Living-related Renal Transplantation Research Articles

241.7: Spectrum of post-transplant malignancies in live related renal transplant setting and their clinical characteristics over a period of 40 years; a single center experience.

241.7: Spectrum of post-transplant malignancies in live related renal transplant setting and their clinical characteristics over a period of 40 years; a single center experience.

Post-transplant CFHR5 mutation-related atypical HUS: The need for pre-transplant diagnosis

Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) affecting multiple organs and can be sporadic or familial. It is most commonly caused by dysregulation of the alternative complement pathway. aHUS can occur at any age with a high rate of progression to end-stage kidney disease. We describe the case of a 24-year-old man with chronic kidney disease, severe hypertension, and antineutrophilic antibody by IF positive. On biopsy, diffuse global glomerulosclerosis with TMA and IF findings of full house pattern suggestive of lupus nephritis were present. Considering a lupus nephritis case, after 2 years of hemodialysis underwent live-related renal transplant (Father Donor). Immediate post-transplant period developed severe cortical necrosis and TMA. An etiological workup was done to ascertain the cause of post-transplant TMA. After excluding common causes of antibody-mediated rejection (C4d and donor-specific alloantibody neg), calcineurin inhibitor toxicity, and infection, we detected an abnormal complement CFHR5 mutation with an autosomal dominant pattern of inheritance. Pre-transplant diagnosis could have prevented taking the kidney from the father for transplant and further prevented recurrence. Systemic lupus erythematosus and TMA both can have alternate complement pathway dysregulation leading to full house IF pattern and misdiagnosis.

Multiple Renal Arteries in Live Donor Renal Transplantation and Impact on Graft Function and Outcome: A Retrospective Study

Objective: The objective of the study is to evaluate the outcomes of live-donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live-related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One-year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant.

A Case of Posttransplant Recurrence of Focal Segmental Glomerulosclerosis with Donor-derived Immunoglobulin A Nephropathy and Banff IIA Acute Cell-mediated Rejection: A Therapeutic Challenge

Primary focal segmental glomerulosclerosis (FSGS) recurrence varies between 10% and 60% and is an important predictor of graft survival. Here, we report the case with a combination of recurrence of FSGS, acute cell-mediated rejection, and donor-derived immunoglobulin A (IgA) nephropathy which required treatment with plasmapheresis and antithymocyte globulin. This patient is an 18-year-old female whose native kidney disease was a biopsy-proven FSGS and underwent ABO compatible live-related renal transplant with her mother as a donor. No induction agents were given and the patient was put on triple immunosuppression with Calcineurin inhibitors (CNIs), Mycophenolate mofetil (MMF), and steroids. On postoperative Day 2, the patient developed nephrotic range proteinuria. A transplant kidney biopsy was done. Biopsy revealed acute cell-mediated rejection, Banff II A with i3, t3, ptc1, v1, and C4d negative. There was also an increase in mesangial cellularity with IgA 3+ and C3 1+ on immunofluorescence which is IgA nephropathy, likely donor derived. Electron microscopy revealed significant effacement of podocytes. CNI levels are adequate. Pulse methylprednisolone 5 doses given. The patient was given two sessions of plasmapheresis with albumin and a single dose of rabbit antithymocyte globulin (ATG) 1.5 mg/kg was given. Plasmapheresis was withheld in view of studies reporting the removal of ATG following plasmapheresis. There was a gradual worsening of renal function with peak serum creatinine of 9 mg/dL which required three sessions of hemodialysis. The second renal biopsy on Day 13 showed features of acute tubular injury with borderline changes suspicious of acute cell mediated rejection (ACMR)–i1, t1. Currently, the patient is on regular follow-up with normal renal function with urine polymerase chain reaction of 0.4. We report this case which presented with a puzzling combination of ACMR, possible recurrence of native disease, and likely donor-derived IgA nephropathy that provided us with challenges in management. Treatment protocols with optimal dosing strategies and assessing response to treatment in these situations are still unclear due to the lack of large randomized trials.

