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MS
Indian J Transplant 2011; 1: 9-45
10(5%),lymphocele 40(20%),wound related 14(7%),in the phase of excellence between 2001-2009,were 95% at one year,and vascular 8,urological 11,lymphocele 16,wound related 14,and the overall surgical complications were reduced to less than 0.9% in the last 500 cases . Conclusion; With improvement in learning curve and regular critical appraisal of the complications, the surgical complications were decreased and graft survival improved significantly.
05 9 THERAPEUTIC DRUG MONITORING BY LCMS/MS Author(s) -Reema Bahri, Sreedhara Chaganty Vimta Labs Limited
Immunosuppressant drug monitoring plays a critical role in success of organ transplantation. The pharmacokinetics of immunosuppressant drugs are complex, unpredictable and prone to numerous drug interactions with high interand intra-individual variability. They are extensively metabolized (> 25 metabolites of cyclosporine known) and cross-react with antibodies used in TDM immunoassays. This causes a significant and unpredictable overestimation of the drug concentrations eg. cyclosporin (35–40%). Liquid chromatography–tandem mass spectrometry (LC-MS/MS) excludes interferences attributable to hydroxylated or demethylated metabolites of these drugs, thereby providing more accurate individualized patient dosing and improving the clinical efficacy. An analytical method was developed and validated using LC-MS/MS. The calibration curve was linear over a concentration range 50 to 2000 ng/ml for cyclosporine A, 1 to 50 ng/ml for sirolimus and tacrolimus with 79.65% recovery for cyclosporine A, 81.62% for sirolimus and 89.65% for tacrolimus. The data demonstrated that the procedure is specific, accurate and reproducible. Performance was verified by participation in External Proficiency Programme by CAP (College of American Pathologists) and found satisfactory. In conclusion, testing by LC-MS/MS is the most accurate technique available and so far we have analyzed more than 3000 incurred samples, which proves that the development of the MS/MS is a grand testament to basic science and the genius involved in the conception and development of the triple quadrupole instrument and to make the dream of doctors to prolong life come true by successful organ transplantation.
Abstracts : XXI ISOT, 2010, Hyderabad
35
060 ACUTE RENAL FAILURE IN A KIDNEY TRANSPLANT RECIPIENT - A CASE REPORT Author(s) -Shivnarayan Acharya, Vijay Shrikhande Acharya Dialysis Centre & Kidney Hospital
Mr J., 56 years old male ,Non diabetic , underwent Kidney Transplantation on 19.1.99 . His perioperative course was uneventful . USG & Doppler study done post op were normal . After about 4 years , On 10.11.03 patient had acute onset anuria . Renal functions deteriorated ( rise in creatinine from 1.4 to 12 mg/dl ). He had pain at graft site . He developed fever after 2 days . USG revealed slightly enlarged graft ( 11.3 x 5 cms), with Grade I echogenicity , Smooth contour and no pelvicalyceal dilatation . Doppler revealed that main Renal artery showed hypoechoic lumen with absent flow s/o thrombus , no intra-renal arterial flow observed , renal vein revealed only to and fro pulsations suggestive of complete occlusion of transplant renal artery . Nuclear scan showed absence of blood flow to the graft . Angioplasty was tried but guide wire could not be negotiated in to the graft renal artery . Patient was back on dialysis , Immuno-suppressants were stopped . But patient continued to have pain at graft site. He had rapid fall in Hemoglobin , had nausea , continuous mild grade fever , appetite loss . He felt sick in spite of adequate dialysis . Graft nephrectomy was done . patient improved . His fever disappeared , appetite improved and was well controlled on hemodialysis . Conclusion – This 56 years old renal transplant recipient had spontaneous thrombosis of graft renal artery without any predisposing factor which is very unusual .
06 1 TRENDS IN MORTALITY OF RENAL TRANSPLANT RECIPIENTS: SINGLE CENTER EXPERIENCE Author(s) - Biplab Ghosh, Ashutosh Soni, Shivendra Singh, Neelam Singh, Jai Prakash Institute of Medical Sciences, BHU, Varanasi
The survival of transplant recipients is significantly lower than age-matched controls in the general population. The aim of this study was to analyze the trends of mortality in renal allograft recipients at our centre. Methods: We retrospectively analyzed data from all patients followed at our center who were transplanted between October 1988 and June 2010. Patients were considered to have death with graft function(DWGF) if death was not preceded by return to dialysis or re-transplantation. Result: The study included 98 renal allograft recipients (male:87, female:11). The median recipient and donor age were 34.5 (range15-69) and 42 (range22-60) years, respectively. Copyright © 2011 by The Indian Society of Organ Transplantation
10(5%),lymphocele 40(20%),wound related 14(7%),in the phase of excellence between 2001-2009,were 95% at one year,and vascular 8,urological 11,lymphocele 16,wound related 14,and the overall surgical complications were reduced to less than 0.9% in the last 500 cases . Conclusion; With improvement in learning curve and regular critical appraisal of the complications, the surgical complications were decreased and graft survival improved significantly.
