Background : Pre dose or trough blood cyclosporine (CSA) concentration is routinely monitored and... more Background : Pre dose or trough blood cyclosporine (CSA) concentration is routinely monitored and the result is used to alter patient's drug dosing. Patients with identical pre dose blood CSA may have very different systemic exposure to the drug. Recently CSA 2 hour post dose level [C2] has been reported to correlate better with drug exposure. We undertook this study to evaluate the influence of trough and C2, CSA concentration monitoring on short-term renal allograft outcomes. Methods : 25 patients of renal transplant receiving a triple drug regimen of CSA micro emulsion (Panacea Biotec) 8mg/kg, azathioprine 1mg/kg and prednisolone 0.5mg/kg were analyzed prospectively for graft outcomes. CSA levels were monitored in whole blood by radioimmunoassay using monoclonal antibodies, at 72 hours after the transplant. Results : The mean age of patients was 37.08 + 9.1 years. There were 20 males and 5 females. The mean age of donors was 40.2 + 8.2 years. There were 11 related donors with at least a haplomatch, 4 spousal and 10 unrelated donors with a nil antigen match. The mean pre dose CSA concentration was 289.22 + 171.9ng/ml; range (98.8 + 783.41ng/ml). The CSA concentration at 2 hours after the CSA administration was 838 + 310.87ng/ml (range, 169 + 1268ng/ml). 3 (12%) patients had acute rejection. In these patients the mean pre dose CSA concentration was 328.67ng/ml and the mean C2, CSA concentration was 1006.26ng/ml. CSA induced hemolytic uraemic syndrome was diagnosed in one patient. The trough and C2, CSA concentration levels were 174 and 870.83ng/ml respectively in this patient. Conclusion : In our study CSA levels, trough and peak showed significant inter patient variability. The trough and C2 concentration levels did not correlate with the episodes of acute rejection. We conclude that in a triple drug regimen with fixed dosing schedules routine trough CSA level monitoring is not helpful in the acute post renal transplant period.
To monitor the activity of the humoral component in graft dysfunction following renal transplanta... more To monitor the activity of the humoral component in graft dysfunction following renal transplantation using live related donors, flowcytomctric cross-match procedure was adopted. Antidonor antibodies were detected in the sera of both pre-and post-transplant patients using conventional serological cytotoxicity cross-match and flowcytometric cross-match assays. In the 52 pretransplant samples no significant differences were observed in flowcytometric and cytotoxicity tests except in 2 secondary transplant cases which were negative by cytotoxicity test. However, in post-transplant samples, flowcytometry was found to be a more objective and useful test than cytotoxicity testing in distinguishing 6 out of 7 mild acute-graft-rejection episodes. Both tests were found to be negative in all 5 cases of cyclosporin-A nephrotoxicity, 7 cases of acute tubular necrosis and 10 out of 11 cases of chronic rejection.
Background: Serum creatinine is not a sensitive marker to assess early loss of renal function in ... more Background: Serum creatinine is not a sensitive marker to assess early loss of renal function in acute kidney injury. Timed creatinine clearance and several formula used to predict glomreular filtration rate have not been validated. Methods: In a prospective observational study in 50 adult patients admitted to the intensive care unit with apparent normal renal function, we assessed the glomerular filtration rate by the formula methods and timed creatinine clearance. Result: The mean serum creatinine was 0.77mg/dl, SD ± 0.15 (range 0.5-1.14 mg/dl). The mean measured creatinine clearance was 87.15 ml/min/1.73m 2 , SD ± 20.5 (range 56.9-137 ml/ min/1.73m 2). In 25 (50%) patients, one hour urinary creatinine clearance was <80 ml/min/1.73m 2 and in two (4%) patients, the creatinine clearance was <60 ml/min/1.73m 2. Spearman correlation coefficient and regression analysis revealed a statistically significant correlation for the Cockcroft-Gault and predictive equations when compared with measured creatinine clearance. The differences between the predictive equations and creatinine clearance, as illustrated by the ±95% confidence interval in the Bland-Altman graphs was very significant [Cockcroft-Gault =-40.3 to 17.7 ml/ min/ 1.73m 2 , Modification of Diet in Renal Disease equation =-46.2 to 30.6 ml/min/1.73m 2 and the simplified Modification of Diet in Renal Disease equation =-72.8 to 24.8 ml/min/1.73m 2 ]. Conclusion:Formula methods and creatinine clearance are more sensitive than serum creatinine in detecting early phase of acute kidney injury. However, there is no agreement between these methods of glomerular filtration rate estimation.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2005
OBJECTIVES The impact of hepatitis C virus (HCV) infection on the success of renal transplant is ... more OBJECTIVES The impact of hepatitis C virus (HCV) infection on the success of renal transplant is controversial. We assessed the effect of HCV infection on graft and patient survival in renal allograft recipients. METHODS We retrospectively analyzed medical records of renal allograft recipients who were transplanted between June 1990 and March 2004. Patients were divided into those positive and negative for anti-HCV antibody. Graft and patient survival were compared between the groups. RESULTS Of 126 patients studied (median age 34.5 years, range, 16-60; 111 men), 35 were positive for anti-HCV antibody. In seven patients, the antibodies were detected for the first time after renal transplant. Mean patient and graft survival duration in the anti-HCV negative group was longer (55 [SD 2] months [95% CI, 51-58]) than in the anti-HCV positive group (50 [SD 4] months [95% CI, 43-58]) (p< 0.05). Twenty-two patients died - 8 (22.8%) in the anti-HCV positive group and 14 (15.3%) in the neg...
