Live Related Renal Transplant Recipients Research Articles

Analysis of Human Leukocyte Antigen Frequency among Renal Transplant Recipients and Donors in Nepal

ABSTRACT Background and Objectives: Kidney transplants are effective for advanced renal failure, but graft rejection can occur when the recipient’s immune system misidentifies the kidney as a foreign object. Human leukocyte antigen (HLA), a component of the host’s immunological defense system, acts as a barrier to graft rejection. Selecting potential kidney recipients and donors for transplantation requires careful consideration of histocompatibility for the HLA-A, HLA-B, and HLA-DRB1 antigens. Mismatches between donors and recipients prolong transplant therapy, leading to lower graft survival and higher mortality. The objective of the study was to analyze HLA-A, HLA-B, and HLA-DRB1 antigens frequency in live-related renal transplant recipients and donors visiting the Department of Histocompatibility and Immunopathology at the National Public Health Laboratory, Teku, Kathmandu, Nepal. Methods: A retrospective study was conducted by using data from 104 renal transplant recipients and donors whose samples had previously been collected, processed, and analyzed to identify the Class I loci (HLA-A and HLA-B) and Class II loci (DRB1) between November 2021 and February 2024. Results: The study found that the majority of donors were female, and the majority of recipients were male. In this study, 10, 17, and 12 different HLA-A, B, and DRB1 alleles were found in recipients and donors. Alleles found more frequently are A*11 (25.00%), A*24 (23.08%), sB*15 (22.60%), B*35 (12.98%), DRB1*15 (22.60%), and DRB1*12 (21.63%). Conclusions: The study suggests that both donors and recipients of renal transplants in Nepal have a diverse HLA antigen distribution, which could aid in selecting a genetically closer group as potential matched donors for transplant recipients.

Ocular complications in live-related renal transplant recipients: A single-centre study.

Renal transplantation is considered to be the treatment of choice for patients with end-stage kidney failure. While transplantation has a high success rate, there are a number of associated challenges which include those related to the primary disease, transplant procedure as well as medications that are necessary to take after transplantation. Steroids, for instance, have been reported to lead to ocular complications in patients who have undergone renal transplantation in other parts of the world. This retrospective case series reports the pattern of ocular complications among patients who underwent renal transplant since the inception of ophthalmology clinic at a dialysis and transplant centre in Karachi, Pakistan. The case series corroborates the findings of other similar studies from around the world, with cataract being the most common occurrence in this cohort. A unique finding in Pakistani setup includes the high prevalence of night blindness, which requires investigation in a larger cohort prospectively.

Urinary Mitochondrial Deoxyribonucleic Acid: A Novel Biomarker of Coronavirus Disease 2019-associated Acute Kidney Injury in Renal Transplant Recipients

Abstract Background: Acute kidney injury (AKI) is one of the common manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. An early identification of AKI is of paramount importance to modulate the management of AKI, limiting the severity, avoiding nephrotoxic medicines, and modifying the drug dose depending on renal function. Aim: To determine the utility of urinary mitochondrial deoxyribonucleic acid (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting coronavirus disease 2019 (COVID-19)-associated AKI and mitochondrial stress. Materials and Methods: Live-related renal transplant recipients (RTRs) (n = 66), who acquired SARS-CoV-2 infection and were admitted to a COVID hospital were included and subclassified into AKI (n = 19) with > 1.5-fold rise in serum creatinine level from the pre-COVID-19 serum creatinine level, and non-AKI (n = 47) whose serum creatinine value remained stable, or a rise of <1.5-fold of the baseline values of pre-COVID-19. A 50 mL urine sample was collected and urinary mt-DNA and NGAL was determined by the reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assays methods. Results: Both the urinary mitochondrial gene NADH dehydrogenase (ND-1) and NGAL level were significantly higher in the AKI group compared to non-AKI. The mean ND-1 gene Ct in the AKI group was (19.44 ± 2.58 a.u) compared to non-AKI (21.77 ± 3.60; P = 0.013). The normalized ND-1 gene cycle of threshold (Ct) in AKI was 0.79 ± 0.11 a.u compared to non-AKI (0.89 ± 0.14; P = 0.007). The median urinary NGAL level in AKI group was (453.53; range, 320.22–725.02, 95% confidence interval [CI]) ng/mL compared to non-AKI (212.78; range, 219.80–383.06, 95% CI; P = 0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58–70.39) ng/mg in the AKI group compared to 11.26 ng/mg (0.41–329.71) in the non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713, uNGAL was 0.663, and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. Conclusions: Urinary mt-DNA quantification can detect the post-COVID mitochondrial distress with higher sensitivity than uNGAL in RTRs.

