Parag Tilve’s research while affiliated with The Institute of Science, Mumbai and other places

Background The outcome of kidney transplantation is determined by multiple factors and infections represent one of the major factors affecting graft and patient survival. Recent COVID-19 pandemic have adversely affected the transplant population. Very little data is available on post-transplant infections and patient survival from India. Materials and Methods In this retrospective observational study, data related to post-transplant infections from patients who had undergone renal transplantation between October 2014 and October 2021 were collected. Results A total of 255 infections episodes were observed in 118 patients. Bacterial infections were the most common (55%) followed by viral (35%), fungal (5%), mycobacterial (4%), and parasitic (1%). The most common bacterial and viral infections were urinary tract infections (70.5%) and COVID-19 (56%), respectively. BK virus and COVID-19 were associated with increased graft loss (p < 0.05). The majority of deaths due to infections were related to COVID-19 infection (71.42%). Kaplan-Meier survival analysis showed 1-, 3-, and 5-year patient survival of 98.23%, 96.36%, and 92.90% and graft survival of 98.14%, 95.97%, and 91.78, respectively. Conclusion Infections with their adverse impact remain a concern in kidney transplant patients. Comparable patient and graft survival to the Western data despite the high infection burden and the COVID-19 pandemic suggests that effective management can reduce the impact of infections on survival.

Tuberculosis is endemic in India, with a prevalence of 8%–13% in kidney transplant patients. Atypical presentations have been described in immunocompromised individuals, and we present an unusual and rare case of isolated tuberculous involvement of the kidney allograft presenting 6 years posttransplant. Our patient presented with fever, poor appetite, and malaise of very short duration without ongoing weight loss; a normal urine examination as well as ultrasonography of allograft, requiring positron emission tomography-computed tomography to determine the source of infection. A vigilant approach with a high degree of suspicion in this case led to early detection and good outcomes.

Introduction: There are several studies of symptomatic hemodialysis patients with proven COVID-19 infection. However, there is paucity of data on asymptomatic COVID-19 infection in the outpatient hemodialysis population. The true prevalence and transmission of this infection in hemodialysis centres is unknown. This study was conducted across hemodialysis centers by testing all patients and staff for COVID-19 PCR and later for IgG antibody, irrespective of their symptoms. Methods: All 705 hemodialysis patients and 103 dialysis staff across nine centres, were tested for COVID-19 over a period of 54 days of the pandemic, and for COVID IgG antibody of available enrolled staff and patients, after 8 weeks of study termination. Results: The period prevalence of infection in patients and staff was 7.1% and 14.6% respectively. Mortality in patients was 18%, and all staff recovered. Clustering of patients and staff occurred at 3 of 9 centers. Of 26 HIV positive patients, only one contracted the COVID-19 infection and has recovered. Of those infected, seroconversion occurred in 80% of patients and 83% of staff. Seroconversion also occurred in 16% of patients and 37% of staff, who were asymptomatic and COVID PCR negative during the study period. Conclusions: Testing a patient only when symptomatic, identified only 26% (13/50) of infected patients. For every single symptomatic patient who tested positive, there were 3 other asymptomatic infected ones. There was a high seroconversion rates in infected subjects. But antibodies also developed in asymptomatic subjects, indicating silent transmission and antibody generation in this population.