A Study on Early Surgical Complications in Renal Transplant Recipients

Introduction: Renal transplantation is one of the most effective treatment measures in patients with end-stage renal disease to improve their quality of life. However, postoperative surgical complications can be seen in 15% to 17% of cases, with significant morbidity in earlier periods. This study aims to study the incidence, presentation, and management of various surgical complications within 2 months of renal transplantation. Materials and Methods: This retrospective descriptive study included data from hospital records of 236 recipients who underwent renal transplantation from 2015 to 2022 at our institute. In addition, salient characteristics of the donors were also noted. Recipients whose hospital records were not available were excluded from the study. Surgery-related complications within 2 months of renal transplantation in recipients and their management were studied. Results: Of 236 cases of renal transplantation, 182 cases were live-related renal transplantation recipients, and 54 were deceased donor renal transplantation recipients. Surgical complications such as posttransplant urine leak in three patients, lymphocele in two patients, graft renal vein thrombosis in three patients, and anastomotic site pseudoaneurysm in one patient occurred. The overall incidence of early surgical complications in our study is 3.81%. The study reports the successful management of all these nine patients with necessary intervention. Conclusion: The early diagnosis of postoperative complications is essential for reducing mortality and preserving graft function.

The Silent Invader: A Case Report of Pulmonary and Cerebral Nocardiosis by Nocardia cyriacigeorgica in a Renal Transplant Recipient

Nocardia species primarily affect the lungs of immunocompromised individuals. The clinical presentation may mimic pulmonary tuberculosis. Accurate identification and high clinical suspicion are crucial for correct diagnosis and treatment, especially in tuberculosisendemic regions. A prolonged antibiotic regimen with two or more drugs is needed, and non adherence to the treatment protocol can lead to potentially fatal outcomes. A 37-year-old man with systemic hypertension and chronic kidney disease, who also underwent live-related renal transplantation, presented with fever, cough, and weight loss. No other significant complaints were noted. Physical examination revealed elevated body temperature and bilateral basal crepitations. Baseline investigations showed anaemia, leukopenia and elevated renal parameters. A chest X-ray indicated right lower zone opacity. A provisional diagnosis of pulmonary tuberculosis or mycosis was considered. Video bronchoscopy revealed thick mucoid secretions that were collected for staining, culture, and sensitivity testing. Gram stain and modified Acid-Fast Bacilli (AFB) stain showed microscopic features suggestive of Nocardia species, while the colonies that grew on culture were identified as N. cyriacigeorgica. Treatment was initiated with oral cotrimoxazole and intravenous imipenem. After 14 days, he was discharged with a continuation plan but did not adhere to the regimen. The patient eventually presented again 10 days later with seizures and altered sensorium, leading to a diagnosis of cerebral nocardiosis. Despite treatment, he progressed to septic shock and died. Effective treatment of nocardiosis requires a multidrug regimen, typically consisting of cotrimoxazole, amikacin, or imipenem, tailored to the severity of the infection. Early diagnosis, prompt treatment, and strict adherence to protocols are mandatory for successful treatment, as delays or non compliance can lead to fatal outcomes.

Effects of sufentanil in combination with dexmedetomidine for patient-controlled intravenous analgesia after renal transplantation