Frequency of urinary tract infections in renal transplant recipients with common bacteria and its sensitivity

Objective: To determine the frequency of urinary tract infection and its common pathogens with antibiotic sensitivity among renal transplant recipients.
 Materials and methods:
 This Cross sectional descriptive study was conducted at Institute of Kidney Diseases (IKD) Hayatabad, Peshawar from January 2008 to December 2012. The cross section included 74 live related renal transplant recipients. Each renal transplant recipient was followed up for 3mpnths for developing urinary tract infection.
 Results: 
 A total of 74 patients were followed after renal transplant. Among them 12 (16.22%) were females and 62 (83.78%) were males respectively. They were all live related renal transplant. UTI developed in 27/74 (36.48%) patients at first 3 months after transplantation (60 ± 15 days). Female patients were more susceptible to UTI than male patients (5 female 41.66%; 22 male 35.48%). On univariate analysis, older age (p?=?0.015), female gender (p?<?0.001), hyperglycaemia (p?=?0.037) and acute rejection episodes (p?=?0.046) were all risk factors for developing urinary tract infection. Isolated bacteria were Escherichia coli (59.25%), Candida albicans (18.51%), Klebsiella (11.11%), Enterococcus spp. (7.40%), followed by Pseudomonas aeruginosa 3.70%. Antibiotic resistance was 26% for ciprofloxacin and 33% for ampicillin.
 Conclusion: Urinary tract infection is a major problem in renal transplant recipients. The female gender, increasing age and uncontrolled hyperglycemia are the risk factors for UTI in renal transplant recipients. There is high resistance to ampicillin and quinolones in renal transplant recipients.
 

Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

BackgroundEnd-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). MethodsThe prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18...60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30.ßseconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72.ßhours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. ResultsThe incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6.ßhours (12.5% vs. 32.1%, p.ß=.ß0.013) and 72.ßhours (1.8% vs. 33.9%, p.ß<.ß0.001), but insignificant difference at 24.ßhours (1.8% vs. 10.7%, p.ß=.ß0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24.ßhours (45.54.ß...ß12.64 vs. 51.96.ß...ß14.70, p.ß=.ß0.015) and 72.ßhours (39.11.ß...ß10.32 vs. 45.7.ß...ß15.12, p.ß=.ß0.015). ConclusionPalonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Renal Allograft Biopsy Findings in Live-related Renal Transplant Recipients.

To determine the pattern of histopathology in living-related, kidney transplant recipients (KTRs) from a transplant centre in Khyber Pakhtunkhwa (KPK), Pakistan. Descriptive, observational study. Institute of Kidney Diseases, Peshawar, from August 2008 to July 2018. A retrospective review of graft biopsy reports and clinical charts from living-related, kidney transplant recipients was carried out. Allograft biopsies were done for graft dysfunction with no apparent cause. The biopsy pathology was classified according to updated Banff classifications. The descriptive statistics were used to tabulate the results. Out of the 55 biopsies, 51 (92.73%) were from males with mean age of 34.35±9.40 years. Out of 52 percutaneous biopsies, 10 (19.23%) belonged to the normal category. Category 2 (borderline rejection) and 3 (acute/active cellular rejection) were seen in three (5.7%) and one (1.9%) cases, respectively. Interstitial fibrosis/tubular atrophy (Banff Category 5) was observed in 18 (34.62%) cases. Banff Category 6 (others) was seen in 19 (36.5%) cases, in which calcineurin inhibitors (CNI) toxicity was commonest (17 [89.4%] of 19 cases). Mixed lesions were found in 19 (36.5%) cases. Out of the 19 mixed category cases, 12 (63.16%) showed both Category 3 and Category 5 changes with most of the cases showing mild to moderate IF/TA; while one case had severe IF/TA. Three graft nephrectomies were done, one each for recurrent oxalosis, nephroblastoma and fungal infection. Among the studied specimens, mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low and that of chronic changes higher, in keeping with delayed biopsies. Key Words: Allograft biopsy, Graft dysfunction, Rejection, Kidney.

