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Tuberculosis in renal transplant recipients
Abstracts / Indian Journal of Transplantation 10 (2016) 81–117
robot assisted deceased donor renal transplantation and open deceased donor renal transplantation. Variables assessed (1) eGFR at the end of one month. (2) Cold ischemia time. (3) Surgery duration. (4) Creatinine at discharge. (5) Urine output in the initial 24 hours. (6) Drain volume in the initial 24 hours. (7) Pain scores. (8) Lymphocele. (9) Wound infection. Results: Total of 45 patients were analyzed. There were 7 patients in the robot assisted live donor renal transplantation group; 30 patients in the open live donor renal transplantation group. 5 patients were included in the open deceased donor and 3 patients in the robot assisted deceased donor renal transplantation group. There was no significant difference in the eGFR at one month in the robot assisted live donor group when compared with the open live donor group (eGFR 56.4 ml/min and 68.37 ml/min respectively; p = 0.235) and robot assisted deceased donor group compared with deceased donor open renal transplant group (eGFR 52.42 ml/min and 68.22 ml/min; p = 0.175). Comparing the cold ischemia time and surgery duration revealed no significant difference in the robot assisted live donor and open live donor groups (p = 0.472 and p = 0.26 respectively) and robot assisted deceased donor compared with deceased donor open renal transplant group (p = 0.471 and p = 0.386). Conclusions: Robotic renal transplantation is a definitely a step forward towards minimally invasive renal transplantation. The increase in cold ischemia time and surgery duration were not found to meaningfully affect graft outcomes. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.021 Tuberculosis in renal transplant recipients Navdeep Singh ∗ , Ashish Sharma, Sarbpreet Singh, Deepesh Kenwer, Sunil Kumar Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India Background: Infections are common after renal transplantation. Tuberculosis is one of the leading infections after renal transplant in our country. While INH prophylaxis is routinely prescribed for patients with previous exposure to tuberculosis undergoing transplantation in the developed countries; its role in preventing tuberculosis in high endemic regions is unclear. Aim of the study: To know the incidence and the outcome of tuberculosis in renal transplant recipients. Methods: Between 2006 and 2016; 1900 patients underwent renal transplantation at our centre. Patient data was screened from the transplant database to know the patients who received antitubercular therapy (ATT) during this period. 78 patients were identified to be on ATT giving an incidence of 4.1%. Out of 78 pts; 29 were excluded due to insufficient data and 49 patients were taken up for data analysis. Results: Mean age of the patients was 35.6 ± 10.2 years. M:F 44:5, 28.5% pts were already on antitubercular therapy prior to transplant. Mean duration (months) of diagnosis of Tb in patients with post transplant tuberculosis is 17.9 ± 15.6 months. 38.7% patients had extrapulmonary tuberculosis, 61.2% had pulmonary tuberculosis. 16.3% pts received induction and 83.6% pts did not receive induction. Immunosuppression comprised of tac/mmf in 75.5% pts,
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cyclosporine/mmf in 10.2%, tac/aza 8.1%, cyclosporine/aza on 4%. Most of the patients were treated with modified ATT based on Levofloxacin and the duration of ATT was 12–18 months. 8/78 (10.3%) patients required treatment with Rifampicin either because of life threatening condition (5) or drug resistance (2) or side effects of other primary drugs (1). Conclusions: Tuberculosis is still a major infection in ESRD and transplant population. Most of infections are detected in first 2 years. There is an urgent need to define role of INH prophylaxis in these patients Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.022 Long-term outcome of renal donors in a tertiary care centre in India Pranith Ram ∗ , D. Bhowmik, Y. Chhabra, R.K. Yadav, S. Bagchi, S. Mahajan, S.K. Agarwal All India Institute of Medical Sciences, New Delhi, India Background: When compared to cadaver; living donor transplant offers many advantages like pre-emptive transplant and superior patient and graft survival in the recipient. However; the organ donation in a living donor is not without any disadvantage like peri-operative morbidity and long term consequences due to single kidney. Although living donor transplant has been practiced for 5 decades; the data regarding the long-term outcome of a living donor is scanty. Aim of the study: The aim of this study was to evaluate renal donors who had undergone donor nephrectomy more than 10 years back. Methods: We attempted to contact all renal donors who donated their kidney before 10 years. From those donors; who could be traced; we collected survival data; and also evaluated them for renal dysfunction and long term consequences. Results: Before 2005; we did 1050 living donor transplants. We obtained information from 104 (10%) renal donors. 17 donors had expired; 8 transplant recipients could not trace their donors and 79 donors were alive. Of the 17 donors who had expired; two were known to have died due to renal failure. 40 out of the 79 live donors gave consent to undergo medical evaluation. Five donors had hypertension and three were diabetic. The mean eGFR of the donors was 77.9 ml/min. Four were found to have renal dysfunction. 3 of these 4 donors with renal dysfunction; were found to have diabetes and hypertension; diagnosed after kidney donation. Conclusions: Most of the Indian renal donors have normal renal function in long term. Nonetheless; some patients may develop renal dysfunction or renal failure and is dependent on underlying risk factors. Hence all renal donors should follow-up at 6–12 monthly intervals in donor clinics. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.023
