole (TMP/SMX). Case Report: A 62-year-old man presented to our hospital with right facial palsy, left arm and leg weakness, and mild fever; he was diagnosed with a stroke in the emergency room. The patient had a history of cadaveric renal transplantation 2 years prior, for which he was prescribed tacrolimus- based immunosuppressive drugs. Multiple myeloma was diagnosed 18 months after renal transplant. He was treated with bortezomib and steroids for the multiple myeloma, and low-dose TMP/SMX for pneumocystis prophylaxis. A listeria brain abscess was diagnosed based on a comprehensive medical history, magnetic resonance images, positive blood culture, and brain biopsy. He underwent ampicillin therapy and achieved full recovery after a 3-month follow-up period. Conclusion: Physicians should monitor unusual stroke symptoms and consider Listeria brain abscess as a differential diagnosis. This case suggests that listeria brain abscesses can potentially cause temporary neurological deficits akin to a stroke, despite TMP/SMX prophylaxis, but these symptoms resolve without necessitating surgical intervention.

A Rare Case of Pelvic Lipomatososis in a Cadaveric Renal Transplant Recipient

A middle-aged male with end-stage renal disease underwent cadaveric transplantation. Intraoperatively, a large mass was seen in the pelvis surrounding the vessels, native ureter, and bladder. Ultrasound showed echogenic fatty tissue in the pelvis suggestive of pelvic lipomatosis vessels were dissected, layers were separated with a lot of difficulty. The urinary bladder could not be defined. Hence, ureteroureterostomy was done and a DJ stent was placed. The patient had immediate graft function and attained a nadir creatinine of 0.6 mg/dl on postoperative day 6.

Successful Endovascular Management of Juxta Internal Iliac Vessel Pseudoaneurysm with Allograft Preservation in Post-Renal Transplant

Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneurysm is even rarer, with an incidence of 0.3%. The presentation can vary from acute blood loss to chronic dull aching pain, anorexia, etc. Majority of pseudoaneurysms are associated with allograft loss. We present a case of an anastomotic pseudoaneurysm successfully managed with an endovascular approach. A 54-year-old female, post cadaveric renal transplant (end-to-end anastomosis between the renal artery and right internal iliac artery) presented on post-operative day 159 with complaint of fever with chills. On treating conservatively with antibiotics, the fever subsided, only to recur after 5-days. On further investigation, c-reactive protein (CRP) was found to be persistently elevated. Patient’s fever of unknown origin was further investigated with repeat blood culture and fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Blood culture was positive for Klebsiella pneumoniae sensitive to colistin and tigecycline and FDG-PET showed a 5 cm aneurysm of the juxta anastomotic segment of the right internal iliac vessels, a possible pseudoaneurysm. After a multidisciplinary discussion, the patient underwent renal angiography, an aneurysm was delineated, and a covered stent was placed which partially excluded the aneurysm. The patient responded well to the intervention. Pseudoaneurysm formation is a rare and potentially life-threatening complication and can present even in the late post-operative period. Endovascular management can be a safe approach in carefully selected cases with allograft preservation being of paramount importance.

Clinical impact of preservation fluid contamination on kidney transplant patients.

Kidney transplantation is associated with a high risk of infectious complications due to immunosuppressive therapy. Although infections may be transmitted from donor to transplant recipient through contaminated preservation solution (PS), the clinical impact of this is not well-understood. We retrospectively evaluated PS contamination rates in a series of 339 patients who underwent cadaveric renal transplant at our centre. All patients with a positive culture received targeted preemptive therapy (PET). Of the 339 PS samples, 136 (40.1%) were positive for a microorganism, mainly coagulase-negative staphylococci (CoNS; n = 89;60.5%), gram-negative bacilli (n = 31;21.1%), non-CoNS gram-positive cocci (n = 18;12.2%), and Candida spp (n = 2;1.4%). Of the 136 positive cases, 42 (30.9%) received PET (12.4% of the cohort). No cases of urinary tract infection, surgical site infection, or graft loss were observed. Overall, our findings indicate that PS contamination, mainly by saprophytic skin flora (CoNS) is common. Only 8% of patients required antibiotic or antifungal therapy. The infection transmission rate from donors to recipients was negligible (0%), perhaps due to the early initiation of a targeted PET after isolation of a recognized pathogen. More data from large, prospective studies are needed to confirm these findings.