The Journal of the Association of Physicians of India, 1991
Spontaneous rupture of the oesophagus presenting as a pyopneumothorax in an elderly male is descr... more Spontaneous rupture of the oesophagus presenting as a pyopneumothorax in an elderly male is described. Delayed presentation of the patient led to serious complications to which he succumbed.
BACKGROUND The incidence of malarial hepatitis in patients with Plasmodium falciparum infection a... more BACKGROUND The incidence of malarial hepatitis in patients with Plasmodium falciparum infection and jaundice is not known and it is not clear whether the condition is a single entity or a heterogeneous syndrome. METHODS We prospectively studied the natural history of all patients with falciparum malaria and jaundice admitted to military hospitals in Northeast India from 1988 to 1991. A possible drug or viral cause for the hepatitis was excluded by the history, serological tests and liver histology. RESULTS Of the 732 patients admitted with falciparum malaria, 39 had jaundice but only 18 had malarial hepatitis indicated by a rise in their serum glutamate pyruvate transaminase levels to more than three times the upper limit of normal and an absence of clinical or serological evidence to suggest drug or viral hepatitis. The liver in these patients was always enlarged. Their mean age was 27.6 years and 85% were males. The mean serum bilirubin was 12.7 +/- 10.3 mg/dl, serum glutamate oxa...
The Journal of the Association of Physicians of India, 1991
Twenty nine patients were diagnosed to have idiopathic oedema; 27 (93.1%) of these were females. ... more Twenty nine patients were diagnosed to have idiopathic oedema; 27 (93.1%) of these were females. Associated psychological symptoms were observed in 86.2% of patients. The most common associated symptoms were related to autonomic dysfunction. Obesity and diuretic abuse were found in 48.3% and 41.4% of patients respectively. The association of bizarre symptoms with idiopathic oedema is a common feature.
Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen ... more Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen in organ transplant recipients and immunosuppressed patients; it is usually associated with hepatitis B virus infection. We report 36-year-old man, a renal transplant recipient, also developed FCH with hepatitis C virus infection and succumbed to it.
Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 407 of total culture‐... more Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 407 of total culture‐positive cases and three patients (6.5%) had a dual infection with the simultaneous isolation of both Gram‐positive and negative organism. Two patients required catheter exchange twice over 2‐month period. Rest were managed with single time catheter exchange till the follow‐up. Table 1 shows the microbiological spectrum of CRBSI in our HD unit.
A prospective study of 120 patients of acute renal failure was done at CH (EC) Calcutta to docume... more A prospective study of 120 patients of acute renal failure was done at CH (EC) Calcutta to document the changing trends in the incidence and etiology of acute renal failure and to assess the prognostic factors. Mean age of patients was 33.7 ± 20.2 years. 75% had a medical risk factor. The etiological factors were volume depletion (13.3%), septicaemia (25.6%), falciparum malaria (16.6%), a transplant related renal failure (5.7%) and drugs (16.7%). Renal histology showed acute tubular necrosis to be the most common lesion (53.3%). In 13.3% patients who died with acute renal failure, associated infection and multisystem involvement was more common.