robot assisted deceased donor renal transplantation and open deceased donor renal transplantation. Variables assessed (1) eGFR at the end of one month. (2) Cold ischemia time. (3) Surgery duration. (4) Creatinine at discharge. (5) Urine output in the initial 24 hours. (6) Drain volume in the initial 24 hours. (7) Pain scores. (8) Lymphocele. (9) Wound infection. Results: Total of 45 patients were analyzed. There were 7 patients in the robot assisted live donor renal transplantation group; 30 patients in the open live donor renal transplantation group. 5 patients were included in the open deceased donor and 3 patients in the robot assisted deceased donor renal transplantation group. There was no significant difference in the eGFR at one month in the robot assisted live donor group when compared with the open live donor group (eGFR 56.4 ml/min and 68.37 ml/min respectively; p = 0.235) and robot assisted deceased donor group compared with deceased donor open renal transplant group (eGFR 52.42 ml/min and 68.22 ml/min; p = 0.175). Comparing the cold ischemia time and surgery duration revealed no significant difference in the robot assisted live donor and open live donor groups (p = 0.472 and p = 0.26 respectively) and robot assisted deceased donor compared with deceased donor open renal transplant group (p = 0.471 and p = 0.386). Conclusions: Robotic renal transplantation is a definitely a step forward towards minimally invasive renal transplantation. The increase in cold ischemia time and surgery duration were not found to meaningfully affect graft outcomes. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.021 Tuberculosis in renal transplant recipients Navdeep Singh ∗ , Ashish Sharma, Sarbpreet Singh, Deepesh Kenwer, Sunil Kumar Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India Background: Infections are common after renal transplantation. Tuberculosis is one of the leading infections after renal transplant in our country. While INH prophylaxis is routinely prescribed for patients with previous exposure to tuberculosis undergoing transplantation in the developed countries; its role in preventing tuberculosis in high endemic regions is unclear. Aim of the study: To know the incidence and the outcome of tuberculosis in renal transplant recipients. Methods: Between 2006 and 2016; 1900 patients underwent renal transplantation at our centre. Patient data was screened from the transplant database to know the patients who received antitubercular therapy (ATT) during this period. 78 patients were identified to be on ATT giving an incidence of 4.1%. Out of 78 pts; 29 were excluded due to insufficient data and 49 patients were taken up for data analysis. Results: Mean age of the patients was 35.6 ± 10.2 years. M:F 44:5, 28.5% pts were already on antitubercular therapy prior to transplant. Mean duration (months) of diagnosis of Tb in patients with post transplant tuberculosis is 17.9 ± 15.6 months. 38.7% patients had extrapulmonary tuberculosis, 61.2% had pulmonary tuberculosis. 16.3% pts received induction and 83.6% pts did not receive induction. Immunosuppression comprised of tac/mmf in 75.5% pts,
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cyclosporine/mmf in 10.2%, tac/aza 8.1%, cyclosporine/aza on 4%. Most of the patients were treated with modified ATT based on Levofloxacin and the duration of ATT was 12–18 months. 8/78 (10.3%) patients required treatment with Rifampicin either because of life threatening condition (5) or drug resistance (2) or side effects of other primary drugs (1). Conclusions: Tuberculosis is still a major infection in ESRD and transplant population. Most of infections are detected in first 2 years. There is an urgent need to define role of INH prophylaxis in these patients Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.022 Long-term outcome of renal donors in a tertiary care centre in India Pranith Ram ∗ , D. Bhowmik, Y. Chhabra, R.K. Yadav, S. Bagchi, S. Mahajan, S.K. Agarwal All India Institute of Medical Sciences, New Delhi, India Background: When compared to cadaver; living donor transplant offers many advantages like pre-emptive transplant and superior patient and graft survival in the recipient. However; the organ donation in a living donor is not without any disadvantage like peri-operative morbidity and long term consequences due to single kidney. Although living donor transplant has been practiced for 5 decades; the data regarding the long-term outcome of a living donor is scanty. Aim of the study: The aim of this study was to evaluate renal donors who had undergone donor nephrectomy more than 10 years back. Methods: We attempted to contact all renal donors who donated their kidney before 10 years. From those donors; who could be traced; we collected survival data; and also evaluated them for renal dysfunction and long term consequences. Results: Before 2005; we did 1050 living donor transplants. We obtained information from 104 (10%) renal donors. 17 donors had expired; 8 transplant recipients could not trace their donors and 79 donors were alive. Of the 17 donors who had expired; two were known to have died due to renal failure. 40 out of the 79 live donors gave consent to undergo medical evaluation. Five donors had hypertension and three were diabetic. The mean eGFR of the donors was 77.9 ml/min. Four were found to have renal dysfunction. 3 of these 4 donors with renal dysfunction; were found to have diabetes and hypertension; diagnosed after kidney donation. Conclusions: Most of the Indian renal donors have normal renal function in long term. Nonetheless; some patients may develop renal dysfunction or renal failure and is dependent on underlying risk factors. Hence all renal donors should follow-up at 6–12 monthly intervals in donor clinics. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.ijt.2016.09.023