Background/Aim. Nowadays, the most convenient analgesic method is patient-controlled intravenous injection of one or more adjuvant drugs. The aim of our study was to evaluate the effects of sufentanil plus dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after renal transplantation. Methods. Seventy-eight patients receiving living-related renal transplantation under general anesthesia were selected. Radioisotope scanning was performed, and the single glomerular filtration rate of the unilateral kidney was ? 40 mL/min/1.73 m2. The control group (CG) and observation group (OG) (39 patients in each group) were analgesic with sufentanil and sufentanil plus dexmedetomidine, respectively. When the Visual Analogue Scale (VAS) score exceeded 4 points, 0.05 mg/kg oxycodone was intravenously injected for remedial analgesia. Plasma levels of endothelin, urea nitrogen, and creatinine were measured by radioimmunoassay. Heart rate (HR), mean arterial pressure, oxygen saturation, VAS score, and sedation score were recorded before anesthesia and after surgery. Analgesic remediation rate, number of effectively pressing the PCIA pump, and incidence rate of adverse reactions within 48 hrs after surgery were recorded. Results. HR of OG was significantly lower than that of CG 6 and 12 hrs after surgery (p < 0.05). VAS score of OG was lower than that of CG 6, 12, and 24 hrs after surgery (p < 0.05). OG had a lower postoperative remedial rate, number of effectively pressing the PCIA pump, and incidence rates of nausea and vomiting (p < 0.05) compared to CG. Endothelin, urea nitrogen, and creatinine levels significantly decreased after surgery compared with those before anesthesia (p < 0.05). The levels of OG were lower than those of CG at each time point after surgery (p < 0.05). Conclusion. Sufentanil plus dexmedetomidine can be safely and effectively used for PCIA after renal transplantation, with superior outcomes to those of sufentanil alone.

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.

Renal Transplantation in Rare Monogenic Urinary Stone Disease – A Single-center Experience

Introduction: Monogenic urinary stone disease (MUSD) tends to be more severe with early onset of symptoms and a higher risk of chronic kidney disease than sporadic USD. The literature on the outcome after renal transplant in patients with certain MUSD is scarce. Materials and Methods: This is a retrospective single-center observational study conducted in a tertiary care renal transplant unit in North India between 2018 and 2021. The renal transplant recipients who developed an end-stage renal disease (ESRD) due to renal calculus disease/nephrocalcinosis were included in the study. All the patients presented to us in an anuric state, and hence, a 24-h urine metabolic profile could not be performed. Ear, nose, and throat and ophthalmological evaluations were done to rule out extrarenal manifestations. These patients were subjected to genetic analysis, i.e., clinical exome sequencing using next-generation sequencing. Results: Out of 283 live renal transplants, 11 patients developed ESRD due to nephrocalcinosis/renal calculus disease. Out of 11, only 4 had genetic mutations and the rest did not have any identifiable genetic mutations. The gene mutations were identified in ADCY10, CLDN16, CaSR, and SLC3A4. The patient with ADCY10 mutation had a strong family history. The clinical phenotype and in silico parameters analysis predicted the variant to be damaging except the one with CaSR mutation which causes Hypocalciuric hypercalcemia syndrome, type 1. Three of four underwent surgical intervention at younger age. All underwent successful live-related renal transplantation, with good graft function on follow-up, without any recurrence of calculus in the allograft. Conclusion: Renal transplantation can be safely proceeded in patients with the above monogenic mutations. Genetic analysis should be a part of pretransplant evaluation in young onset nephrolithiasis and end-stage kidney disease patients to look for a monogenic cause, to assess the risk of recurrence postrenal transplant.

Predictive Value of Camera-based Donor Glomerular Filtration Rate Estimation on the Immediate Renal Allograft Outcome Following Live-related Renal Transplant: A Single-center Retrospective Study.

The purpose of this study was to assess the association of measured glomerular filtration rate (mGFR) using camera-based method with early transplant outcomes. Diethylenetriamine pentaacetate renograms of all voluntary kidney donors between January 2016 and December 2022 at Kasturba Hospital, Manipal, India, were retrieved for the study. Recipients' posttransplant biochemical parameters were collected and compared against donors with scaled mGFR >80 ml/min/1.73 m2 (Group 1) and with mGFR between 60 and 80 ml/min/1.73 m2 (Group 2). Donor-recipient pair age, anthropometric parameters, and their differences were also assessed against the immediate transplant outcome. Posttransplant immediate graft function was assessed by posttransplant nadir serum creatinine, day to achieve nadir serum creatinine, the incidence of slow graft or delayed graft function, and serum creatinine at 1-month posttransplantation. Recipients with serum creatinine of >2.5 mg/dl on posttransplant day 7 were taken as slow graft function. A total of 161 donor-recipient pairs were analyzed in the study. In recipients who showed persistently high serum creatinine posttransplant, older donor age(p < 0.001), higher difference in body mass index among the donor-recipient pair (p= 0.03), and mGFR <80ml/min (p < 0.001) were significantly associated. Slow graft function was significantly more in Group II recipients, with donors having mGFR <80ml/min as compared to Group I with mGFR >80 ml/min (37.3% vs. 10.6%) (P < 0.001). Camera-based mGFR using Gates' formula is a reliable tool to predict inferior graft outcomes in the immediate posttransplant period. Kidneys from donors with mGFR of 60-80 mL/min/1.73 m2 are likely to experience slow graft function in the immediate posttransplant period.

