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Double filtration plasmapheresis using evaflux filter in ABO incompatible kidney transplant: Initial experience at our center
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Abstracts / Indian Journal of Transplantation 10 (2016) 81–117
1.7(±1). 11(10.2%) of 107 PRA −ve group could not be transplanted, mainly due to nonimmunological reasons (p < 0.0001). Immunological work up is available for 17 PRA +ve and 103PRA −ve group. 11of 17 PRA +ve and 9 of 103 PRA −ve patients had any one immunological test positive (p = 0.001). For transplanted patients, both PRA +ve and PRA −ve groups were comparable except for ATG induction for which difference is approaching significance [7of 9 in PRA +ve vs. 45 of 96 in PRA −ve, p = 0.07). Creatinine at followup was 1.3 ± 0.4 mg/dl in PRA −ve and 1.2 ± 0.2 mg/dl in PRA +ve group (p = 0.40). 5(5%) in PRA −ve while none in PRA +ve group had acute rejection (p = 0.483). Patient and death censored graft survival was 98.9% each in PRA −ve and 100% each in PRA +ve group. Conclusions: PRA positivity reduced the chances of getting a transplant. PRA positive patients had lower acute rejection rate, which may be because of more potent immunosuppression (ATG induction). This study is limited by small sample size and short follow up. Studies of larger sample size are needed. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.084 Late acute rejections (LAR) clinical spectrum and outcomes Aniket Hase ∗ , Shaym B. Bansal, Reetesh Sharma, Manish Jain, Pranav Jha, Sidharth Sethi, Ashish Nandwani, Amit Mahapatra Medanta – The Medicity, Gurgaon, India Background: Kidney transplant is the treatment of choice for most patients with end stage renal disease. Advances in surgical techniques and immunosuppressant have markedly improved one year graft survival. Several studies have shown that acute rejections beyond 6 months have poor outcomes on long term graft survival. We report our experience of late acute rejections with respect to incidence, etiology, treatment and outcomes. Aim of the study: To study the clinical spectrum and outcomes in late acute rejections. Methods: This is a retrospective analysis of kidney transplants done at Medanta – Medicity Hospital, Gurgaon. Total of 1023 renal transplants done from period of February 2010 to December 2014 at our center. The patients with biopsy proven acute rejection occurring beyond 6 months of transplant were included in the study. The rejection episodes were analyzed for incidence; severity; risk factors; response to treatment and outcome. Results: The incidence of LAR was 4.8%(50/1023). 25(50%) episodes of LAR were within 12 months; 19(38.7%) between 12–24 months and 6(12.24%) occurred beyond 2 years. 34(68%) had acute cellular rejection (ACR) 5(10.2%) had associated antibody mediated rejections (AMR); 16(32.6%) had borderline rejection while 8(16%) had significant plasma cell infiltration and labeled as plasma cell rejection. Of these 39(78%) received induction with basiliximab, 1(2%) received ATG wile 10(20%) had no induction. For treatment; all patients received pulse methylprednisolone; 13(26%) were given thymoglobulin and 8(36.6%) also needed plasma exchange along with IVIG. After a median follow up of 2 years; Only 8(16%) had complete recovery. 23(46%) had partial recovery and developed chronic graft dysfunction. 7(14%) had graft loss and 8(16.3%) died of sepsis while 4 lost to follow up. It was found that 18(36%) patients were noncompliant to immunosuppressives. Of the 7 graft losses; 4(57%) had plasma cell rich rejections and 16.6% had AMR.
Conclusions: LAR have adverse outcomes on long term graft and patient survival. Most patients either have partial or no response and some patients die of sepsis due to intensification of immunosuppression. The main risk factor of LAR in our study was noncompliance to immunosuppressive drugs. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.085 Double filtration plasmapheresis using evaflux filter in ABO incompatible kidney transplant: Initial experience at our center Varun Gupta ∗ , Priyadarshi Ranjan, Vikrant Mahajan, Nitin Agarwal, Monica Rana Department of Urology and Kidney Transplantation, Fortis Hospital Mohali, Punjab, India Background: With the increasing demand of kidney transplant, the technique of double filtration plasmapheresis has allowed us to cross the barrier of ABO blood group system and expand the donor pool. Aim of the study: The aim of present paper is to present our initial experience in first 20 patients undergoing ABO incompatible transplant at our center. Methods: Retrospective analysis of 20 patients who underwent ABO incompatible kidney transplant at our center between December, 2013 to December, 2015. Antibody titers were monitored before and after transplant. Pre conditioning protocol included rituximab, mycophenolate mofetil, tacrolimus, corticosteroids, double filtration plasmapheresis and intravenous immunoglobulin. Data on complications, patient and graft survival was recorded. Results: There was no episode of acute T-cell mediated rejection and only single episode of antibody mediated rejection was noted. Bleeding was the major surgical complication resulting in death of 2 patients. After 1 year follow up there was no graft loss. 3 deaths were reported due to infections. Conclusions: The technique of double filtration plasmapheresis as pre conditioning protocol has made ABO incompatible kidney transplant a success. Post operative bleeding continues to be a major risk factor. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.086 Femoral neuropraxia after renal transplantation: How to prevent? Varun Gupta ∗ , Priyadarshi Ranjan, Vikrant Mahajan, Nitin Agarwal, Monica Rana Department of Urology and Kidney Transplantation, Fortis Hospital Mohali, Punjab, India Background: Femoral neuropraxia is an uncommon but disabling complication following renal transplantation. Aim of the study: We present the incidence; clinical presentation and outcome of this complication at our center.