BI30 Remission of a large plantar verruca vulgaris in an immunocompromised patient postincisional punch biopsy

Abstract We report the case of a 41-year-old renal transplant recipient who has been attending dermatology for skin surveillance following a cadaveric renal transplant. His immunosuppressive treatment consists of tacrolimus, mycophenolate mofetil and prednisolone 5 mg once daily. His primary dermatological complaint was that of a large wart on the plantar aspect of his right foot. Given the location of this lesion, there was significant associated pain, which also resulted in a functional impediment, impacting on his ability to exercise or work. On examination, he had a large, hyperkeratotic, papillomatous nodule measuring 3.5 × 3 cm on the plantar aspect of his right foot, clinically in keeping with verruca vulgaris. This had been recalcitrant to extensive treatment, including topical salicylic acid, 5-fluorouracil, cantharidin and numerous courses of cryotherapy and paring over the previous 6 years. Following administration of xylocaine 1% with adrenaline as the local anaesthetic, we performed three incisional 4-mm punch biopsies through the centre of the wart to the depth of the dermis. We ensured visualization of haemorrhage at the base of each punch incision. The biopsy cores were left in situ and the wound was dressed with petroleum jelly, Kaltostat® and Opsite. At his 6-week follow-up review, the verruca vulgaris had completely resolved. No postprocedural complications were noted by the patient. Further skin surveillance was scheduled for 6 months later, at which time no recurrence of this verruca vulgaris had occurred. Verruca vulgaris is a benign papillomatous proliferation of epidermal cells driven by human papillomavirus (HPV) infection, commonly acquired in childhood. For many patients, verruca vulgaris will spontaneously regress. However, it can represent a therapeutic challenge when persistent, as it is recalcitrant to multiple treatment modalities, particularly in immunosuppressed patients. To our knowledge, our case is the first documented resolution of a giant plantar wart in an immunocompromised patient using such an approach. Renal transplant patients represent a unique cohort in relation to verruca vulgaris, whereby impaired cell-mediated immunity can increase their susceptibility to HPV, thereby reducing effective treatment options and meaning definitive clearance may never be achieved. Our case highlights that incisional punch biopsy may represent an accessible and cost-effective approach to the treatment of verruca vulgaris in immunosuppressed patients, where alternative treatment options would necessitate numerous hospital visits.

#5999 GRADES II-III INTRA-ABDOMINAL HYPERTENSION INCREASE THE RISK OF GRAFT LOSS OR DEATH AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims Intra-abdominal hypertension (IAH) is common among post-surgical, critically ill and kidney transplant patients, and is associated with acute kidney injury and increased morbidity and mortality. We aimed to describe the medium-term effect of IAH on graft and patient survival after deceased-donor kidney transplantation. Method 192 consecutive patients who received a cadaveric renal allograft transplant at our hospital were included in this study. IAP was measured every 8h for at least the first 72h after surgery using the urinary bladder technique, and an average value was obtained. Patients were followed up for 24 months or until a composite outcome (defined as graft loss or recipient death) occurred. Clinical, anthropometric, and analytical data was extracted from our hospital's database. Statistical analysis was performed using IBM SPSS Statistics 22. The study was approved by the local ethics committee. Results 192 patients were included. Relevant clinical and anthropometric data are summarized in Table 1. Patients with grades II or III IAH were more frequently male, had longer dialysis vintage, received more frequently hemodialysis as renal replacement therapy and suffered delayed graft function, graft loss or death more repeatedly. In Kaplan-Meier analysis, grade II IAH or higher were associated with lower composite-outcome free survival (Log-Rank: 8.053; p = 0.018) (Figure 1). Conclusion Grade II-III IAH appear to be a risk factor for graft loss or recipient death in our sample of deceased donor kidney transplant recipients. Monitoring of intra-abdominal hypertension could provide useful information to identify patients at higher risk of post-transplant complications.