Malik et al in their article 'Renal Transplant : An Early Experience (MJAFI 1994; 50:197-201.... more Malik et al in their article 'Renal Transplant : An Early Experience (MJAFI 1994; 50:197-201.) have raised some very pertinent questions on whom to accept as a kidney donor, the duration of haemodialysis in HBsAg positive patients with end-stage renal disease and the offering of second renal transplant to cases of chronic rejection. To maintain the altruistic nature, of organ donation and to prevent trafficking in human organs under the guise of emotionally related or philanthrophic donors the Government of India has enacted 'The Transplantation of Human Organs Bill', applicable to the states of Goa, Himachal Pradesh and Maharashtra and in the Union territories. The bill states that 'no human organ removed from the body of a donor before his death shall be transplanted into a recepient unless the donor is a near relative of the recepient'. Near relative means spouse, son, daughter, father, mother, brother or sister. Other live donors can only be considered with, prior sanction from an 'Authorisation Committee' to be constituted by the Contra! Government. The details of this committee are yet to be spelt out. What is more important is that the Bill has recognized the concept of and provided legal safeguards for diagnosing 'Brain death' and carrying out cadaveric organ transplantation [1]. With, the increasing shortage of human organs being experienced every year, it is now time for us in the Armed Forces to formulate within the framework of the Bill our own cadaveric organ donation programme. The second question the authors have raised is on HBsAg positivity vis a vis long term haemodialysis. In asymptomatic HBsAg carrier state 15% 20% patients have been reported to become negative on long term maintenance haemodialysis [2], After renal transplant in these patients, many workers have noticed increased morbidity and mortality from chronic active hepatitis and hepatic failure while others have demonstrated similar patient and graft survival in HBsAg positive and negative patients (3). However definite contraindications to renal transplant in this group of patients are active hepatitis Β infection and progressive liver disease [4]. Liver biopsy is useful in excluding patients with pathological changes suggestive of chronic active hepatitis, but when biopsy is not feasible other serological markers including HBeAg are useful in selecting asymptomatic HBsAg positive patients for renal transplant [5]. In our centre at Army Hospital Delhi Cantt, we have been accepting HBsAg positive patients with end-stage renal disease for renal transplantation. Of the four patients transplanted, one has died of acute liver cell failure while the other three are doing well. The authors have expressed doubts on offering a retransplant to patients who have rejected the first kidney graft. Second and subsequent renal allorgrafts do pose peculiar problems, particularly due to the risk of sensitization occurring from the first graft in addition to other sources such as blood transfusions and pregnancy. However with a little more attention to immunological matching many workers have shown a second living allograft to do as well as the first [6] and 1-year survival of cadaveric regrafts to be just around 10% less than the first cadaveric graft [7]. Therefore, where indicated, a retransplant should be considered as a viable option in management of chronic rejection.
A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and l... more A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and live unrelated donor (LURD) kidneys were studied for opportunistic infections. Immune diagnosis of Toxoplasma, Cytomegalovirus (CMV), Herpes-simplex virus type II (HSV-2), Aspergillosis and Tuberculosis was carried out in these patients along with sputum examination, CSF studies and biopsy of lymphnode and other tissues in few cases. A high degree of Toxoplasma, CMV & HSV-2 positivity was seen in transplanted patients. However sensitivity of serological diagnosis of tuberculos was found to be low with standard criteria, which increased significantly when modified criteria were used. It is concluded that regular immunological monitoring should be carried out in transplanted patients so as to reach an early diagnosis and management of opportunistic infections.
Twenty five hyperthyroid patients and 25 healthy volunteers were evaluated for carbohydrate metab... more Twenty five hyperthyroid patients and 25 healthy volunteers were evaluated for carbohydrate metabolic disturbance with an oral glucose tolerance test and glycosylated haemoglobin percentage. Insulin secretory response was studied in 17 hyperthyroids and 10 controls. A varying degree of abnormality was noted in hyperthyroids. Forty per cent patients had a significantly higher glycosylated haemoglobin and 3 (12%) patients had impaired glucose tolerance and 1 (4%) patient had frank diabetes mellitus. Significant hyperinsulinism was seen in the hyperthyroid group. Our data suggests that carbohydrate metabolic aberration exists in hyperthyroids and may reflect insulin resistance.
