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Intracranial space occupying lesion in renal transplant recipients – A case series report
indian journal of transplantation 9 (2015) 73–81
Aims: To study a selected adult population of Kannur, Kerala with regard to their attitudes towards different aspects of organ donation. Methodology: A cross-sectional study was done in a population of 225 patients attending the out-patient department of a primary health center in Kannur district of North Kerala to study their attitudes towards organ donation. Participants selected by systematic random sampling were assessed using a semi-structured interview schedule with a pre-tested questionnaire containing sociodemographic variables and questions directed at different aspects of their attitudes towards organ donation. Statistical analysis was done using SPSS v21. Results: Amid 225 participants 218 had heard of organ donation. The willingness to donate organs was 43%, amongst which 16% had expressed strong motivation to donate irrespective of the circumstances. Most important influencing factors influencing their decision to donate were health status and relationship to the recipient. 61% considered abuse and misappropriation of their donated organs to be a possibility. Most respondents (94%) would authorize consent of donation of a deceased persons organs to either his/her family or spouse. Regarding unclaimed bodies, majority wanted medical colleges to be the consenting authority (41%) and parents or guardians in case of mentally unsound donors. 92% were favourable for promotion of organ donation. Majority preferred organ recipients to be a family member (52%), younger (57%) and physically and mentally sound. Respondents were largely unwilling to donate to an alcoholic or a smoker. Legislations governing donations were considered a must by most (94%). Conclusions: Though largely aware, the willingness to donate organs among public is low. Sociodemographic characteristics, emotional factors and laws to ensure appropriate use of donated organs influence the public willingness to donate. Educational and behavioural change campaigning is the need of the hour. http://dx.doi.org/10.1016/j.ijt.2015.09.080 Abstract #: ISOT2015-60 Intracranial space occupying lesion in renal transplant recipients – A case series report Geo Philip John, Jacob George, M.K. Mohandas, Noble Gracious, Sajeev Kumar, Vineetha Department of Nephrology, Govt Medical College, Thiruvananthapuram, India Background: Patients can present with Intracranial space occupying lesions at any time in the post renal transplantation period. Making an accurate diagnosis even with the current advanced imaging modalities is very difficult. Aims: To study the clinical profile and etiology of intracranial space occupying lesions in the post renal transplant setting. To assess the prognosis of these patients in terms of CNS outcome. Methodology: We included all post renal transplant patients who were diagnosed to have intracranial space occupying lesion after imaging. 3 patients were identified from the study group. Results: Case 1. 23-year-old male who underwent renal transplantation. After 3 weeks of transplantation, he was evaluated for fever and persistent headache. MRI revealed multiple small cerebral parenchymal nodules. Was started on empiric ATT. His symptoms improved within a week. Case 2. 42-year-old male, presented after 5 years of transplantation with complaints of headache, fever and seizures. His brain imaging showed multiple rim enhancing lesions. Since there was no improvement after antibiotics and antifungals, he was started on empiric ATT. An open brain biopsy was done due to
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persistence of lesions. Biopsy revealed Monomorphic Post Transplant Lympho Proliferattive Disorder – CD20 positive, CAN negative and EBER negative. He improved with chemotherapy and radiotherapy along with reduction in immunosuppression. Case 3. 47-year-old male, developed ICSOL after 15 years of transplant. He was started on antibiotics & Empiric ATT, but he succumbed to his illness. Conclusions: Intracranial space occupying lesions in the post renal transplant setting can have varying presentations and differing etiologies. The current imaging modalities cannot make an accurate diagnosis and often can be misleading. An open brain biopsy from the lesion if feasible should be sought. http://dx.doi.org/10.1016/j.ijt.2015.09.081 Abstract #: ISOT2015-48 Nocardiosis in renal transplant recipients S.J. Acharya, Nainesh Patel Orange City Hospital & Research Institute, Nagpur, India Background: Infections are common post transplant due to immunosuppressants. Aims: Study of clinical profile and management of Nocardiosis in kidney transplant recipients. Methodology: 4 patients were found to have nocardiosis post transplant. 2 had pulmonary, 1 cutaneous and 4th with nasopharyngeal nocardiosis. Results: All the 4 patients survived with aggressive management. Conclusions: Early diagnosis with high suspicion and aggressive treatment is a must for management of nocardiosis. http://dx.doi.org/10.1016/j.ijt.2015.09.082 Abstract #: ISOT2015-44 Depression, anxiety, stress and coping strategies among persons with ESRD enlisted for deceased donor renal transplant Patricia Namitha Maria Viego, Prakashi Rajaram, P. Marimuthu National Institute of Mental Health and Neuro Sciences, Bengaluru, India Background: Depression is a common manifestation in persons diagnosed with end stage renal disease (ESRD) or chronic kidney disease (CKD). These individuals further experience higher levels of anxiety coupled with stress when they are put on the waiting list for a deceased donor renal transplant due to the scarcity of organs. Aims: This study aimed to find out the extent of depression, anxiety and stress among patients with ESRD or CKD enlisted for a deceased donor renal transplant and the coping strategies employed by them. Methodology: Persons aged 18 to 65 years with ESRD/CKD, hailing from Bangalore, India were included. Persons with mental retardation and any active psychotic symptoms and those who had registered for multiple organ transplants were excluded. 80 persons who satisfied the inclusion and exclusion criteria were selected randomly from the list of patients registered on the state list for a deceased donor renal transplant. Ethical guidelines were followed. The Depression, Anxiety, Stress Scale (DASS), Coping Checklist and a semi-structured psychosocial assessment tool were used. Data were analysed using SPSS. The descriptive statistics, mean, standard deviation and proportions were calculated. Chi-square analysis was performed to find the association between two nominal