#4973 PATHOGENIC ROLE OF D313Y MUTATION IN FABRY DISEASE

Abstract Background and Aims Fabry disease (FD) is a multisystem lysosomal storage disorder caused by mutations in the GLA gene. The significance of the mutation p.D313Y in the GLA gene is under debate. Our aim is to evaluated the pathogenic role of the D313Y. Method For clinical FD phenotype a 60-year-old woman (index case) with cadaveric donor renal transplantation and unknown cause of renal disease was undergoing genetic investigation. She reported D313Y as single variant in the GLA gene. A prospective analysis of clinical manifestation, genetic and biochemical (lyso-GB3 and enzyme activity) data was performed in all her brothers, sisters and sons. Data were assessed as part of routine follow-up visits. Results Genotype information of our index case was: nucleotide change c.937G>T, exon 6 involved, amino acid change p.Asp313Tyr, HGMD accession CM930335, mutation type missense. In our cohort comprising n.9 family members: n°5 (55%, n°3 females, n°3 males age range 45-60) had the p.D313Y mutation. In nobody the biomarker lyso-Gb3 was elevated. Two brothers (age range of 40-50 y) died for acute cardiovascular attack before genetic investivagation was performed. The 5 family members showed the following clinical features: 2 hypertension and cardiac hypertrophy (2M, 44/61y); our index case renal failure, LVH and bruning pains; 2F with burning pains (49/46y). Enzyme replacement therapy (ERT) was started in our index case. Annual routine visits are performed in the others. Conclusion D313Y mutation seems to correlate with clinically rilevant symptoms (mainly cardiovascular and renal) compatible with FD, also without lyso-Gb3 elevation. ERT might be considered as therapeutic option not only in patients with already organ involvement, but also in paucisymptomatic to prevent disease progression.

CARDIOVASCULAR COMPLICATIONS AFTER CADAVERIC RENAL TRANSPLANTATION

Objective: Renal transplantation is the treatment for end-stage renal disease. Cadaveric donor renal transplantation (CDRT) is still uncommon in Tunisia, constituting less than 20% of total renal transplants. The aim of our study was to evaluate the results and cardiovascular complications in our center Design and method: A retrospective analysis of 30 CDRT was performed between November 1995 and December 2018. Data analysis included. age, gender, cold ischemia time, graft function graft function, dialysis requirements dialysis requirements, rejection episodes rejection, infectious episodes, new onset diabetes after transplantation (NODAT), hypertension and cardiovascular events Results: Thirty patients underwent CDRT among 172 renal transplants performed in our unit. Among the donors, there were 23 males and 7 females, with a mean age of 32 ± 9 years. All transplants were blood group compatible with 3 HLA matches in the majority of cases (45%). The mean age of the recipients was 34 ± 9 years. Chronic glomerulonephritis (40%) and chronic chronic interstitial nephropathy (32%) represented the main type of native renal disease. 88.5% of the patients were hemodialysis before transplantation and the median time to transplantation on dialysis was dialysis was eight years. The mean nadir of creatinine was 108 ± 27 μmol/l. Two biopsies showed acute tubular injury, four patients had acute rejection and two patients had allograft nephropathy allograft nephropathy with one case of segmental and focal hyalinosis. segmental and focal hyalinosis. The major infectious complication was a cytomegalovirus cytomegalovirus infection (33.3%) followed by a urinary tract infection (23.8%). Regarding metabolic complications metabolic complications, NODAT and hypertension were observed in three and four patients respectively. Two patients presented an acute coronary syndrome treated with medical therapy. Five patients returned to dialysis. The rest (57.7%) have been followed up regularly in our consultation so far over a period of 87 months (range 16-209 months). Conclusions: CDRT is not common in our center, but the analysis shows good results and provides encouraging data that support broadening the criteria for potential donors eligible for organ donation especially in the face of increasing organ shortages. Cardiovascular complications are not as common

Low-solute hyponatremia in a kidney transplant recipient.