05 9 THERAPEUTIC DRUG MONITORING BY LCMS/MS Author(s) -Reema Bahri, Sreedhara Chaganty Vimta Labs Limited
Immunosuppressant drug monitoring plays a critical role in success of organ transplantation. The pharmacokinetics of immunosuppressant drugs are complex, unpredictable and prone to numerous drug interactions with high interand intra-individual variability. They are extensively metabolized (> 25 metabolites of cyclosporine known) and cross-react with antibodies used in TDM immunoassays. This causes a significant and unpredictable overestimation of the drug concentrations eg. cyclosporin (35–40%). Liquid chromatography–tandem mass spectrometry (LC-MS/MS) excludes interferences attributable to hydroxylated or demethylated metabolites of these drugs, thereby providing more accurate individualized patient dosing and improving the clinical efficacy. An analytical method was developed and validated using LC-MS/MS. The calibration curve was linear over a concentration range 50 to 2000 ng/ml for cyclosporine A, 1 to 50 ng/ml for sirolimus and tacrolimus with 79.65% recovery for cyclosporine A, 81.62% for sirolimus and 89.65% for tacrolimus. The data demonstrated that the procedure is specific, accurate and reproducible. Performance was verified by participation in External Proficiency Programme by CAP (College of American Pathologists) and found satisfactory. In conclusion, testing by LC-MS/MS is the most accurate technique available and so far we have analyzed more than 3000 incurred samples, which proves that the development of the MS/MS is a grand testament to basic science and the genius involved in the conception and development of the triple quadrupole instrument and to make the dream of doctors to prolong life come true by successful organ transplantation.
Abstracts : XXI ISOT, 2010, Hyderabad
35
060 ACUTE RENAL FAILURE IN A KIDNEY TRANSPLANT RECIPIENT - A CASE REPORT Author(s) -Shivnarayan Acharya, Vijay Shrikhande Acharya Dialysis Centre & Kidney Hospital
Mr J., 56 years old male ,Non diabetic , underwent Kidney Transplantation on 19.1.99 . His perioperative course was uneventful . USG & Doppler study done post op were normal . After about 4 years , On 10.11.03 patient had acute onset anuria . Renal functions deteriorated ( rise in creatinine from 1.4 to 12 mg/dl ). He had pain at graft site . He developed fever after 2 days . USG revealed slightly enlarged graft ( 11.3 x 5 cms), with Grade I echogenicity , Smooth contour and no pelvicalyceal dilatation . Doppler revealed that main Renal artery showed hypoechoic lumen with absent flow s/o thrombus , no intra-renal arterial flow observed , renal vein revealed only to and fro pulsations suggestive of complete occlusion of transplant renal artery . Nuclear scan showed absence of blood flow to the graft . Angioplasty was tried but guide wire could not be negotiated in to the graft renal artery . Patient was back on dialysis , Immuno-suppressants were stopped . But patient continued to have pain at graft site. He had rapid fall in Hemoglobin , had nausea , continuous mild grade fever , appetite loss . He felt sick in spite of adequate dialysis . Graft nephrectomy was done . patient improved . His fever disappeared , appetite improved and was well controlled on hemodialysis . Conclusion – This 56 years old renal transplant recipient had spontaneous thrombosis of graft renal artery without any predisposing factor which is very unusual .
06 1 TRENDS IN MORTALITY OF RENAL TRANSPLANT RECIPIENTS: SINGLE CENTER EXPERIENCE Author(s) - Biplab Ghosh, Ashutosh Soni, Shivendra Singh, Neelam Singh, Jai Prakash Institute of Medical Sciences, BHU, Varanasi
The survival of transplant recipients is significantly lower than age-matched controls in the general population. The aim of this study was to analyze the trends of mortality in renal allograft recipients at our centre. Methods: We retrospectively analyzed data from all patients followed at our center who were transplanted between October 1988 and June 2010. Patients were considered to have death with graft function(DWGF) if death was not preceded by return to dialysis or re-transplantation. Result: The study included 98 renal allograft recipients (male:87, female:11). The median recipient and donor age were 34.5 (range15-69) and 42 (range22-60) years, respectively. Copyright © 2011 by The Indian Society of Organ Transplantation