INF2 and ROBO2 gene mutation in an Indian family with end stage renal failure and follow-up of renal transplantation.

Accurate genetic diagnosis of end-stage renal disease patients with a family history of renal dysfunction is very essential. It not only helps in proper prognosis, but becomes crucial in designating donor for live related renal transplant. We here present a case of family with deleterious mutations in INF2 and ROBO2 and its importance of genetic testing before preparing for kidney transplantation. We report the case of a 29-year-female with end-stage renal disease and rapidly progressive renal failure. Mutational analysis revealed an Autosomal Dominant inheritance pattern and mutation in exon 4 of the INF2 gene (p. Thr215Ser) and exon 26 of the ROBO2 gene (p. Arg1371Cys). Her mother was diagnosed for CKD stage 4 with creatinine level of 4.3 mg/dL. Genetic variants (INF2 and ROBO2) identified in proband were tested in her sisters and mother. Her elder sister was positive for both heterozygous variants (INF2 and ROBO2). Her mother was positive for mutation in INF2 gene, and her donor elder sister did not showed mutation in INF2 gene and had mutation in ROBO2 gene without any clinical symptoms. This case report emphasize that familial genetic screening has allowed us in allocating the donor selection in family where family member had history of genetic defect of Chronic Kidney Disease. Information of the causative renal disorder is extremely valuable for risk-assessment and planning of kidney transplantation.

Posttransplant Thrombotic Microangiopathy: Unraveling a Mystery

A 24 year old lady who was diagnosed with chronic kidney disease stage 5 in 2016 underwent a pre-emptive live related renal transplant in the same year. She had kidney allograft dysfunction and eventually lost the transplant kidney in 2019 requiring hemodialysis. She underwent a deceased donor renal transplant in February 2022. She developed allograft dysfunction with a creatinine of 2.5 mg/dl in October 2022, and a renal allograft biopsy subsequently showed Thrombotic microangiopathy, arteriolar form. There were no features of rejection in the biopsy and Donor specific antibody done by Luminex lysate method was negative. Her Single antigen bead done subsequently was also negative. CMV DNA PCR was not detectable. Tacrolimus was switched to Cyclosporine, however her allograft function continued to worsen. Complement mutation analysis was negative and acquired complement defects were also not detected. Subsequently, Single antigen bead for non HLA antibodies showed positivity for MICA antibodies. She underwent 7 sessions of plasmapheresis and her renal functions did not improve and her creatinine continued to increase to 4.2 mg/dl. Complement activating assay for these MICA antibodies was positive. She was treated with two doses of 300 mg Eculizumab in December 2022, her allograft functions in February 2023 have improved to 2 mg/dl. This case highlights the extensive evaluation for post transplant TMA, the use of non HLA antibody assays and complement activating assays of these antibodies to decide on appropriate use of Eculizumab for salvaging transplant allograft.