Electrolyte and acid-base disturbances are common in kidney transplant recipients, but there are few reports of low-solute hyponatremia or beer potomania in this population. We report herein a case of low-solute hyponatremia in a kidney transplant recipient with impaired graft function, highlighting key issues in diagnosis and management of low-solute hyponatremia, as well as exploring the pathophysiology of hyponatremia after kidney transplantation. A 51-year-old man who had received a cadaveric renal transplant 18 years before presented with symptomatic hyponatremia and seizure. Workup for an underlying intracranial pathology was negative, and subsequent biochemical workup suggested low-solute hyponatremia with potomania, arising from dietary modifications taken by the patient while self-isolating during the COVID-19 pandemic. Correction of hyponatremia was successful with conservative management with close monitoring. This case illustrates key points in the diagnosis and management of low-solute hyponatremia and highlights the pathophysiology of hyponatremia after kidney transplantation.

Why Do Not All Living Kidney Donor Candidates Are Accepted for Donation? A Pediatric Center Experience

BackgroundLiving donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. MethodsWe retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. ResultsA total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). ConclusionsDespite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases.

Intraoperative administration of methadone reduced postoperative pain and opioid consumption following cadaveric renal transplantation: a randomized controlled trial

Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed.
 Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications.
 Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001).
 Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery.

Četrdeset godina ciklosporina u kliničkoj praksi

Cyclosporine (CsA) was discovered in the lab of Sandoz in Switzerland in 1972. while searching for an antifungal drug. However, it quickly became an irreplaceable immunosuppressive drug for renal and other solid organ transplantation. It has been found, in the initial experiments, that CsA inhibits both in vitro cell-mediated lysis and lymphocyte sensitization by allogeneic target cells. Clinical trials have demonstrated better one-year graft survival after cadaveric renal transplants when receiving CsA instead of azathioprine. Although improvement has been observed in the rates of one-year renal graft survival and acute rejection, but long-term graft survival rate did not improve. This can be attributed to the nephrotoxic effects of the CsA. This issue is a consequence of hemodynamic effects on renal blood flow and glomerular filtration, effect on renal tubular function and blood vessels. Along with nephrotoxicity, CsA also causes other adverse effects such as hypertension, gingival hyperplasia, hyperkalemia, hypomagnesemia, hyperlipidemia, neurotoxicity, and in some cases thrombotic microangiopathies. However, in recent years CsA nephrotoxicity has been looked at from a different angle, where it has been linked to high CsA doses that used to be administered. Following its use in solid organ transplantation, CsA has been found to have an important role in treating systemic connective tissue diseases, as well as its consequences, primary glomerulonephritis, inflammatory bowel disease, and psoriasis. CsA effectiveness in treating above mentioned diseases is still greater than its side effects, which makes it a base of treatment options for numerous diseases.

P8.123: A Retrospective Comparison of ABO Incompatible With ABO Compatible and Cadaveric Renal Transplant: Single Centre Experience