The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes ... more The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes mellitus. The mean age of patients was 52.1 ± 11.6 years and the duration of diabetes was 8.3 ± 6.8 years. Twenty (40%) patients had microalbuminuria. Microalbuminuria was more common in patients with a longer duration of diabetes (more than 5 years), a poor glycaemic control, and higher systolic blood pressure.
DNA based HLA typing is fast replacing conventional Microlymphocytotoxicity based method, which h... more DNA based HLA typing is fast replacing conventional Microlymphocytotoxicity based method, which has been regarded as the gold standard. Many laboratories in Mumbai have already switched over to molecular methods, as the results are far superior. This study was undertaken to compare the results of generic molecular typing by sequence specific primers (SSP) with that by serology in our laboratory. A pilot study was performed in which available data tissue typing results of 200 patients and their donors were analysed. DNA was extracted from whole blood or buffy coat using QIA amp @ DNA Mini kit from Qiagen (Germany). SSP based low resolution typing was performed for 50 individuals using commercial kits from Biotest (Germany) and Genovision (USA). Microlymphocytotoxicity based tissue typing was also done for twenty individuals using commercial sera, while the remaining were typed by SSP alone. Samples were run in two different time phases labeled in Table as first and second run. DNA quality and quantity was found to be sufficient by the method for tissue typing. Of the pilot study of 200 cases typed earlier by serology, all six HLA antigens were identified only in 40% individuals, with maximum number of blanks in DR typing. DNA typing results were best for class II typing and not very satisfactory for HLA B typing. The results of DR SSP typing were far superior and almost 90% of alleles were identified. The cost of molecular typing was approximately $ 82-124 per sample while for serology it was $ 64-69. The SSP based HLA typing is an economical, rapid, precise, technically simple and reproducible method. Further the non availability of specific HLA antisera from native populations, large number of blank alleles, and comparable cost of immunomagnetic isolation of B cells, it is suggested that DNA based methods must completely replace serology.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen ... more Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen in organ transplant recipients and immunosuppressed patients; it is usually associated with hepatitis B virus infection. We report 36-year-old man, a renal transplant recipient, also developed FCH with hepatitis C virus infection and succumbed to it.
Background : Pre dose or trough blood cyclosporine (CSA) concentration is routinely monitored and... more Background : Pre dose or trough blood cyclosporine (CSA) concentration is routinely monitored and the result is used to alter patient's drug dosing. Patients with identical pre dose blood CSA may have very different systemic exposure to the drug. Recently CSA 2 hour post dose level [C2] has been reported to correlate better with drug exposure. We undertook this study to evaluate the influence of trough and C2, CSA concentration monitoring on short-term renal allograft outcomes. Methods : 25 patients of renal transplant receiving a triple drug regimen of CSA micro emulsion (Panacea Biotec) 8mg/kg, azathioprine 1mg/kg and prednisolone 0.5mg/kg were analyzed prospectively for graft outcomes. CSA levels were monitored in whole blood by radioimmunoassay using monoclonal antibodies, at 72 hours after the transplant. Results : The mean age of patients was 37.08 + 9.1 years. There were 20 males and 5 females. The mean age of donors was 40.2 + 8.2 years. There were 11 related donors with at least a haplomatch, 4 spousal and 10 unrelated donors with a nil antigen match. The mean pre dose CSA concentration was 289.22 + 171.9ng/ml; range (98.8 + 783.41ng/ml). The CSA concentration at 2 hours after the CSA administration was 838 + 310.87ng/ml (range, 169 + 1268ng/ml). 3 (12%) patients had acute rejection. In these patients the mean pre dose CSA concentration was 328.67ng/ml and the mean C2, CSA concentration was 1006.26ng/ml. CSA induced hemolytic uraemic syndrome was diagnosed in one patient. The trough and C2, CSA concentration levels were 174 and 870.83ng/ml respectively in this patient. Conclusion : In our study CSA levels, trough and peak showed significant inter patient variability. The trough and C2 concentration levels did not correlate with the episodes of acute rejection. We conclude that in a triple drug regimen with fixed dosing schedules routine trough CSA level monitoring is not helpful in the acute post renal transplant period.
