Kidney transplantation

Stressors and coping mechanisms in live related renal transplantation

by Paul Gill

Gill P (2012) Journal of Clinical Nursing 21, 1622–1631

12 Organ donation and transplantation: the Canadian experience

by Diego S. Silva

Co-authored with L. Wright.

In "Organ Shortage: Ethics, Law and Pragmatism" - Ed. Farrell, Price, Quigley (Cambridge Press; 2011)

Canada has approximately thirty-three million inhabitants, spread over nine million square kilometres, and there are... more Canada has approximately thirty-three million inhabitants, spread over nine million square kilometres, and there are two official languages: French and English. There is a Canadian federal government as well as ten provincial and three territorial governments which are in charge of local affairs. Canada has many First Nations populations; it is multi-cultural and multi-lingual, particularly in large cities such as Vancouver, Montreal and Toronto, reflecting extensive immigration of peoples from many parts of the world. Universal access to publicly insured healthcare is funded from general taxation, in accordance with the Canada Health Act 1984. This federal Act influences provincial healthcare insurance plans nationally by promising to pay out if the provinces and territories meet a number of requirements. The administration and delivery of healthcare is carried out by each province and territory, producing variation in services across the country.

Canada has an opt-in system of organ donation. In 2007, 2,153 transplants were performed in Canada, and the country recorded a deceased organ donation rate of 14.7 per million population (pmp) in 2008. There is a significant shortfall in the availability of organs for transplantation, with variation between the provinces. In 2008, 4,380 Canadians waited for a transplant, 2,083 received a transplant and 215 died waiting (see Table 12.1 below).

Organ transplantation is administered provincially, with limited national regulatory authority. The federal government's health agency, Health Canada, is empowered to require registration and to inspect Organ Procurement Organizations (OPOs) and living donor transplantation programmes.

Resurfacing the back of the hand as treatment and prevention of multiple skin cancers in kidney transplant recipients

by Esther van Zuuren

van Zuuren EJ, Posma AN, Scholtens REM, Vermeer BJ, van der Woude FJ, Bouwes Bavinck JN. Resurfacing the back of the hand as treatment and prevention of multiple skin cancers in kidney tranplant recipients. In Sober AJ Fitzpatrick TB, eds. The year book of dermatology 1995;330-333

Who should travel in kidney exchange programs: the donor, or the organ?

by Bryn Williams-Jones

Fortin, M-C. & Williams-Jones, B. 2011 “Who Should Travel in Kidney Exchange Programs – the Donor or the Organ?” Open Medicine 5(1): 23-25.

Selling Life—The global organs trade and the part played by Brazilian slum-dwellers

by Phillip Gresham

Suggested citation: Gresham, P.B. (2010). Selling Life: The global organs trade and the part played by Brazilian slum-dwellers. Unpublished manuscript. Human Geography Department. Radboud University Nijmegen.

A 1000-word précis of the global organ trade, using Salvador da Bahia, Brazil as a case study. A 1000-word précis of the global organ trade, using Salvador da Bahia, Brazil as a case study.

Transparancy in organ transplantation - equal chances for patients?

by Juliane Hardt

Hardt J, Raspe H (2008). Transparenter Zugang zu Organspenden: Chancengleichheit für Patienten? Gutachten zu Organtransplantationen in Schleswig-Holstein. In: Schleswig-Holsteinischer Landtag, Bericht der Landesregierung: Transparenter und gerechter Zugang zu Organspenden, Drucksache 16/1943 des Landtags

Treatment of recurrent focal segmental glomerular sclerosis posttransplant with a multimodal approach including high-galactose diet and oral galactose supplementation

by Kenar Jhaveri

Innovative teaching tools In Nephrology

by Kenar Jhaveri

Bone mineral density in patients with end-stage renal disease and its evolution after kidney transplantation

