Publications by authors named "Umesh Varyani"
Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19).
Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR.
Background: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors.
Methods: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes.
A 52 year old previously healthy woman from Mumbai presented with fever and jaundice of 10 days duration. At admission, she was jaundiced with tachycardia, tachypnea, hypoxia, hypotension, conjunctival congestion and mild erythematous flush over the skin. She had very high WBC counts and CRP's with direct hyperbilirubinemia and azotemia.
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- The study evaluated kidney paired donations (KPDs) as a viable method to boost living donor kidney transplants in a program where traditional methods are limited by costs and complications.
- Conducted at a single center, the research involved 77 KPD transplants, noting various reasons for KPD use including ABO incompatibility and sensitization, and highlighted an overall 25% increase in living donor transplants over one year.
- The findings showed high success rates with excellent graft and patient survival, and shorter waiting times for KPD compared to deceased donor transplants, emphasizing the importance of a well-organized KPD registry and counseling efforts.
Article Synopsis
- - One-third of living kidney donors are rejected due to ABO blood type incompatibility and donor-specific antibodies, which leads to longer wait times and increased health risks for patients in need of a kidney transplant.
- - Kidney paired donation has become a prominent way to boost the number of living kidney transplants, particularly in regions with limited resources where incompatible transplants are not feasible.
- - Strategies to enhance kidney paired donation include compatible pairs, altruistic donor chains, and leveraging social media for awareness, along with the establishment of dedicated teams or a national program to improve access and efficiency in matching donors and recipients.
Article Synopsis
- In countries with limited resources for kidney transplants, kidney paired donation (KPD) can effectively increase living donor kidney transplants (LDKT), as shown by a study in India involving 300 KPD transplants from 2000 to 2016.
- The most common reasons for patients joining KPD included ABO incompatibility, positive cross-match, and better matching, leading to a variety of exchange configurations that successfully facilitated these transplants.
- The program demonstrated excellent patient outcomes, with high graft and patient survival rates, and highlights the importance of registry maintenance, patient counseling, and a strong teamwork approach to optimize transplant success.
Article Synopsis
- The study reports the first international living related two-way kidney paired donation (KPD) transplantation from India, which occurred on February 17, 2015, following legal approval.
- The procedure involved donor-recipients from Portugal and India who were highly sensitized and ABO incompatible, with successful negative cross-matching confirming compatibility for the exchange.
- The results demonstrated that both pairs had successful surgeries with good kidney function at 11 months post-transplant, highlighting international KPD as a promising solution to kidney shortages and improving outcomes for difficult-to-match patients.
Aim: To avoid desensitization protocols and ABO incompatible kidney transplantation (KT) due to high costs and increased risk of infections from intense immunosuppression.
Methods: We present institutional ethical review board - approved study of single center 6-way kidney exchange transplantation. The participants comprised ABO incompatibility ( = 1); positive cross-match and/or presence of donor specific antibody ( = 5).
The combination of kidney paired donation (KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation (LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient.
View Article and Find Full Text PDFThe triad of hemolytic anemia, pancytopenia, and thrombosis makes paroxysmal nocturnal hemoglobinuria (PNH) a truly unique clinical syndrome. Intravascular hemolysis in PNH can lead to a severe hemolytic episode with massive hemoglobinuria which can cause acute kidney injury (AKI) probably from acute tubular necrosis (ATN). A 15 -year-old girl was admitted with history of fever, diarrhea, vomiting followed by decreased urine output since 3 days.
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