To monitor the activity of the humoral component in graft dysfunction following renal transplanta... more To monitor the activity of the humoral component in graft dysfunction following renal transplantation using live related donors, flowcytomctric cross-match procedure was adopted. Antidonor antibodies were detected in the sera of both pre-and post-transplant patients using conventional serological cytotoxicity cross-match and flowcytometric cross-match assays. In the 52 pretransplant samples no significant differences were observed in flowcytometric and cytotoxicity tests except in 2 secondary transplant cases which were negative by cytotoxicity test. However, in post-transplant samples, flowcytometry was found to be a more objective and useful test than cytotoxicity testing in distinguishing 6 out of 7 mild acute-graft-rejection episodes. Both tests were found to be negative in all 5 cases of cyclosporin-A nephrotoxicity, 7 cases of acute tubular necrosis and 10 out of 11 cases of chronic rejection.
Background: Serum creatinine is not a sensitive marker to assess early loss of renal function in ... more Background: Serum creatinine is not a sensitive marker to assess early loss of renal function in acute kidney injury. Timed creatinine clearance and several formula used to predict glomreular filtration rate have not been validated. Methods: In a prospective observational study in 50 adult patients admitted to the intensive care unit with apparent normal renal function, we assessed the glomerular filtration rate by the formula methods and timed creatinine clearance. Result: The mean serum creatinine was 0.77mg/dl, SD ± 0.15 (range 0.5-1.14 mg/dl). The mean measured creatinine clearance was 87.15 ml/min/1.73m 2 , SD ± 20.5 (range 56.9-137 ml/ min/1.73m 2). In 25 (50%) patients, one hour urinary creatinine clearance was <80 ml/min/1.73m 2 and in two (4%) patients, the creatinine clearance was <60 ml/min/1.73m 2. Spearman correlation coefficient and regression analysis revealed a statistically significant correlation for the Cockcroft-Gault and predictive equations when compared with measured creatinine clearance. The differences between the predictive equations and creatinine clearance, as illustrated by the ±95% confidence interval in the Bland-Altman graphs was very significant [Cockcroft-Gault =-40.3 to 17.7 ml/ min/ 1.73m 2 , Modification of Diet in Renal Disease equation =-46.2 to 30.6 ml/min/1.73m 2 and the simplified Modification of Diet in Renal Disease equation =-72.8 to 24.8 ml/min/1.73m 2 ]. Conclusion:Formula methods and creatinine clearance are more sensitive than serum creatinine in detecting early phase of acute kidney injury. However, there is no agreement between these methods of glomerular filtration rate estimation.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2005
OBJECTIVES The impact of hepatitis C virus (HCV) infection on the success of renal transplant is ... more OBJECTIVES The impact of hepatitis C virus (HCV) infection on the success of renal transplant is controversial. We assessed the effect of HCV infection on graft and patient survival in renal allograft recipients. METHODS We retrospectively analyzed medical records of renal allograft recipients who were transplanted between June 1990 and March 2004. Patients were divided into those positive and negative for anti-HCV antibody. Graft and patient survival were compared between the groups. RESULTS Of 126 patients studied (median age 34.5 years, range, 16-60; 111 men), 35 were positive for anti-HCV antibody. In seven patients, the antibodies were detected for the first time after renal transplant. Mean patient and graft survival duration in the anti-HCV negative group was longer (55 [SD 2] months [95% CI, 51-58]) than in the anti-HCV positive group (50 [SD 4] months [95% CI, 43-58]) (p< 0.05). Twenty-two patients died - 8 (22.8%) in the anti-HCV positive group and 14 (15.3%) in the neg...
The Journal of the Association of Physicians of India, 1991
Spontaneous rupture of the oesophagus presenting as a pyopneumothorax in an elderly male is descr... more Spontaneous rupture of the oesophagus presenting as a pyopneumothorax in an elderly male is described. Delayed presentation of the patient led to serious complications to which he succumbed.
BACKGROUND The incidence of malarial hepatitis in patients with Plasmodium falciparum infection a... more BACKGROUND The incidence of malarial hepatitis in patients with Plasmodium falciparum infection and jaundice is not known and it is not clear whether the condition is a single entity or a heterogeneous syndrome. METHODS We prospectively studied the natural history of all patients with falciparum malaria and jaundice admitted to military hospitals in Northeast India from 1988 to 1991. A possible drug or viral cause for the hepatitis was excluded by the history, serological tests and liver histology. RESULTS Of the 732 patients admitted with falciparum malaria, 39 had jaundice but only 18 had malarial hepatitis indicated by a rise in their serum glutamate pyruvate transaminase levels to more than three times the upper limit of normal and an absence of clinical or serological evidence to suggest drug or viral hepatitis. The liver in these patients was always enlarged. Their mean age was 27.6 years and 85% were males. The mean serum bilirubin was 12.7 +/- 10.3 mg/dl, serum glutamate oxa...