by Vivekanand Jha

S. Govindarajan, N. Khandelwal1, V. Sakhuja, V. Jha, Indian J Nephrol 2011;21:85-9.

Renal transplantation is associated with abnormalities of the structure and function of the musculoskeletal system. No... more Renal transplantation is associated with abnormalities of the structure and function of the musculoskeletal system. No data are available on bone health in Indian patients with end-stage renal disease (ESRD) and its evolution after transplantation. Consecutive ESRD patients who underwent living donor renal transplantation were studied prospectively. Bone mineral density (BMD) was measured at lumbar vertebrae using quantitative computed tomography (CT) scan before transplantation and after 3 and 6 months. T and Z scores were calculated by comparing with normal control data, and values were correlated with various clinical and biochemical parameters. Of the 56 patients enrolled (mean age, 33.7 years; 47 males), 40 completed the 6-month follow-up. The vertebral trabecular bone density at the time of transplantation was 172±53 mg/cc and the average Z score was 0.26±1.7. There was a significant decline in BMD at 3 months (11.8%; P<0.0001) and 6 months (16%; P<0.0001) after transplantation. Both T and Z scores showed a significant decline at 3 and 6 months. There was a significant decline in intact parathormone (iPTH) levels after transplantation, but 15 (37.5%) patients continued to have raised iPTH 6 months after transplantation. The iPTH levels at 6 months had significant correlation with BMD decline (r=0.43, P=0.006). We conclude that Indian ESRD patients have relatively well-preserved BMD, but the density declines rapidly after transplantation. A significant proportion of patients exhibit persistent hyperparathyroidism 6 months after transplantation, which correlates with bone loss.

Gift exchange and organ donation: Donor and recipient experiences of live related kidney transplantation

by Paul Gill

Gill P, Lowes L (2008) International Journal of Nursing Studies, 45, 1607-1617

The kidney transplant failure experience: a longitudinal case study

by Paul Gill

Gill P, Lowes L (2009) Progress in Transplantation, 19 (2), 114-121

Pathological Spectrum of Cytomegalovirus Infection of Renal Allograft Recipients-An Autopsy Study From North India.

by Vivekanand Jha

Co-Infection by Cytomegalovirus and BK Polyoma Virus In Renal Allograft, Mimicking Acute Rejection

by Vivekanand Jha

Esophageal Candidiasis After Renal Transplantation: Comparative Study In Patients on Different Immunosuppressive Protocols

by Vivekanand Jha

The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation

by Vivekanand Jha

The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering... more The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering both  donation after cardiac death than donation after brain death. The pathway provides a tool for assessing the potential of deceased donation and for the prospective identification and referral
of possible deceased donors.

CYP3A5*1/*3 genotype influences the blood concentration of tacrolimus in response to metabolic inhibition by ketoconazole

by Vivekanand Jha

OBJECTIVES: Ketoconazole retards metabolic degradation of tacrolimus through its effect on the cytochrome P-450 enzyme... more OBJECTIVES: Ketoconazole retards metabolic degradation of tacrolimus through its effect on the cytochrome P-450 enzyme system and allows reduction in treatment costs. Enzyme activity is determined by a single nucleotide polymorphism (*1/*3) in the CYP3A5 gene. METHODS: We prospectively investigated the impact of this polymorphism on tacrolimus concentration in a cohort of 79 renal transplant recipients on ketoconazole. Genotyping was carried out by using polymerase chain reaction-restriction fragment length polymorphism technique. Dose-adjusted trough level (C0) was calculated at baseline and at 3, 7, 15, 30, and 60 days. RESULTS: The baseline C0 was significantly lower in those with at least one *1 allele [44.95+/-14.12 vs. 63.43+/-14.72 (ng/ml)/(mg/kg/day), P<0.0001]. After starting ketoconazole in all genotypes, dose-normalized C0 increased and the cost of therapy decreased. Compared with baseline, the magnitude of increase was 112% and 79% in those without and with *1 allele, respectively (P<0.001). The cost savings were 32% and 39% in mycophenolate mofetil-treated and 47% and 61% in azathioprine-treated patients who were with and without one *1 allele, respectively. CONCLUSION: We show that the CYP3A5*1/*3 polymorphism is an important determinant of the response to inhibition of tacrolimus metabolism by ketoconazole, with a 30% greater inhibition in those lacking *1 allele. This finding will allow better dose adjustment and minimize exposure to subtherapeutic or toxic concentrations.

Prevention and Transplantation in Chronic Kidney Disease: What Is Achievable in Emerging Countries?. Meeting Report: Bamako Meeting December 4-6, 2008.

by Vivekanand Jha

Persy VP, Remuzzi G, Perico N, Benghanem Gharbi M, Adu D, Jha V, Rizvi A, Ben Ammar M, Fongoro S, De Broe ME. Nephron Clin Pract. 2010 Apr 22;115(2):c122-c132. [Epub ahead of print]

Experts from all continents discussed the present and future of nephrology and transplantation medicine in emerging... more Experts from all continents discussed the present and future of nephrology and transplantation medicine in emerging countries during a 3-day conference, supported by the World Health Organization, the International Society of Nephrology, the Transplantation Society - Global Alliance for Transplantation and the Ministry of Health of the Republic of Mali. This conference was held in Bamako, Mali on December 4-6, 2008, and focused on prevention and treatment of chronic kidney disease in emerging countries. Apart from delivering high-quality medical and scientific knowledge, the meeting was mainly a call to action for emerging countries to start chronic kidney disease prevention and screening programs, develop end-stage renal disease registries and start or further elaborate transplantation programs. International as well as regional collaborations need to be stimulated and strengthened in order to allow emerging countries to acquire the information, technology, experience and skills necessary to achieve these ambitious goals. Copyright © 2010 S. Karger AG, Basel.