MP74-02 ROLE OF EARLY POVIDONE IODINE INSTILLATION IN POST RENAL TRANSPLANT LYMPHORRHOEA: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III1 Apr 2017MP74-02 ROLE OF EARLY POVIDONE IODINE INSTILLATION IN POST RENAL TRANSPLANT LYMPHORRHOEA: A PROSPECTIVE RANDOMIZED STUDY Sanjoy Sureka, Aneesh Srivastava, Priyank Yadav, Rakesh Kapoor, M S Ansari, and Uday Singh Sanjoy SurekaSanjoy Sureka More articles by this author , Aneesh SrivastavaAneesh Srivastava More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Rakesh KapoorRakesh Kapoor More articles by this author , M S AnsariM S Ansari More articles by this author , and Uday SinghUday Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphatic collections commonly develop after renal transplantation although most of them are asymptomatic and resolve spontaneously. Persistent drain output is one of the earliest signs of lymphatic leak. An encysted collection or lymphocoele if symptomatic, can lead to complications as grave as the graft dysfunction itself. This study aimed at prospectively evaluating the role of early povidone iodine instillation in the management of post renal transplant lymphorrhoea. METHODS A prospective evaluation of live related renal transplant recipients was done from Jan 2002 to Dec 2015. Significant lymphorrhoea was defined as >50 mL lymph from drain beyond POD 5. Such patients were randomized into 2 groups: Group A (received 0.5% povidone iodine instillation) and Group B (no instillation). Povidone iodine instillation was done for upto three weeks. The drain was removed if the output decreased to <50ml/day or at three weeks drainage persisted. Absolute risk reduction and NNT were calculated to estimate effect of povidone iodine instillation for the treatment of lymphorrhoea. Fisher exact test or chi square test for categorical data descriptive statistics and t test was used for continuous data SPSS version 20.0. Armonk, NY: IBM Corp. RESULTS 1766 patients underwent renal transplant during this period. 117 patients with lymphorrhoea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58(95%) patients had successful resolution within two weeks while in group B, 34(60%) patients had successful resolution within two weeks. Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow up. Absolute risk reduction was 10.8% and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. CONCLUSIONS Povidone iodine instillation helps in early resolution of post renal transplantation lymphorrhoea as well as reduces the incidence of lymphocoele formation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e995-e996 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sanjoy Sureka More articles by this author Aneesh Srivastava More articles by this author Priyank Yadav More articles by this author Rakesh Kapoor More articles by this author M S Ansari More articles by this author Uday Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is Late Conversion To Everolimus Beneficial in Kidney Transplant Patients With Interstitial Fibrosis Tubular Atrophy?

Introduction: Interstitial fibrosis & tubular atrophy is the leading cause of graft loss in kidney transplant patient. Proliferation signal inhibitors may help in reducing calcineurin inhibitor exposure without increasing acute rejection episodes. Current study evaluated efficacy of conversion from mycophenolate to everolimus with CNI minimization in patients with biopsy proven IFTA and deteriorating renal function. Methods: Prospective single center trial, study cohort selected from 200 live related renal transplant recipients in followup. All had received basiliximab induction and triple drug immunosupression (tacrolimus, MMF/EC-MFS, steroids). Inclusion criteria: biopsy proven IFTA, absence of significance proteinuria (<400 mg/24 hour), progressive graft dysfunction (decline of GFR > 15% over 1 month), eGFR>40ml/min/1.73m2. All underwent conversion from mycophenolate to everolimus with CNI minimization. Results: The study group composed of 22 patients (M:F=19:3), mean age 37 years (range 24-58). Conversion done at 24 months (range: 3-112 months) post-transplantation and median follow-up is 22 (IQR: 5-9) months. Of these 23 patients, only 2 had an early conversion and the rest 21 had a late conversion. The tacrolimus trough levels decreased from 5.1 ± 1.6 ng/ml to 3.6 ± 1.1 ng/ml (p=0.03). The everolimus levels achieved were 6.68 ± 2.4 ng/ml and 5.7±1.4 ng/ml at 1 and 3 months. The eGFR that had declined from best stable values of 59.3± 11.9ml/min to 48.2±9.5ml/min at conversion stabilized and improved to 50.7±11, 53.3±13.1, 54.9±13.9 and 57.1±10.1 ml/min at 1, 3, 6 and 12 months post conversion respectively (p=0.028 at 3 months). The eGFR showed futher improvement. After a total 471 patient treatment months, there were no episodes of rejection CMV or BK virus infection. Of 22 patients, certican was withdrawn in 2 patients at 12 months & 24 months due to appearance of proteinuria. Conclusion: Late conversion from mycophenolate to everolimus with CNI minimization resulted in stabilization of renal function with no evidnece of Rejection or infections.