Introduction: ABO incompatibility was a major barrier in kidney transplantation. Advances in immunosuppressive therapy and desensitization protocol have made ABO incompatible transplants safe and effective. The present study is a retrospective comparison of ABO incompatible with ABO compatible and Cadaveric renal transplant in single centre. Method: The study includes 7 ABO incompatible, 14 similar age and HLA matched ABO compatible and 7 cadaveric kidney transplant recipients. All ABO incompatible recipients underwent desensitization with Rituximab and plasmapheresis with IVIg. Their outcomes at 6 months in terms of eGFR calculated by MDRD formula, incidence of rejection and infection as well as graft survival and patient survival were compared. Result: The outcome in terms of eGFR at 6 months was equivalent in ABO compatible (66.90ml/min/1.73m2) and ABO incompatible (60.42ml/min/m2) group and was significantly lower in the cadaveric group (45.32ml/min/m2). The incidence of infection at 6 months was equal in ABO incompatible (28.5%) and ABO compatible group (28.5%) and it was significantly higher in cadaveric transplant groups (42.85%). There was one incidence of acute rejection and one graft loss in cadaveric transplant group whereas no rejection and graft loss in ABO compatible and ABO incompatible transplant group. All three groups had 100% patient survival. Conclusion: The graft function, risk of infection and graft survival at 6 months in ABO incompatible transplant is non inferior to ABO compatible transplant and is superior to Cadaver transplant. ABO incompatible transplant also circumvents the waiting period on dialysis and mortality and morbidity associated with it.

Outgrowing skin involvement in malakoplakia after kidney transplantation: A case report

IntroductionMalakoplakia is a rare pseudotumor that arises in the context of recurrent infections, particularly in immunocompromised states. We report a case of renal allograft parenchymal malakoplakia. Case reportA 59-year-old woman successfully received a cadaveric renal transplant in June 2018. Two months after transplantation, she was treated for a urinary tract infection (UTI). In March 2019, she underwent allograft biopsy for increasing creatinine. The biopsy identified T cell mediated rejection and steroid pulse therapy was performed. In December 2019, she was hospitalized for right flank pain and pyuria, and her creatinine level was 1.9 mg/dL. Radiographic findings were suggestive of a hematoma or abscess in the perirenal area, and septated fluid collection was suspected. Biopsy results suggested malakoplakia, and von Kossa stain was positive for Michaelis- Gutmann bodies. Tissue culture demonstrated Escherichia coli, and this was treated with antibiotics. The dose of tacrolimus was reduced. The patient was discharged after 1 month of hospitalization and was maintained on oral antibiotics. Follow-up imaging revealed an increase in the extent of lesion into the adjacent abdominal wall. Assuming the case to be refractory, we performed surgical resection and abscess drainage. Although the renal parenchymal involvement persisted, the size showed a decreasing trend over 2 months of serial observation with ultrasonography. ConclusionsMalakoplakia should be considered as a differential diagnosis for recurrent UTI with graft dysfunction. Malakoplakia can be successfully treated with reduction in immunosuppression and medical therapy using long-term antibiotic treatment in most cases. However, early surgical treatment must be considered for refractory cases.

Influence of double J stent in the complications of ureterovesical anastomosis during kidney transplantation

IntroductionComplications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. ObjectiveThe aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. Material and MethodsRetrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. ResultsTransplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. ConclusionDJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

ASPERGILLUS PNEUMONIA-A DIAGNOSIS OF SUSPICION

A 59-year-old woman, status post cadaveric renal transplant 2 weeks ago, presents to the ED with a fever. The patient has had 10 days of worsening dry, non-productive cough, chills, mild shortness of breath, and a fever up to 100.4 ̊. She reports that the dry cough has been present for 2 months, but has become worse over the last several days. She also reports feeling increasing fatigue and wheezing. She denies dysuria or frequency, diarrhea, nausea, or vomiting. Her review of systems is otherwise negative.

Influencia del catéter doble J en las complicaciones de la anastomosis vesicoureteral realizada durante el trasplante renal

IntroductionComplications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. ObjectiveThe aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. Material and methodsRetrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. ResultsTransplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. ConclusionDJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