The Journal of the Association of Physicians of India, 1991
Twenty nine patients were diagnosed to have idiopathic oedema; 27 (93.1%) of these were females. ... more Twenty nine patients were diagnosed to have idiopathic oedema; 27 (93.1%) of these were females. Associated psychological symptoms were observed in 86.2% of patients. The most common associated symptoms were related to autonomic dysfunction. Obesity and diuretic abuse were found in 48.3% and 41.4% of patients respectively. The association of bizarre symptoms with idiopathic oedema is a common feature.
Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen ... more Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen in organ transplant recipients and immunosuppressed patients; it is usually associated with hepatitis B virus infection. We report 36-year-old man, a renal transplant recipient, also developed FCH with hepatitis C virus infection and succumbed to it.
Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 407 of total culture‐... more Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 407 of total culture‐positive cases and three patients (6.5%) had a dual infection with the simultaneous isolation of both Gram‐positive and negative organism. Two patients required catheter exchange twice over 2‐month period. Rest were managed with single time catheter exchange till the follow‐up. Table 1 shows the microbiological spectrum of CRBSI in our HD unit.
A prospective study of 120 patients of acute renal failure was done at CH (EC) Calcutta to docume... more A prospective study of 120 patients of acute renal failure was done at CH (EC) Calcutta to document the changing trends in the incidence and etiology of acute renal failure and to assess the prognostic factors. Mean age of patients was 33.7 ± 20.2 years. 75% had a medical risk factor. The etiological factors were volume depletion (13.3%), septicaemia (25.6%), falciparum malaria (16.6%), a transplant related renal failure (5.7%) and drugs (16.7%). Renal histology showed acute tubular necrosis to be the most common lesion (53.3%). In 13.3% patients who died with acute renal failure, associated infection and multisystem involvement was more common.
Malik et al in their article 'Renal Transplant : An Early Experience (MJAFI 1994; 50:197-201.... more Malik et al in their article 'Renal Transplant : An Early Experience (MJAFI 1994; 50:197-201.) have raised some very pertinent questions on whom to accept as a kidney donor, the duration of haemodialysis in HBsAg positive patients with end-stage renal disease and the offering of second renal transplant to cases of chronic rejection. To maintain the altruistic nature, of organ donation and to prevent trafficking in human organs under the guise of emotionally related or philanthrophic donors the Government of India has enacted 'The Transplantation of Human Organs Bill', applicable to the states of Goa, Himachal Pradesh and Maharashtra and in the Union territories. The bill states that 'no human organ removed from the body of a donor before his death shall be transplanted into a recepient unless the donor is a near relative of the recepient'. Near relative means spouse, son, daughter, father, mother, brother or sister. Other live donors can only be considered with, prior sanction from an 'Authorisation Committee' to be constituted by the Contra! Government. The details of this committee are yet to be spelt out. What is more important is that the Bill has recognized the concept of and provided legal safeguards for diagnosing 'Brain death' and carrying out cadaveric organ transplantation [1]. With, the increasing shortage of human organs being experienced every year, it is now time for us in the Armed Forces to formulate within the framework of the Bill our own cadaveric organ donation programme. The second question the authors have raised is on HBsAg positivity vis a vis long term haemodialysis. In asymptomatic HBsAg carrier state 15% 20% patients have been reported to become negative on long term maintenance haemodialysis [2], After renal transplant in these patients, many workers have noticed increased morbidity and mortality from chronic active hepatitis and hepatic failure while others have demonstrated similar patient and graft survival in HBsAg positive and negative patients (3). However definite contraindications to renal transplant in this group of patients are active hepatitis Β infection and progressive liver disease [4]. Liver biopsy is useful in excluding patients with pathological changes suggestive of chronic active hepatitis, but when biopsy is not feasible other serological markers including HBeAg are useful in selecting asymptomatic HBsAg positive patients for renal transplant [5]. In our centre at Army Hospital Delhi Cantt, we have been accepting HBsAg positive patients with end-stage renal disease for renal transplantation. Of the four patients transplanted, one has died of acute liver cell failure while the other three are doing well. The authors have expressed doubts on offering a retransplant to patients who have rejected the first kidney graft. Second and subsequent renal allorgrafts do pose peculiar problems, particularly due to the risk of sensitization occurring from the first graft in addition to other sources such as blood transfusions and pregnancy. However with a little more attention to immunological matching many workers have shown a second living allograft to do as well as the first [6] and 1-year survival of cadaveric regrafts to be just around 10% less than the first cadaveric graft [7]. Therefore, where indicated, a retransplant should be considered as a viable option in management of chronic rejection.