An institutional based study of post-operative surgical complications of live related renal transplant recipients

Abstract Objectives This study was done to know the frequency of surgical complications among the live related renal transplants at our institution and to analyze the different factors that may influence the occurrence of such complications. Settings and design A prospective study of 182 live related renal transplants from August 2006 to December 2008 done at our institution was designed and conducted. All patients received their kidneys from living donors who were first degree relatives. All patients were followed for a minimum one year period. Surgical complications were reported and their incidence was correlated with several pretransplant, technical and post-transplant risk factors by both univariate and multivariate analyses. Results Among the 182 patients, 27 surgical complications were encountered. These complications included ureteric stricture in 1 patient, lymphocele in 13 patients, deep vein thrombosis in 1 patient, vascular complications in 4 patients, wound infection in 6 patients with dehiscence in one patient in one patient and pyocoele in one patient. The incidence of urological complications was 0.5%, vascular complications 2.2% lymphocoele was 7.1% and wound infections was 3.3%. On univariate analysis, the factors that significantly affected the incidence of surgical complications were occurrence of post-transplant ATN for lymphocoeles and the number of graft renal arteries for vascular complications. On multivariate analysis, the number of graft renal arteries significantly affected the occurrence of vascular complications. Conclusion Surgical complications in live renal transplantation can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication is paramount to graft and patient survival.

Biopsy Findings in Renal Allograft Dysfunction in a Live Related Renal Transplant Program

Background: There is little information in literature on renal allograft biopsy findings in renal allograft dysfunction in live related renal transplant recipients. Material and Methods: A retrospective review of 1210 renal allograft biopsies from 575 renal transplant patients was carried out over a period of seven years from June 1997 till December 2004. The demographic, clinical, laboratory and biopsy findings were collected and analyzed. Results: A total of 1210 graft biopsies were performed on 575 patients. The mean age of recipients and donors was 29.2±9.7 years, and 35.7±10.5 years, respectively. The males were predominant among recipients (76.7 vs. 23.3%), while among donors they only slightly outnumbered females (51.8 vs. 48.2%). Regarding pathological lesions, acute rejection was seen in 292 (24%) cases, followed by acute tubular injury and cyclosporine A (CsA) toxicity, found in 281 (23.2%) and 134 (11%) cases respectively. Chronic allograft nephropathy (CAN) with variable degree of tubular atrophy was seen in 361 (29.8%) cases. Seventy nine cases (6.5%) of acute pyelonephritis were detected on graft biopsies. A number of rare lesions were also found, including 13 (1.07%) cases of recurrent/de novo renal disease, and 13 (1.07%) of polyoma virus infection. Five cases of CsA induced hemolytic uremic syndrome (HUS) were also noted. Conclusion: In conclusion, the incidence of acute rejection is low in our patients as compared to cadaveric renal transplant recipients as reported in Western studies and CsA toxicity is more common. Recurrent/de novo renal disease is uncommon in our patients.

Use of isoniazid chemoprophylaxis in renal transplant recipients

The use of isoniazid (INH) as chemoprophylaxis for tuberculosis (TB) in renal transplant recipients has not been widely studied or reported from a country where TB is endemic. We are reporting here the results of the largest ever-reported randomized, prospective study of the use of INH in renal transplant recipients. Four hundred consecutive live related renal transplant recipients between April 2001 and September 2004, from this single center, were randomized to receive or not receive INH for 1 year after transplantation. There were 12 dropouts. Of the remaining 388, 181 recipients received INH for 1 year post-transplant and 207 did not. The primary disease, comorbidities, HLA (human leucocyte antigen) match, immunosuppression, episodes of rejection, the use of anti-rejection agents, a past history of TB in the donor, the recipients and in family members living in same house and a history of TB in the family were factors compared in the two groups. The only significant difference between the two groups was that there was an increased family history of TB in recipients who received INH (P = 0.01). One recipient from the INH group and 16 recipients from the non-INH group developed TB (P = 0.0003). Discontinuation of INH for hepatotoxicity was not required in any patient. These results provide evidence that the use of INH following renal transplantation should be considered mandatory in geographical areas where the prevalence of TB is high. Furthermore, these results have important implication in patients from such areas who are immunosuppressed following other kinds of transplantation and for those who are immunocompromised for any other reason.

