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Pediatric renal transplantation – Overcoming the age barrier
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Abstracts / Indian Journal of Transplantation 10 (2016) 81–117
deciding factor although the incidence appeared to decrease with the increase in the number of LDN. Slippage of arterial clips was associated with early branching with short common stump in all 3 cases. There were no adverse events in the last 450 cases of LDN after implementation of corrective measures. Conclusions: Laparoscopic donor nephrectomy is associated with a low but definite risk of adverse events that can be reduced with increasing center experience. This should be a goal given the unique nature of donor nephrectomy. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.032 Serum Neopterin levels: A single institutional analysis of 211 kidney transplant recipients from North India Ravi Dhital ∗ , Ranjana W. Minz, Mukut Minz, Ritambhara Nada, Ashish Sharma, Sarbpreet Singh, Deepesh Kenwer, Shashi Anand Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India Background: Neopterin; a main cleavage product of guanosine triphosphate (GTP) in living cells; is a pyrazino-pyrimidine compound belonging to the chemical group known as pteridines. It is chiefly produced by; but not limited to; activated monocytes; macrophages and dendritic cells. Therefore, increased concentration of Neopterin is a reliable marker of activation of cellular immune responses. Increased level of serum and/or urine Neopterin has been associated with progression of renal allograft rejection. Aim of the study: We wished to investigate the changes in serum Neopterin levels in renal allograft recipients from Northern parts of India and to determine whether these changes vary in different types of rejection. Methods: This study included 211 consecutive first renal allograft recipients from North Indian community in the transplant department of the institute. All the recipients were followed up for 12 months post-transplant. Of 211 recipients, 35 (16.58%) recipients had 38 episodes of biopsy proven acute rejection (BPAR) in the first year of transplantation. Thirty-five, age and sex matched donors prior to nephrectomy were selected as healthy controls. The cases, therefore, were categorised in three groups: Rejection group (BPAR, N = 38), Stable Graft group (SG, N = 176) and Healthy Controls (HC, N = 35). The BPAR group was further classified as Cellular (ACR, N = 21), Antibody Mediated (ABMR, N = 8) and Mixed (N = 9). Two millilitres of peripheral blood was collected from all the recipients at pre-transplant, 1 month post-transplant and at the time of rejection. Neopterin level was measured in serum by enzyme immune assay (EIA) using commercially available ELISA Kit according to the manufacturer’s instruction. Results: Serum Neopterin levels were significantly higher in uremic patients as compared to healthy controls (288.5 ± 23.05 vs. 15.36 ± 1.851 nmol/l, P < 0.0001). SG group of patients had significantly decreased level of serum Neopterin at 1 M posttransplant as compared to their baseline (BL) level (36.02 ± 11.55 vs. BL 393.3 ± 36.61 nmol/l, P < 0.0001). BPAR group also showed decreased serum Neopterin levels at the time of rejection (156.2 ± 37.54 vs. BL 180.7 ± 12.16 nmol/l) but the decrease in the level was statistically not significant (P = 0.5399). ACR and ABMR group showed decreased level of serum Neopterin at the
time of rejection (138.8 ± 46.65 vs. BL 210.1 ± 16.87 nmol/l and 104.5 ± 38.49 vs. BL 145.8 ± 21.24 nmol/l respectively). On the contrary, the mixed cohort had increased level of serum Neopterin during rejection episodes (242.7 ± 111.1 vs. BL 143.1 ± 17.66 nmol/l). Nevertheless, the decrease of Neopterin at rejection was statistically not significant in any of the rejection types. Conclusions: Uremic patients showed increased levels of serum Neopterin suggesting that these patients are always in the stage of immune-activation. Post-transplantation; normalization of immune-activation is achieved except at rejection implying that BPAR is not necessarily associated with Neopterin levels. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.033 Pediatric renal transplantation – Overcoming the age barrier Kanav Anand ∗ , Shivani Bansal, Shraddha Lohia, P.K. Pruthi Sir Ganga Ram Hospital, New Delhi, India Background: The optimal timing for renal transplantation in children remains controversial; as very young children face hurdles of age; weight and issues of accommodation of large kidney in their small abdominal cavity. Aim of the study: CKD in a child causes number of metabolic derangements like growth failure; anemia; metabolic acidosis and neuro-developmental delay; which can be prevented if early renal transplantation is done. Methods: 3 years old CKD child; weighing 11 kg and height = 95 cm; with native kidney disease of reflux nephropathy; on continuous ambulatory peritoneal dialysis for 6 months; with serum creatinine of 5.05 mg/dl was planned for renal transplantation. Donor was his father (age = 36 years; height = 180.5 cm) with 3/6 HLA mismatch. Induction was done with basiliximab and child was started on triple immunosupression (steroids; tacrolimus and mycophenolate mofetil) as per institutional protocol. Postoperatively; child achieved serum creatinine = 1.7 mg/dl by 24 h and 0.28 mg/dl after 48 h and urine output of 12 ml/kg/h. At discharge; his creatinine was 0.27 mg/dl and urine output was 7 ml/kg/h. Results: At 3 months of follow up; child has stable graft function (creatinine = 0.34 mg/dl); with urine output = 1.5 ml/kg/h and has gained weight of 1.2 kg and height of 1.5 cm. Conclusions: To the best of our knowledge and as per literature search; this child is the youngest to undergo a successful renal transplantation from India. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.034