A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and l... more A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and live unrelated donor (LURD) kidneys were studied for opportunistic infections. Immune diagnosis of Toxoplasma, Cytomegalovirus (CMV), Herpes-simplex virus type II (HSV-2), Aspergillosis and Tuberculosis was carried out in these patients along with sputum examination, CSF studies and biopsy of lymphnode and other tissues in few cases. A high degree of Toxoplasma, CMV & HSV-2 positivity was seen in transplanted patients. However sensitivity of serological diagnosis of tuberculos was found to be low with standard criteria, which increased significantly when modified criteria were used. It is concluded that regular immunological monitoring should be carried out in transplanted patients so as to reach an early diagnosis and management of opportunistic infections.
Twenty five hyperthyroid patients and 25 healthy volunteers were evaluated for carbohydrate metab... more Twenty five hyperthyroid patients and 25 healthy volunteers were evaluated for carbohydrate metabolic disturbance with an oral glucose tolerance test and glycosylated haemoglobin percentage. Insulin secretory response was studied in 17 hyperthyroids and 10 controls. A varying degree of abnormality was noted in hyperthyroids. Forty per cent patients had a significantly higher glycosylated haemoglobin and 3 (12%) patients had impaired glucose tolerance and 1 (4%) patient had frank diabetes mellitus. Significant hyperinsulinism was seen in the hyperthyroid group. Our data suggests that carbohydrate metabolic aberration exists in hyperthyroids and may reflect insulin resistance.
The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes ... more The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes mellitus. The mean age of patients was 52.1 ± 11.6 years and the duration of diabetes was 8.3 ± 6.8 years. Twenty (40%) patients had microalbuminuria. Microalbuminuria was more common in patients with a longer duration of diabetes (more than 5 years), a poor glycaemic control, and higher systolic blood pressure.
DNA based HLA typing is fast replacing conventional Microlymphocytotoxicity based method, which h... more DNA based HLA typing is fast replacing conventional Microlymphocytotoxicity based method, which has been regarded as the gold standard. Many laboratories in Mumbai have already switched over to molecular methods, as the results are far superior. This study was undertaken to compare the results of generic molecular typing by sequence specific primers (SSP) with that by serology in our laboratory. A pilot study was performed in which available data tissue typing results of 200 patients and their donors were analysed. DNA was extracted from whole blood or buffy coat using QIA amp @ DNA Mini kit from Qiagen (Germany). SSP based low resolution typing was performed for 50 individuals using commercial kits from Biotest (Germany) and Genovision (USA). Microlymphocytotoxicity based tissue typing was also done for twenty individuals using commercial sera, while the remaining were typed by SSP alone. Samples were run in two different time phases labeled in Table as first and second run. DNA quality and quantity was found to be sufficient by the method for tissue typing. Of the pilot study of 200 cases typed earlier by serology, all six HLA antigens were identified only in 40% individuals, with maximum number of blanks in DR typing. DNA typing results were best for class II typing and not very satisfactory for HLA B typing. The results of DR SSP typing were far superior and almost 90% of alleles were identified. The cost of molecular typing was approximately $ 82-124 per sample while for serology it was $ 64-69. The SSP based HLA typing is an economical, rapid, precise, technically simple and reproducible method. Further the non availability of specific HLA antisera from native populations, large number of blank alleles, and comparable cost of immunomagnetic isolation of B cells, it is suggested that DNA based methods must completely replace serology.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen ... more Fibrosing cholestatic hepatitis (FCH) is a severe and progressive form of liver dysfunction seen in organ transplant recipients and immunosuppressed patients; it is usually associated with hepatitis B virus infection. We report 36-year-old man, a renal transplant recipient, also developed FCH with hepatitis C virus infection and succumbed to it.
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