Live Related Kidney Transplantation: Experience of 360 Patients in a Tertiary Care Hospital of Bangladesh

Background: Live related kidney transplantation is the most preferred form of renal replacement therapy worldwide including Bangladesh. However, it is challenging and also rewarding both for patients and treating physicians. BSMMU hospital has given maximum effort for its greater success. The aim of this study was to share our ten years’ experience regarding some aspects of live related renal transplantation. Methods: This retrospective study was conducted in nephrology department of BSMMU hospital from January 2002 to December 2015. Data were collected from hospital records and some previously conducted study on these transplant recipients. Results: A total of 360 live related kidney transplant recipients were evaluated during this period. Recipients Male: Female ratio was 1.57:1. Mean age of recipients were 39.58 ± 10.46 years. The causes of ESRD were chronic glomerulonephritis 220(61.60 %), diabetic nephropathy 58(16.24%), hypertensive nephrosclerosis 22 (6.16 %), chronic interstitial nephritis 11 (3.08 %), SLE 10(2.8%), ADPKD 6(1.68 %), unknown 19(5.32 %). Most of the donors were mother (21.84% %) followed by spouse mostly wife (20.44%) and sister (18.76 %). Almost all recipients were on MHD 352(97.78%), 2 were on CAPD and 06 were pre-emptive transplantation. Triple immunosuppressive protocol Cyclosporine or Tacrolimus, MPA or Azathioprine and Prednisolone were used in each patient. Recipients with poor HLA matching received Baciliximab in standard dose. CMV prophylaxis was given in selected patients and each patient received pneumocystis jirovecii prophylaxis. Common complications during post-operative period were ATN 41(11.48%), DGF 23(6.44%), Acute rejection 50(14%) and infection mainly urinary tract infection 46(12.88%) and RTI 14(3.92) followed by wound infection and other surgical complication. Presence of BK virus infection was studied in 29 transplant recipient and it was found to be positive in 6(20.7%) cases. Protocol biopsy was done in 37 transplant recipient in the 2008-2009 on day 14, and day 90 to see subclinical rejection and early graft dysfunction. On day 14th biopsy report showed 21(56.7%) normal histology, 5(13.5%) had subclinical rejection, 5(13.5%) had clinical rejection, 4(10.8 %) developed ATN, 2(5.2 % ) cyclosporine toxicity, and report at 3 month showed normal histology 18(48.60%), subclinical rejection 7(18.90%), clinical rejection 5(10.80%). Leading cause of chronic allograft dysfunction was chronic allograft nephropathy (CAN) 60(19.80%) followed by chronic cyclosporine toxicity 37(12.21%) and de-novo or recurrent glomerulonephritis. Mean post-transplant hospital stay was 18.46 ± 5.56 days. Mean duration of normalization of serum creatinine after surgery was 7.38 ± 3.88 days. At discharge 74.40% patients had normal renal function with mean serum creatinine 1.10 ± 0.26 mg/dl and 21.34% patients showed gradual improvement of renal function with mean serum creatinine 2.12 ± 0.97 mg/dl. In our study 1 year and 5 years’ graft survival was 93.88% and 75.16% respectively and 1 year and 5 years’ patient’s survival was 346(96.08%) and 290(81.2%). Conclusion: Our report shows that short and long term graft and patient survival is encouraging and comparable to other centers of both developing and some developed countries with limited resources and facilities.