Abstracts / Indian Journal of Transplantation 10 (2016) 81–117
deciding factor although the incidence appeared to decrease with the increase in the number of LDN. Slippage of arterial clips was associated with early branching with short common stump in all 3 cases. There were no adverse events in the last 450 cases of LDN after implementation of corrective measures. Conclusions: Laparoscopic donor nephrectomy is associated with a low but definite risk of adverse events that can be reduced with increasing center experience. This should be a goal given the unique nature of donor nephrectomy. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.032 Serum Neopterin levels: A single institutional analysis of 211 kidney transplant recipients from North India Ravi Dhital ∗ , Ranjana W. Minz, Mukut Minz, Ritambhara Nada, Ashish Sharma, Sarbpreet Singh, Deepesh Kenwer, Shashi Anand Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India Background: Neopterin; a main cleavage product of guanosine triphosphate (GTP) in living cells; is a pyrazino-pyrimidine compound belonging to the chemical group known as pteridines. It is chiefly produced by; but not limited to; activated monocytes; macrophages and dendritic cells. Therefore, increased concentration of Neopterin is a reliable marker of activation of cellular immune responses. Increased level of serum and/or urine Neopterin has been associated with progression of renal allograft rejection. Aim of the study: We wished to investigate the changes in serum Neopterin levels in renal allograft recipients from Northern parts of India and to determine whether these changes vary in different types of rejection. Methods: This study included 211 consecutive first renal allograft recipients from North Indian community in the transplant department of the institute. All the recipients were followed up for 12 months post-transplant. Of 211 recipients, 35 (16.58%) recipients had 38 episodes of biopsy proven acute rejection (BPAR) in the first year of transplantation. Thirty-five, age and sex matched donors prior to nephrectomy were selected as healthy controls. The cases, therefore, were categorised in three groups: Rejection group (BPAR, N = 38), Stable Graft group (SG, N = 176) and Healthy Controls (HC, N = 35). The BPAR group was further classified as Cellular (ACR, N = 21), Antibody Mediated (ABMR, N = 8) and Mixed (N = 9). Two millilitres of peripheral blood was collected from all the recipients at pre-transplant, 1 month post-transplant and at the time of rejection. Neopterin level was measured in serum by enzyme immune assay (EIA) using commercially available ELISA Kit according to the manufacturer’s instruction. Results: Serum Neopterin levels were significantly higher in uremic patients as compared to healthy controls (288.5 ± 23.05 vs. 15.36 ± 1.851 nmol/l, P < 0.0001). SG group of patients had significantly decreased level of serum Neopterin at 1 M posttransplant as compared to their baseline (BL) level (36.02 ± 11.55 vs. BL 393.3 ± 36.61 nmol/l, P < 0.0001). BPAR group also showed decreased serum Neopterin levels at the time of rejection (156.2 ± 37.54 vs. BL 180.7 ± 12.16 nmol/l) but the decrease in the level was statistically not significant (P = 0.5399). ACR and ABMR group showed decreased level of serum Neopterin at the
time of rejection (138.8 ± 46.65 vs. BL 210.1 ± 16.87 nmol/l and 104.5 ± 38.49 vs. BL 145.8 ± 21.24 nmol/l respectively). On the contrary, the mixed cohort had increased level of serum Neopterin during rejection episodes (242.7 ± 111.1 vs. BL 143.1 ± 17.66 nmol/l). Nevertheless, the decrease of Neopterin at rejection was statistically not significant in any of the rejection types. Conclusions: Uremic patients showed increased levels of serum Neopterin suggesting that these patients are always in the stage of immune-activation. Post-transplantation; normalization of immune-activation is achieved except at rejection implying that BPAR is not necessarily associated with Neopterin levels. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.033 Pediatric renal transplantation – Overcoming the age barrier Kanav Anand ∗ , Shivani Bansal, Shraddha Lohia, P.K. Pruthi Sir Ganga Ram Hospital, New Delhi, India Background: The optimal timing for renal transplantation in children remains controversial; as very young children face hurdles of age; weight and issues of accommodation of large kidney in their small abdominal cavity. Aim of the study: CKD in a child causes number of metabolic derangements like growth failure; anemia; metabolic acidosis and neuro-developmental delay; which can be prevented if early renal transplantation is done. Methods: 3 years old CKD child; weighing 11 kg and height = 95 cm; with native kidney disease of reflux nephropathy; on continuous ambulatory peritoneal dialysis for 6 months; with serum creatinine of 5.05 mg/dl was planned for renal transplantation. Donor was his father (age = 36 years; height = 180.5 cm) with 3/6 HLA mismatch. Induction was done with basiliximab and child was started on triple immunosupression (steroids; tacrolimus and mycophenolate mofetil) as per institutional protocol. Postoperatively; child achieved serum creatinine = 1.7 mg/dl by 24 h and 0.28 mg/dl after 48 h and urine output of 12 ml/kg/h. At discharge; his creatinine was 0.27 mg/dl and urine output was 7 ml/kg/h. Results: At 3 months of follow up; child has stable graft function (creatinine = 0.34 mg/dl); with urine output = 1.5 ml/kg/h and has gained weight of 1.2 kg and height of 1.5 cm. Conclusions: To the best of our knowledge and as per literature search; this child is the youngest to undergo a successful renal transplantation from India. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.034