Background: Chronic aluminum toxicity (CAT) in end stage kidney disease (ESKD) patients is now a rare clinical disorder, unlike in the past, because of improvements in hemodialysis water purification systems and discontinuation of use of aluminum hydroxide as a phosphate binder. The use of aluminum utensils for cooking could be an unrecognised cause of the CAT. Objective: To assess the association between aluminum kitchen utensils used for cooking meals and chronic aluminum toxicity (CAT) in patients on maintenance hemodialysis (MHD). Material and methods: In this case control study, a total of 31 (cases n=10; controls n=21) patients on MHD for more than one year were included. Cases were defined as patients with clinical manifestations (including laboratory parameters) of CAT and high (>200 mcg/L) serum aluminum levels. Control group was chosen from the same hemodialysis facilities. Association between use of aluminum utensils for cooking and occurrence of CAT was assessed. Results: The mean age of patients in the cases and the control group was 52.90 and 52.95 years respectively with on significant difference (p=0.99). There was no difference in mean duration of dialysis (p=0.78), serum calcium level (p=0.06), serum phosphate level (p=0.19), serum albumin level (p=0.06), history of hypertension (p=1.00) and history of diabetes (n=0.12) between two groups. Mean haemoglobin (p<0.05) and mean iPTH (p<0.05) was significantly lower in the cases as compared to control group. Thirteen patients had history of use of aluminum utensils [cases 10 (76.90%) and control 3 (23.10%); p<0.05]. All cases i.e. 10 (100%) had exposure to aluminum utensils whereas three (14.3%) patients in the control group had exposure to aluminum utensils whereas 18 (85.7%) patients had no exposure. The relative risk of having CAT because of use of aluminum utensils compared to not using was 28.46 (1.81 to 445.3) and the odd's ratio estimated was 120 (5.45 to 2642). Conclusion: Use of aluminum utensils for cooking meals is associated with CAT. Larger studies are required to confirm these findings.

Objective: To study the magnitude of the complication of catheter associated right atrial thrombus (CRAT) in patients with tunnelled central venous hemodialysis catheters (THC) for maintenance hemodialysis (MHD). Material and methods: A retrospective study was conducted among patients with end stage kidney disease (ESKD) with THC for MHD who had undergone screening for CRAT with a 2D-echo (2DE) just before removal of the THC. The occurrence of CRAT and other clinical parameters were documented in these patients. Results: A total of 28 patients (mean [SD] age 51 [15.2] years; females 17 [60.7%]) were included in the study. CRAT was observed in 5 (17.9%) patients. There was no difference in mean age in patients with or without thrombus (48±13.02 vs 51.61 ± 15.78 years; p = 0.61). History of diabetes and hypertension was present in 2 and all 5 patients respectively. There was no significant difference in the period the THC was in place in patients with or without CRAT (13±7.8 months vs 10.57±5.66 months; p = 0.54). There was no association between catheter related blood stream infection (CRBSI) and CRAT (p= 0.29). Conclusion: The incidence of CRAT in patients with THC for MHD was 17.9%. Patients with THC for MHD should be examined for presence of CRAT before removal of THC to prevent fatal pulmonary thromboembolism.

BACKGROUND Increasing deceased donor kidney donation is the only answer to fill the large gap between availability and need for organ donors. Deceased donor kidney transplant rates are picking up in the Southern and Western regions of India and there is a need to look at the outcomes at various institutes and share the experience. The objective of the study is to evaluate outcomes of deceased donor kidney transplants (DKT) done at a tertiary care centre in Mumbai. MATERIALS AND METHODS In this retrospective study, outcomes of all DKTs done from April 2012 to July 2017 were evaluated. Induction immunosuppression consisted of two to three doses of anti-thymocyte globulin (1.5 mg/kg per dose) and methylprednisolone pulses whereas maintenance immunosuppression regimen consisted of prednisolone, mycophenolate mofetil and tacrolimus. The data was analysed for demographic profile of recipients and donors, comorbidities in recipients, cause of kidney disease in recipients, waiting period on dialysis, delayed graft function, episodes of rejections, induction agents used, maintenance immunosuppressants, infection episodes, patient and graft survival and causes of death. RESULTS A total of 21 DKTs (52.4% male recipients) were performed during the study period. The mean (+ SD) age of recipients and donors was 46.71 (±10.6) and 47.8 (+13.5) years respectively. Incidence of biopsy proven acute cellular rejection was 9.5%. Patient survival at one, three and five years were 90.5%, 84.5% and 84.5% respectively. Four (19.04%) grafts were lost during the study period, three grafts were lost because of death of the patients (two at three months and one at 22 months posttransplant) and only one other graft was lost at 43 months with patient returning to dialysis. Three patients (14.3%) died during the study period; two due to sepsis and one due to cardiovascular disease. CONCLUSION Current study results suggest that DKT can be successfully carried out with good results even with the current limitations.