Abstracts / Indian Journal of Transplantation 10 (2016) 81–117
1.7(±1). 11(10.2%) of 107 PRA −ve group could not be transplanted, mainly due to nonimmunological reasons (p < 0.0001). Immunological work up is available for 17 PRA +ve and 103PRA −ve group. 11of 17 PRA +ve and 9 of 103 PRA −ve patients had any one immunological test positive (p = 0.001). For transplanted patients, both PRA +ve and PRA −ve groups were comparable except for ATG induction for which difference is approaching significance [7of 9 in PRA +ve vs. 45 of 96 in PRA −ve, p = 0.07). Creatinine at followup was 1.3 ± 0.4 mg/dl in PRA −ve and 1.2 ± 0.2 mg/dl in PRA +ve group (p = 0.40). 5(5%) in PRA −ve while none in PRA +ve group had acute rejection (p = 0.483). Patient and death censored graft survival was 98.9% each in PRA −ve and 100% each in PRA +ve group. Conclusions: PRA positivity reduced the chances of getting a transplant. PRA positive patients had lower acute rejection rate, which may be because of more potent immunosuppression (ATG induction). This study is limited by small sample size and short follow up. Studies of larger sample size are needed. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.084 Late acute rejections (LAR) clinical spectrum and outcomes Aniket Hase ∗ , Shaym B. Bansal, Reetesh Sharma, Manish Jain, Pranav Jha, Sidharth Sethi, Ashish Nandwani, Amit Mahapatra Medanta – The Medicity, Gurgaon, India Background: Kidney transplant is the treatment of choice for most patients with end stage renal disease. Advances in surgical techniques and immunosuppressant have markedly improved one year graft survival. Several studies have shown that acute rejections beyond 6 months have poor outcomes on long term graft survival. We report our experience of late acute rejections with respect to incidence, etiology, treatment and outcomes. Aim of the study: To study the clinical spectrum and outcomes in late acute rejections. Methods: This is a retrospective analysis of kidney transplants done at Medanta – Medicity Hospital, Gurgaon. Total of 1023 renal transplants done from period of February 2010 to December 2014 at our center. The patients with biopsy proven acute rejection occurring beyond 6 months of transplant were included in the study. The rejection episodes were analyzed for incidence; severity; risk factors; response to treatment and outcome. Results: The incidence of LAR was 4.8%(50/1023). 25(50%) episodes of LAR were within 12 months; 19(38.7%) between 12–24 months and 6(12.24%) occurred beyond 2 years. 34(68%) had acute cellular rejection (ACR) 5(10.2%) had associated antibody mediated rejections (AMR); 16(32.6%) had borderline rejection while 8(16%) had significant plasma cell infiltration and labeled as plasma cell rejection. Of these 39(78%) received induction with basiliximab, 1(2%) received ATG wile 10(20%) had no induction. For treatment; all patients received pulse methylprednisolone; 13(26%) were given thymoglobulin and 8(36.6%) also needed plasma exchange along with IVIG. After a median follow up of 2 years; Only 8(16%) had complete recovery. 23(46%) had partial recovery and developed chronic graft dysfunction. 7(14%) had graft loss and 8(16.3%) died of sepsis while 4 lost to follow up. It was found that 18(36%) patients were noncompliant to immunosuppressives. Of the 7 graft losses; 4(57%) had plasma cell rich rejections and 16.6% had AMR.
Conclusions: LAR have adverse outcomes on long term graft and patient survival. Most patients either have partial or no response and some patients die of sepsis due to intensification of immunosuppression. The main risk factor of LAR in our study was noncompliance to immunosuppressive drugs. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.085 Double filtration plasmapheresis using evaflux filter in ABO incompatible kidney transplant: Initial experience at our center Varun Gupta ∗ , Priyadarshi Ranjan, Vikrant Mahajan, Nitin Agarwal, Monica Rana Department of Urology and Kidney Transplantation, Fortis Hospital Mohali, Punjab, India Background: With the increasing demand of kidney transplant, the technique of double filtration plasmapheresis has allowed us to cross the barrier of ABO blood group system and expand the donor pool. Aim of the study: The aim of present paper is to present our initial experience in first 20 patients undergoing ABO incompatible transplant at our center. Methods: Retrospective analysis of 20 patients who underwent ABO incompatible kidney transplant at our center between December, 2013 to December, 2015. Antibody titers were monitored before and after transplant. Pre conditioning protocol included rituximab, mycophenolate mofetil, tacrolimus, corticosteroids, double filtration plasmapheresis and intravenous immunoglobulin. Data on complications, patient and graft survival was recorded. Results: There was no episode of acute T-cell mediated rejection and only single episode of antibody mediated rejection was noted. Bleeding was the major surgical complication resulting in death of 2 patients. After 1 year follow up there was no graft loss. 3 deaths were reported due to infections. Conclusions: The technique of double filtration plasmapheresis as pre conditioning protocol has made ABO incompatible kidney transplant a success. Post operative bleeding continues to be a major risk factor. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.086 Femoral neuropraxia after renal transplantation: How to prevent? Varun Gupta ∗ , Priyadarshi Ranjan, Vikrant Mahajan, Nitin Agarwal, Monica Rana Department of Urology and Kidney Transplantation, Fortis Hospital Mohali, Punjab, India Background: Femoral neuropraxia is an uncommon but disabling complication following renal transplantation. Aim of the study: We present the incidence; clinical presentation and outcome of this complication at our center.