Aim: Tacrolimus has proven efficacy as an immunosuppressive therapy to prevent transplant rejection and is widely used as an immediate-release formulation in a twice-daily regimen. Once-daily prolonged-release tacrolimus aims to improve the outcomes by reducing variability in exposure and improving adherence. However, there are limited published data available on prolonged-release tacrolimus in routine clinical practice in India. Methods: This was a Phase IV, multicenter, prospective study of prolonged-release tacrolimus conducted over 12 weeks in adult patients eligible for de novo kidney or liver transplantation in India. Primary efficacy end-point was the event rate of biopsy-confirmed acute rejections (BCARs). Secondary end-points included corticosteroid-resistant rejection incidence, time to first BCAR, graft loss, and death. Safety end-points included renal function, lipid profile, incidence of new-onset diabetes mellitus after transplantation (NODAT), and infection. Results: The study enrolled 92 patients undergoing kidney (81 [88.0%]) or liver transplantation (11 [12.0%]); a total of 76 patients (82.6%) completed the study. Ten kidney transplant patients (overall 10.9%) experienced BCAR. There were seven corticosteroid-sensitive and three corticosteroid-resistant rejections. Median (range) time to kidney transplant rejection was 6.5 (1.0–76.0) days. Renal function was stable or improved. Lipid levels showed a significant increase. Eleven instances of NODAT and seven infections occurred and there were eight deaths (8.7%; six kidney and two liver transplant patients). Conclusions: In de novo kidney and liver transplant recipients in India, prolonged-release tacrolimus was well-tolerated and efficacious with a low incidence of acute rejection. Safety profile was similar to immediate-release tacrolimus from published data.
To study patient and graft outcome and donor characteristics in cadaveric renal transplantation.Fifty nine patients (35 males and 24 females) who underwent cadaveric renal transplantation between Oct'95 and Nov'98 were analysed. The recovery of renal function was correlated with the type and duration of dialysis. The number of rejections, donor characteristics and patient and graft survival was studied.Fifty nine patients were followed for a mean period of 14.58 months (SD 10.73), their age ranged from 17 to 64 years. Ten patients had primary graft failure, out of which four died and six are on maintenance dialysis. Seven died of other causes. Twelve patients had been on CAPD and 47 were on haemodialysis. Recovery of renal function was earlier in the haemodialysis group (mean 19.29 days SD 16.97) than in the CAPD group (31.6 days SD 32.3 days). But the difference was not statistically significant (p=0.36). The age of the donors ranged from 2 to 72 years (mean 42.8, SD 17.3). Seventeen died of CVA, 16 died of head injury, and one died of sedative overdose. Dual kidney transplant was done in nine patients of whom five have adequate graft function.Follow up for a mean period of 14.58 months shows patient survival of 81.3% and graft survival 72.8% with no significant difference in recovery of renal function between CAPD and HD groups. Poor results are due to HLA mismatch leading to rejection. The majority of the deaths were related to septicaemia.
ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft.
Quadripolar left ventricular (LV) leads in cardiac resynchronization therapy (CRT) offer multi-vector pacing with different pacing configurations and hence enabling LV pacing at most suitable site with better lead stability. We aim to compare the outcomes between quadripolar and bipolar LV lead in patients receiving CRT.In this prospective, non-randomized, single-center observational study, we enrolled 93 patients receiving CRT with bipolar (BiP) (n = 31) and quadripolar (Quad) (n = 62) LV lead between August 2016 to August 2019. Patients were followed for six months, and outcomes were compared with respect to CRT response (defined as ≥5% absolute increase in left ventricle ejection fraction), electrocardiographic, echocardiographic parameters, NYHA functional class improvement, and incidence of LV lead-related complication.At the end of six months follow up, CRT with quadripolar lead was associated with better response rate as compared to bipolar pacing (85.48% vs 64.51%; p = 0.03), lesser heart failure (HF) hospitalization events (1.5 vs 2; p = 0.04) and better improvement in HF symptoms (patients with ≥1 NYHA improvement 87.09% vs 67.74%; p = 0.04). There were fewer deaths per 100 patient-year (6.45 vs 9.37; p = 0.04) and more narrowing of QRS duration (Δ12.56 ± 3.11 ms vs Δ7.29 ± 1.87 ms; p = 0.04) with quadripolar lead use. Lead related complications were significantly more with the use of bipolar lead (74.19% vs 41.94%; p = 0.02).Our prospective, non-randomized, single-center observational study reveals that patients receiving CRT with quadripolar leads have a better response to therapy, lesser heart failure hospitalizations, lower all-cause mortality, and fewer lead-related complications, proving its superiority over the bipolar lead.
Approximately 400 million people are chronic HBV carriers worldwide. The spectrum of chronic HBV infection ranges from asymptomatic hepatitis B surface antigen carrier state to chronic hepatitis with progression to cirrhosis and end-stage liver disease and carcinoma of liver. Several extrahepatic syndromes are associated with acute HBV infection like serum sickness reaction, polyarteritis nodosa due to ischemia of vasa nervosum of the nerves and glomerulonephritis. We present here the a case of a 38-year male with end stage renal disease due to diabetic nephropathy on maintenance haemodialysis with acute hepatitis B virus infection with extra hepatic, extra renal immunological manifestations.
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