From the EDITOR’S DESK

As we begin the year 2022, we, in the young group ‘Women in Nephrology, India’, are filled with a new hope. Hope of a new dawn in the academic horizon, hope of making a new beginning and a new mark in the Nephrology world. We take a new step in this direction by presenting the first issue of our official scientific publication ‘Indian Journal of Kidney Diseases’(IJKD). Although the women nephrologists in India, had the dream of coming together as a group for many years, it attained fruition just about six months back. But it is remarkable that over a short span of six months, the group has made a commendable impact in the academic world. The dynamism of its leaders has taken the shape of a quarterly, open access, journal covering all aspects of Nephrology-General Nephrology, dialysis and transplantation. We aim to provide a platform for the young nephrologists of India and elsewhere to publish their scientific work and shape their academic career. It is my privilege and honor to present the first issue of Indian Journal of Kidney Diseases to the readership. I am grateful to Dr Swarnalatha G for literally taking the publication from the stage of conception to reality, going stage-by-stage through the publication process. Words are not enough to thank the WIN Leads headed by Dr Urmila Anandh and editors, Dr Anita Saxena and Dr Manisha Sahay who guided us at crucial steps. We have a young, enthusiastic editorial team with us to help with the publication. Thanks are also due to the energetic reviewers who helped us with the peer review process and completed the process in very short time periods, varying between two hours and a week. In this issue, we present a variety of clinical materials and I am thankful to each author for the time they have spent on this. Firstly, there is a perspective article from our dynamic leader, Dr Urmila Anandh, regarding her views on the challenges ahead of the women nephrologists and the barriers for their growth. She presents her solutions for enhancing the productivity and mitigation of stress to the women in medicine. Dr Swarnalatha presents the results of a comparative analysis of the outcomes of live donor renal transplants and cadaver renal transplants. Dr Priyamvada and her co-author discuss the nuances of xenotransplantation, which is making the news these days in different parts of the world. There is an interesting case report of recurrent crescentic glomerulonephritis in a young girl. There is also an illustrative image of calciphylaxis. In view of the March month being the Kidney month, on the occasion of the World Kidney Day, there is a topical commentary on the theme of ‘Kidney Health for all’ and its implications for India. As we present this first issue, we are aware of the numerous challenges ahead. We intend to get our journal indexed in some of the prominent indexing sites and for this we need quality publications. Funds are a very prominent challenge. But hope runs eternal and we are hopeful to face the challenges one-by-one and turn them in our favour. In this context, it would serve us well to remember these immortal lines by the ancient Indian poet Kalidasa in ‘Salutations to the dawn’. Look well to this day, For it and it alone is life. In its brief course Lie all the essence of your existence: The Glory of Growth The Satisfaction of Achievement The Splendor of Beauty For yesterday is but a dream, And tomorrow is but a vision. But today well lived makes every yesterday a dream of happiness, And every tomorrow a vision of hope.

Reconstruction of Calcified Hepatic Artery in the Donor Liver: A Case Report

The transplant teams may even push the boundaries outside the norm to ensure optimal outcome from donation. An offer of liver graft from 58 years old female DBD donor was accepted. Donor history entailed type I diabetes mellitus, hypertension and previous hemodialysis, before undergoing cadaveric renal transplant. A male recipient with cryptogenic cirrhosis and HCC with UKELD of 58, was selected as the recipient. The organ was retrieved by a different surgical team, once the images of the liver were received and the retrieval team reported no anomalies or injuries, recipient hepatectomy was stared prior to the graft arrival in order to keep the cold ischemia time as short as possible. On back table dissection of the liver graft it was identified that the donor common hepatic artery was heavily calcified. As the recipient was already anhepatic therefore after careful consideration it was decided to precede with the implantation of the donor liver. Recipient CHA was prepared at the GDA junction and corresponding CHA/GDA patch on the graft. A 5mm diameter extruding calcified plaque was excised from the site of the anastomosis but most of the circumference of graft patch had integrated wall calcification which could not be excised. On table Doppler USS suggested extensive intrahepatic calcification but excellent traces after arterial reconstruction. The Peak systolic volume was >60cm. Graft function was evident by good bile production, normal TEG, INR and lactate clearance. We believe that hepatic artery atherosclerosis on its own is not an absolute contraindication to liver transplantation.