#3404 UTILITY OF RENAL BIOPSY IN THE ETIOLOGY, MANAGEMENT AND OUTCOME OF POSTPARTUM ACUTE KIDNEY INJURY

Abstract Background and Aims Acute kidney injury (AKI) is a serious complication during pregnancy and postpartum period resulting in significant maternal morbidity, mortality and fetal loss. Pregnancy related acute kidney injury is still more prevalent in developing countries. This study aims to evaluate renal biopsies in postpartum period AKI (PPAKI) with etiology and its management and outcome. Method Retrospective analysis of 83 native renal biopsies received in the department of pathology, SGPGIMS, Lucknow, a tertiary care center in India with PPAKI from January 2007 to December 2021 were analyzed. Clinical and laboratory data were retrieved and renal biopsy histology slides were reviewed. Results Eighty-three patients with mean age 27.5±4.6 years had biopsy proven PPAKI. Cesarian section, vaginal delivery, hysterectomy and abortion were performed in 51, 19, 2 and 11 patients respectively. The cause of AKI was sepsis (38.6%), postpartum hemorrhage (26.5%), thrombotic microangiopathy (TMA) (11%), pre-eclampsia (3.7%) and other (20%). Duration of onset of AKI after delivery/abortion ranged from 0 to 30 days (mean 4.5±6.3 days). Fetal loss was seen in 31.7% patients. Biopsy showed partial/complete renal cortical necrosis (56.6%), TMA (24.1%), acute tubular injury (ATI) (4.8%), Lupus nephritis flare in 3.6% and other glomerular diseases (8.4%) and Tubulointerstitial nephritis in (1.2%) patient. All received multiple sessions of haemodialysis and 10 patients also had plasmapheresis. During hospital stay one died due to sepsis and shock, remainder were discharged in a stable condition with complete recovery in (5), partially recovery in (7); and 61 (71%) patients required continued renal replacement therapy. Two patients died and two had subsequent live related renal transplantation on available follow-up. Conclusion AKI is a serious complication in postpartum period and require early and prompt attention to reduce fetal and maternal morbidity. Sepsis is the commonest cause of postpartum AKI

A Survey of National Practices of Anaesthesia for Live Donor Renal Transplantation

Objective: To compare the institutional practices among patients undergoing living-related renal transplants in different hospitals throughout Pakistan.&#x0D; Study Design: Cross-sectional survey.&#x0D; Place and Duration of Study: Armed Forces of Institute of Urology, Rawalpindi Pakistan, from Jun 2020 to Jan 2021.&#x0D; Methodology: Pakistan's leading kidney transplant centres were sent data electronically to ask about their anaesthetic practices. The methodology adopted was a simple questionnaire model that included 26 questions encompassing all the steps the anaesthesia team took for renal transplant. Uniformity in anaesthetic practices was expected in large centres through rigorous training and workload management. The teams responded according to their standard operating procedures and compared their answers using statistical formulas.&#x0D; Results: Nine out of 11(81.8%) institutes responded. Marked heterogeneity in Anaesthesia practices was found among different institutes. Only 2(18.2%) institutes had Anaesthesia guidelines for a kidney transplant.&#x0D; Conclusion: There is a need for centralized country-specific homogeneous guidelines for Anaesthesia for the kidney transplant to improve outcomes.

MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL Tejas Mistry, Mrinal Pahwa, and Vipin Tyagi Tejas MistryTejas Mistry More articles by this author , Mrinal PahwaMrinal Pahwa More articles by this author , and Vipin TyagiVipin Tyagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative bleeding is one of the major complications associated with vascular anastomosis in kidney transplant. One of the novel measures for its prevention is the application of fibrin sealant over renal vein anastomotic site after completing the suturing. Till date, there is no study published to evaluate its role for this purpose. Hence, the current study was undertaken to evaluate the hemostatic role of fibrin sealant on renal vein anastomosis during renal transplant surgery. METHODS: This was a prospective randomised study (FORVEIN stands for Fibrin sealant On Renal VEIN anastomosis) done in our institute from April 2017 to March 2022. Approval of the study protocol was obtained from the Institutional review board. Total 307 renal allograft recipients (with age 18 to 60 years) who had undergone live related renal transplant at our center were included in the study as per the inclusion and exclusion criteria. Patients were randomised according to computer generated random numbers into test group in whom fibrin sealant was to be used and control group in whom saline was to be applied. Time to hemostasis was measured from removal of venous clamps to complete hemostasis at the site and was compared between both the groups. Data regarding age, sex, body mass index, number of vessels was recorded for subgroup analysis. Statistical analysis was done using t-test and MedCalc software (Version 20, Ostend, Belgium). RESULTS: Out of 307 cases, fibrin sealant was applied in 129 cases, whereas 178 cases received saline application. There was significant difference between mean time to hemostasis in fibrin sealant group (7.2min) and in control group (10.2min) (p<0.0001). On subgroup analysis, it was found that hemostasis time was significantly lower in fibrin sealant group for multiple vessels, obese and complex cases with multiple factors (p=0.02, p=0.005, p=0.04 respectively). No case of venous thrombosis was observed. CONCLUSIONS: Application of fibrin sealant over renal vein anastomosis during renal transplant surgery is safe and effective for achieving early hemostasis. Larger multi-centric randomised controlled studies would be needed for its generalized extrapolation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e432 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tejas Mistry More articles by this author Mrinal Pahwa More articles by this author Vipin Tyagi More articles by this author Expand All Advertisement PDF downloadLoading ...