Aims: To study a selected adult population of Kannur, Kerala with regard to their attitudes towards different aspects of organ donation. Methodology: A cross-sectional study was done in a population of 225 patients attending the out-patient department of a primary health center in Kannur district of North Kerala to study their attitudes towards organ donation. Participants selected by systematic random sampling were assessed using a semi-structured interview schedule with a pre-tested questionnaire containing sociodemographic variables and questions directed at different aspects of their attitudes towards organ donation. Statistical analysis was done using SPSS v21. Results: Amid 225 participants 218 had heard of organ donation. The willingness to donate organs was 43%, amongst which 16% had expressed strong motivation to donate irrespective of the circumstances. Most important influencing factors influencing their decision to donate were health status and relationship to the recipient. 61% considered abuse and misappropriation of their donated organs to be a possibility. Most respondents (94%) would authorize consent of donation of a deceased persons organs to either his/her family or spouse. Regarding unclaimed bodies, majority wanted medical colleges to be the consenting authority (41%) and parents or guardians in case of mentally unsound donors. 92% were favourable for promotion of organ donation. Majority preferred organ recipients to be a family member (52%), younger (57%) and physically and mentally sound. Respondents were largely unwilling to donate to an alcoholic or a smoker. Legislations governing donations were considered a must by most (94%). Conclusions: Though largely aware, the willingness to donate organs among public is low. Sociodemographic characteristics, emotional factors and laws to ensure appropriate use of donated organs influence the public willingness to donate. Educational and behavioural change campaigning is the need of the hour. http://dx.doi.org/10.1016/j.ijt.2015.09.080 Abstract #: ISOT2015-60 Intracranial space occupying lesion in renal transplant recipients – A case series report Geo Philip John, Jacob George, M.K. Mohandas, Noble Gracious, Sajeev Kumar, Vineetha Department of Nephrology, Govt Medical College, Thiruvananthapuram, India Background: Patients can present with Intracranial space occupying lesions at any time in the post renal transplantation period. Making an accurate diagnosis even with the current advanced imaging modalities is very difficult. Aims: To study the clinical profile and etiology of intracranial space occupying lesions in the post renal transplant setting. To assess the prognosis of these patients in terms of CNS outcome. Methodology: We included all post renal transplant patients who were diagnosed to have intracranial space occupying lesion after imaging. 3 patients were identified from the study group. Results: Case 1. 23-year-old male who underwent renal transplantation. After 3 weeks of transplantation, he was evaluated for fever and persistent headache. MRI revealed multiple small cerebral parenchymal nodules. Was started on empiric ATT. His symptoms improved within a week. Case 2. 42-year-old male, presented after 5 years of transplantation with complaints of headache, fever and seizures. His brain imaging showed multiple rim enhancing lesions. Since there was no improvement after antibiotics and antifungals, he was started on empiric ATT. An open brain biopsy was done due to
79
persistence of lesions. Biopsy revealed Monomorphic Post Transplant Lympho Proliferattive Disorder – CD20 positive, CAN negative and EBER negative. He improved with chemotherapy and radiotherapy along with reduction in immunosuppression. Case 3. 47-year-old male, developed ICSOL after 15 years of transplant. He was started on antibiotics & Empiric ATT, but he succumbed to his illness. Conclusions: Intracranial space occupying lesions in the post renal transplant setting can have varying presentations and differing etiologies. The current imaging modalities cannot make an accurate diagnosis and often can be misleading. An open brain biopsy from the lesion if feasible should be sought. http://dx.doi.org/10.1016/j.ijt.2015.09.081 Abstract #: ISOT2015-48 Nocardiosis in renal transplant recipients S.J. Acharya, Nainesh Patel Orange City Hospital & Research Institute, Nagpur, India Background: Infections are common post transplant due to immunosuppressants. Aims: Study of clinical profile and management of Nocardiosis in kidney transplant recipients. Methodology: 4 patients were found to have nocardiosis post transplant. 2 had pulmonary, 1 cutaneous and 4th with nasopharyngeal nocardiosis. Results: All the 4 patients survived with aggressive management. Conclusions: Early diagnosis with high suspicion and aggressive treatment is a must for management of nocardiosis. http://dx.doi.org/10.1016/j.ijt.2015.09.082 Abstract #: ISOT2015-44 Depression, anxiety, stress and coping strategies among persons with ESRD enlisted for deceased donor renal transplant Patricia Namitha Maria Viego, Prakashi Rajaram, P. Marimuthu National Institute of Mental Health and Neuro Sciences, Bengaluru, India Background: Depression is a common manifestation in persons diagnosed with end stage renal disease (ESRD) or chronic kidney disease (CKD). These individuals further experience higher levels of anxiety coupled with stress when they are put on the waiting list for a deceased donor renal transplant due to the scarcity of organs. Aims: This study aimed to find out the extent of depression, anxiety and stress among patients with ESRD or CKD enlisted for a deceased donor renal transplant and the coping strategies employed by them. Methodology: Persons aged 18 to 65 years with ESRD/CKD, hailing from Bangalore, India were included. Persons with mental retardation and any active psychotic symptoms and those who had registered for multiple organ transplants were excluded. 80 persons who satisfied the inclusion and exclusion criteria were selected randomly from the list of patients registered on the state list for a deceased donor renal transplant. Ethical guidelines were followed. The Depression, Anxiety, Stress Scale (DASS), Coping Checklist and a semi-structured psychosocial assessment tool were used. Data were analysed using SPSS. The descriptive statistics, mean, standard deviation and proportions were calculated. Chi-square analysis was performed to find the association between two nominal