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   Table of Contents - Current issue
July-September 2021
Volume 21 | Issue 3
Page Nos. 115-147

Online since Monday, August 9, 2021

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Induction agents and their role in low-immunological-risk kidney transplant recipients: A Review p. 115
Swaraj Sathyan, Ajay Sharma, Ahmed M Halawa
Induction agents are widely used at the time of kidney transplantation to decrease the risk of rejection. While there is a strong immunological rationale supporting the use of induction immunosuppression, the clinical evidence demonstrating benefit in low-immunological-risk recipients in addition to current effective maintenance immunosuppression is less robust, especially in terms of improvement in long-term graft survival. This review aims to shed light on the immunological basis of use of induction immunosuppression, available options of induction agents and the current evidence and recommendation for their use in low-immunological-risk kidney transplant recipients.
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Correlation of parathyroid hormone level with left ventricular mass in patients with end-stage kidney disease on hemodialysis p. 124
Asmaa H Shaltout, Sameh Samir, Fayza I Lashin, Mohammed H Sherif, Mohamed S Aboelnasr
Background Patients with end-stage kidney disease (ESKD) on hemodialysis (HD) have a high prevalence of left ventricular hypertrophy (LVH), which is associated with increased cardiovascular risk. Hyperparathyroidism in these patients plays a key role in the development of LVH. The aim of this study was to evaluate the correlation of parathyroid hormone (PTH) level with left ventricular mass in patients with ESKD on HD. Other factors that contribute to the development of LVH were also included. Patients and methods This study included 40 patients with ESKD at our dialysis unit. Patients were classified into two groups: group I included 20 patients with LVH and group II included 20 patients without LVH. Patients were defined as having LVH if they had left ventricular mass index more than 95 g/m2 in women and more than 115 g/m2 in men. Results There was a statistically significant increase in PTH in patients in group I than group II (P=0.009). Hemoglobin % was significantly lower in patients in group I than group II (P=0.042). Left ventricular mass index showed a significant positive correlation with PTH and a significant negative correlation with hemoglobin %. Conclusion Hyperparathyroidism and anemia are the two major contributors to the development of LVH in patients with ESKD on HD.
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Long-term outcome of kidney retransplants with different donor sources p. 130
Osama A Gheith, Ayman Maher Nagib, Medhat A Halim, Suzann Rida, Tarek Mahmoud, Prasad Nair, Torki Alotaibi
Background It has been reported that the long-term survival of second transplants may be similar to that of primary transplants. Reports of retransplantation outcomes are scarce, especially in the middle east region. We aimed to present our experience with second renal transplant in Kuwait and compare the donor source among our retransplant recipients. Patients and methods Data of kidney retransplants, under follow-up at the Hamed Al-essa Organ Transplant Center of Kuwait, between 1980 and 2019 were retrospectively analyzed. Out of 3038 kidney transplants, 198 (6.51%) were kidney retransplants. The number of kidney transplants from living donors was 150; from deceased donors, 48 and third transplants represented 15 cases. We compared living donor group 1 with deceased donor group 2 in terms of demographics, posttransplant complications and outcome. Results We observed that episodes of acute antibody-mediated rejection (nine cases, 18.7%, in group 1 vs. eight cases, 16.6%, in group 2, respectively) and T-cell-mediated rejection (14 cases, 9.33%, in group 1 vs.15 cases, 10%, in group 2, respectively) were more frequent among patients in group 2, but this did not reach statistical significance. In terms of the second graft outcome, we observed that the percentage of patients with failed grafts was higher among group 2 patients, but this did not reach statistical significance during their last follow-up, while the two groups were comparable in terms of patient outcome. Conclusion Both living donor and cadaveric renal allotransplants carry the same risk for graft rejection, either AMR or ACR. Meanwhile retransplants who received their kidneys from either living or deceased donors had experienced similar graft and patients’ outcomes. Therefore, retransplant either from living or deceased donor is considered a good option after first renal allograft loss.
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Retinal findings in chronic kidney disease patients on hemodialysis p. 138
Rasha Youssef Hagag, Shimaa Hassan El-Attar, Waleed Elrefaey, Amin E Nawar, Nashwa M El gharbawy
Background Chronic kidney disease (CKD) is an irreversible condition that leads to progression to end-stage renal disease that requires hemodialysis or kidney transplantation for patient survival and these patients are at risk of developing many complications. In the present study, the retinal findings in CKD patients on hemodialysis are evaluated. Patients and methods This is a cross-sectional noninterventional study that was carried out on CKD patients on hemodialysis for at least 3 months in the Nephrology Unit, Tanta University, Egypt; 160 eyes of 80 patients were included over 6 months. A complete ophthalmic evaluation was performed. Color fundus and spectral domain optical coherence tomography were performed at presentation. Results The visual acuity ranged from 6/6 to 6/18 in 80 eyes, which represents 50%, from 6/24 to 6/60 in 62 eyes, which represents 38.75%, and from less than 6/60 to perception of light in 18 eyes, which represents 11.25%. Fundus examination revealed that eight eyes were normal (5%). Hypertensive retinal changes occurred in 82 eyes with variable degrees of retinopathy. Diabetic retinopathy was found in 30 (18.75%) eyes and macular degeneration was detected in 20 (12.5%) eyes. Retinal vasculitis occurred in two (1.25%) eyes, branch retinal vein occlusion was detected in six (3.75%) eyes, glaucomatous optic neuropathy was found in eight (5%) eyes and central retinal artery occlusion occurred in four (2.5%) eyes. Conclusion The most common visual problems in hemodialysis patients that lead to visual loss are hypertensive and diabetic retinopathy. Hence, it is mandatory to screen fundus changes in CKD to prevent loss of vision.
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Successful kidney transplantation of a patient with thalassemia major: case report and review of literature p. 144
Mohamed Emam, Mohamed A Moneem, Osama Gheith, Tarek Mahmoud, Ayman M Nagib, Khalid Abdultawab, Zakaria Elsayed, Prasad Nair, Torki Al-otaibi
Thalassemia minor has a good prognosis, whereas thalassemia major (TM) is a severe disease, and the long-term prognosis depends on the treatment adherence to transfusion and iron chelation therapies. To our knowledge, there are no reported thalassemia cases that underwent kidney transplant. We aimed to highlight a successful kidney transplant in a patient with TM with stable graft function after 16 months of follow-up. In our case, repeated blood transfusions were inevitably associated with iron overload despite iron chelating agents. Moreover, she developed anti-HLA antibodies, but fortunately, there were no donor-specific antibodies, which facilitated the procedure of renal transplant that was performed on 17/3/2019. After 6 weeks of transplant, she started follow-up in the clinic and resumed iron chelation using deferasirox along with much less frequent blood transfusion. After more than 20 months of follow-up, she is enjoying stable graft function, hemoglobin around 9.2 g/dl, and with occasional trace proteinuria. This is a case report showing a β-TM case can undergo renal transplant with no contraindications under special circumstances, and it is the first case in the literature.
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