Opportunistic infections (noncytomegalovirus) in live related renal transplant recipients

The purpose of review was increasing number of opportunistic infections with use of newer immunosuppression and difficulty in diagnosis and management of such patients. For this review, MEDLINE database was searched from 2000 to 2006 with the keywords of opportunistic infections in renal transplantation.Opportunistic infection is a serious clinical complication in patients receiving immunosuppressive therapy after kidney transplantation. The two major factors for successful renal transplantation are better control of rejection and better prevention and treatment of infection. In renal allograft recipient, immunosuppressive drug therapy is the major cause of immunocompromised status and occurrence of infections, which arise most commonly as a result of invasion by endogenous opportunists. The opportunistic infections with varicella zoster viruses, parvovirus B-19, polyomavirus, nocardia and mucormycosis in immunosuppressed patients were present with severe complications that are reviewed in this article. As a result of use of strong immunosuppressive drugs like tacrolimus, mycophenolate mofetyl and antirejection therapy with antithymocyte globulins, these infections are now seen frequently, so they should always be included in differential diagnostic consideration. New diagnostic procedures and new treatment strategies are required to allow early detection and successful treatment of opportunistic infections in kidney transplant recipients.

Intestinal cryptosporidiasis in living related renal transplant recipients

Cryptosporidium infestations are common in immunocompromised AIDS patients. However, the literature in renal transplant recipients is scarce. We conducted a study to know the prevalence, disease manifestations, and management of cryptosporidial infestations in live related renal transplant recipients. Cryptosporidial infestations were observed in 20% of patients, including 16.6% who had symptomatic diarrhea. We conclude that the prevalence is high in the transplant population, but only a few patients are symptomatic. Clinicians should routinely request special stains to demonstrate cryptosporidium in stool specimens.

Therapeutic implication of quantitative pp65 antigen assay in living renal transplant in a high seroendemic population

Various methods have been used to diagnose cytomegalovirus (CMV) infection/disease; however, pp65 antigenemia assay has emerged as a good marker for CMV disease in a high seroendemic population. We studied the role of quantitative pp65 antigen assay in live related renal transplant recipients in a high seroendemic population. Between November 1998 and May 2003, a total of 350 blood samples from 250 symptomatic patients were tested by quantitative pp65 antigen assay; 14% of the patients tested positive. There were 5 (14%) low-positive and 30 (86%) high-positive patients. All high-positive patients had CMV disease. The response to antiviral therapy monitored by the assay was dramatic, and one low-positive patient responded to reduction in immunosuppression. In conclusion, pp65 antigen assay is a good test for diagnosing CMV disease and monitoring response to antiviral therapy in a high seroendemic population.

PHARMACOKINETIC PROFILE OF ASIAN PEDIATRIC RENAL TRANSPLANT RECIPIENTS BY SPARSE SAMPLING AUC

P694 Aims: Evaluate pharmacokinetics of micro emulsion cyclosporine in Asian pediatric live related renal transplant recipients. Methods: Seventy eight children received live related renal transplants. Sparse sampling area under the curve (AUC) was undertaken in all on 5th day of transplant. AUC was done by estimating C0, C2 and C6 levels and substituting C0 for C12 and AUC determined by a computer programme. The dose of CyA was 10mg/kg/day in two divided doses (BD) or in three doses (TDS). An AUC of 6000 – 8000 ng/ml/hr was taken as adequate for BD and 4000 – 5000 for a TDS dose. Results: The mean AUC was 7400 ± 1659 and the mean C0 was 312 ± 116 and C2 1296 ± 354. Of the 78, 41 (52%) had adequate AUC. Twenty four (31%) were rapid metabolizers (AUC < 6000) and 17% were slow metabolizers (AUC > 8000) and required dose reduction. Of the 24 with low AUC, 20 did not respond to dose increments and were placed on TDS dose at 10mg/kg/day. The mean AUC was 4814 ± 1132 in TDS dose. Rejection episodes were 42% in BD dose and 38% in TDS dose (p=0.1). One year graft survival was 90% in both groups. The correlation of C0 vs AUC was 0.54 (p=0.005) and C2 vs AUC was 0.45 (p=0.02). All 78 recipients required dose readjustments within the first three months. In all 40 (51%) required repeated AUC’s for dose monitoring. Conclusions: The metabolism of CyA is unpredictable in our children and no monitoring parameter C0 or C2 is a safe option in the early transplant period. A 3 point AUC provided the best guide to overall exposure. Changes from BD to TDS doses were more important in the early transplant period to maintain adequate levels.