Post-transplant infections: An ounce of prevention

by Vivekanand Jha

Indian Journal of Nephrology. 2010 Oct; 20(4): 171-178

Infections are the leading cause of hospitalization in transplant recipients. The increased risk of new onset diabetes... more Infections are the leading cause of hospitalization in transplant recipients. The increased risk of new onset diabetes after transplantation, cardiovascular disease, post-transplant lymphoproliferative disorders adversely affects allograft outcomes. Risk is determined by epidemiologic exposure, immunosuppressive therapy and prophylaxis. The predictable sequence of appearance of infections helps in making management decisions. High likelihood of infections with unusual and multiple organisms necessitates aggressive use of imaging techniques and invasive procedures. Serologic tests depend upon antibody response and are unreliable. Nucleic acid based assays are sensitive, rapid, and allow detection of subclinical infection and assessment of response to therapy. Preventive steps include screening of donors and recipients and vaccination. All indicated vaccines should be administered before transplantation. Inactivated vaccines can be administered after transplantation but produce weak and transient antibody response. Boosters may be required once antibody titers wane. Post-transplant chemoprophylaxis includes cotrimoxazole for preventing urinary tract infections, pneumocystis and Nocardia infections; ganciclovir, valganciclovir, or acyclovir for cytomegalovirus related complications in at-risk recipients; and lamivudine for prevention of progressive liver disease in HBsAg positive recipients. Viral load monitoring and pre-emptive treatment is used for BK virus infection. Infection with new organisms has recently been reported, mostly due to inadvertent transmission via the donor organ.

Renal allograft tuberculosis-an evaluation using blood oxygen level-dependent magnetic resonance imaging.

by Basu Gopal

Transplantation. 2010 Jan 15;89(1):124-5.
Renal allograft tuberculosis-an evaluation using blood oxygen level-dependent magnetic resonance imaging.
Koshy CG, Livingstone RS, Basu G, John GT.

PMID: 20061928 [PubMed - indexed for MEDLINE]

Mycophenolic acid estimation by pooled sampling: a novel strategy.

by Basu Gopal

Ther Drug Monit. 2010 Apr;32(2):141-4.

Mathew BS, Fleming DH, Prasanna S, Basu G, Chandy SJ, John GT.

Nephrology and Clinical Pharmacology Unit, Christian Medical College, Vellore, Tamil Nadu, India.

The aim of the study was to determine the reliability of estimating area under the curve from 0 to 6 hours (AUC0-6) of... more The aim of the study was to determine the reliability of estimating area under the curve from 0 to 6 hours (AUC0-6) of mycophenolic acid (MPA) by pooling the blood samples from different sampling time points. Eighty 6-hour concentration-time profiles were obtained from 68 patients on mycophenolate mofetil and the MPA AUC0-6 was calculated. In the pooled strategy, each of the equally spaced time point samples was pooled into two samples. Two rectangles were created instead of multiple trapezoids and the sum of their areas equal to the MPA AUC0-6. The linear correlation (r), intraclass correlation, bias, and precision were calculated between the pooled MPA AUC0-6 and the MPA AUC0-6 derived from measurements at different time points. Pharmacokinetic profiles of an additional 20 patients were obtained to study the possibility of using fewer time points to create a single pooled sample to obtain MPA AUC0-6. The linear correlation (r) and intraclass correlation between pooled and measured MPA AUC0-6 was 0.982 and 0.979, respectively. There was a highly significant correlation (r) of 0.978 between the pooled versus measured for both MPA AUC0-3 and MPA AUC3-6. The mean bias and precision (95% confidence interval) for pooled with total measured MPA AUC0-6 was -6.4% (-7.8% to -4.94%) and 7.37% (6.21%-8.54%), respectively. The pooled sample approach using only five time points to estimate MPA AUC0-6 had an unacceptable bias and precision. Pooling 10 samples to a set of two samples gave a highly accurate measure of MPA AUC0-6. The advantages for a central laboratory are the high throughput of samples and the transportation of only two specimens from other centers, all of which leads to a reduction in cost. This approach is extremely useful for studies aimed at examining the bioavailability of mycophenolate mofetil in different ethnic populations within India.

PMID: 20216116 [PubMed - indexed for MEDLINE]