Renal Allograft Mucormycosis: An Unusual Case Report

Mucormycosis of the renal allograft is an extremely rare and rapidly fatal infection with an incidence of 0.2−1.2%. The major predisposing risk factors are uncontrolled diabetes mellitus, immunosuppression, anti-rejection treatment, unrelated donors, and cytomegalovirus infection. We describe a case of 27-year-old young adult patient who underwent a live-related renal allograft transplant at our centre and presented 4 weeks post-transplant with high-grade fever and rapid rise in serum creatinine. Initial cultures were repeatedly sterile, and imaging studies were normal. A few days later, he developed graft tenderness, and contrast CT abdomen revealed graft pyelonephritis. He was non-responsive to broad-spectrum antibiotics, and renal function gradually declined to anuric state. Prophylactic antifungal was added and hemodialysis was initiated. A graft biopsy was done, which revealed infiltration of the graft kidney with mucor species. After a week of antifungal treatment, graft nephrectomy was done and dual antifungals were continued. The patient initially improved symptomatically but again deteriorated with new onset fever and pain abdomen. Repeat imaging revealed a moderate intra-abdominal collection managed with per-cutaneous aspiration showing sterile growth and an abdominal drain kept in situ. Four days later, there was an accidental intra-abdominal drain expulsion with oozing of pus with blood which increased acutely with a sudden drop in blood pressure and hematocrit. Emergency exploration was done, which revealed a rent in the external iliac artery. After vascular rent repair surgery, the patient initially showed gradual improvement hemodynamically, but later, he developed superadded bacterial infection at the graft nephrectomy wound site with refractory septic shock and expired. Though early diagnosis, appropriate antifungal agents, and graft nephrectomy may improve the patient outcome, the case fatality rate of renal graft mucormycosis still remains very high.

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.

WCN23-0610 Single center experience of short-term outcomes of live related renal transplantation without induction – A retrospective study

WCN23-0610 Single center experience of short-term outcomes of live related renal transplantation without induction – A retrospective study

Frequency of New Onset Diabetes Mellitus in Patients with Live Related Renal Transplant

Background: Kidney transplant is only the cure of end stage renal diseases. It is because it provides the maximum replacement of renal functions. New onset diabetes after transplantation is one of the serious and chronic problem of renal transplant. NODAT is reported to occur in 4%-25% of renal transplant recipients. New onset diabetes may be identified after the renal transplant at any time. Objective: The study aimed to determine the frequency of new onset of diabetes mellitus in the patients with live related renal transplant. Study design: It is a retrospective study conducted in the department of nephrology and transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat for the duration of six months from July 2022 to December 2022. Material and Methods: There were 50 patients in PTDM group and 70 were in the non PTDM group. The anthropometric and clinical characteristics were recorded. The SPSS software was used for the analysis. The Patients were divided into two groups according to the diagnosis. Results: The average age of patients in PTDM group is 43.2 years whereas in non-PTDM group the average age is 45 years. Statistical analysis revealed that results are statistically significant with 95% CI. Most of the cases appeared during 2 weeks of transplant however, 14 patients also reported about diabetes after 2 months of transplant. Conclusion: Common metabolic disease PTDM is usually diagnosed during first 6 weeks of renal transplantation. Old age, family history of diabetes, the presence of IGF during first week of transplantation are some of the risk factors that lead to PTDM prevalence. The PTDM was observed in the 40% patients in our study. Keywords: renal functions and post-transplant diabetes mellitus.