Four-Way Kidney Exchange Transplant With Desensitization Increases Access to Living-Donor Kidney Transplant: First Report From India.

OBJECTIVES: This study reports our experience of the first 4-way kidney exchange transplant combined with desensitization in India, which allows increased access to living-donor kidney transplant for sensitized patients. MATERIALS AND METHODS: Four-way kidney exchange transplant procedures were approved by the ethics committee of our institution and the Organ Transplantation Authorization Committee of state governments of India (as per the Transplantation of Human Organs Act of India). The protocols conformed to Declaration of Istanbul principles and the ethical guidelines of the 1975 Helsinki Declaration. Written informed consent was obtained from patients, donors, and their guardians. RESULTS: In April 2016, our transplant team completed simultaneous 4-way kidney exchange transplant procedures without any medical (rejection and infections) or surgical complications. Reasons for being included for kidney exchange transplant were ABO incom-patible (2 recipients) and sensitization (2 recipients). All 4 recipients had stable graft function with no proteinuria and donor-specific antibody at 11-month follow-up on standard triple immunosup-pression. Patient and graft survival rates were both 100%. CONCLUSIONS: To the best of our knowledge, this is the first single-center report of 4-way kidney exchange transplant combined with desensitization from India. This procedure has the potential to expand living-donor kidney transplant in disadvantaged groups (eg, sensitized patients). Recipients who are hard to match due to high panel reactive antibody and difficult to desensitize due to strong donor-specific antibodies can receive a transplant with a combination of kidney exchange and desensitization. Our study suggests that 4-way kidney exchange transplant can be performed in developing countries (India) similar to that shown in programs in developed countries with team work, kidney exchange registry, and counseling.

Transabdominal Ultrasonography-Defined Optimal and Definitive Bladder-Filling Protocol With Time Trends During Pelvic Radiation for Cervical Cancer.

PURPOSE: Advanced radiotherapy techniques have emphasized on the importance of accurate target volume localization and delineation. The aim of this study was to determine time taken to achieve moderate bladder volume under physiological conditions, using transabdominal ultrasound. MATERIALS AND METHODS: Patients with cervical cancer undergoing radical radiation with or without concomitant chemotherapy underwent serial ultrasound to estimate bladder filling. With a strict bladder protocol of consuming 1000 mL of water orally over 30 minutes after emptying the bladder, ultrasound was done after 45 minutes from bladder emptying time and repeated at 15-minute interval till 300 (25) mL filling was achieved and repeated every week. RESULTS: Forty-six patients with weekly ultrasound for bladder-filling documentation were evaluated. The mean (standard deviation) bladder volume measured at 45 minutes was 220 (93), 210 (95), 195 (91), 195 (96), and 190 (85) mL (average: 200; median: 195 mL) for the first to fifth week, respectively, and the mean (standard deviation) volume at 75 minutes was 300 (95), 310 (80), 290 (80), 295 (80), and 285 (70) mL (average: 295; median: 300 mL). The mean (standard deviation) time for bladder filling to 300 mL in the first, second, third, fourth, and fifth week was 57 ( 13.5), 67 (16.6), 66 (16.7), 66 (15.5), and 69 (17.1) minutes, respectively. CONCLUSION: Bladder filling to a definitive moderate volume at a reasonably fixed time period in each week of radiation is well tolerated, feasible, and measurable by weekly transabdominal ultrasound measurements.

Radiation therapy for early stage unfavorable Hodgkin lymphoma: is dose reduction feasible?

One hundred and fifty-one patients aged between 3 and 70 years with early stage unfavorable Hodgkin lymphoma were included. Patients received 4-6 cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) chemotherapy and involved field radiation therapy (IFRT). The most common histology was mixed cellularity (43%). The majority had stage IIAX disease. IFRT doses were 25.2 Gy/14 fractions and 34.2 Gy/19 fractions for adults with a complete response (CR) and partial response (PR), respectively, while the doses were 19.8 Gy/11 fractions and 30.6 Gy/17 fractions, respectively, for children. After 60 months (median), the 10-year progression-free survival (PFS) and overall survival (OS) were 88.4% and 93.2%, respectively. On univariate analysis, prognostic factors with significant impact on PFS were age ≥ 18 years, nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) histology, extranodal disease and response to treatment. Extranodal disease had a significant impact on OS. On multivariate analysis, NLPHL histology (p = 0.001) and response at 3 months (p = 0.000) had a significant impact on PFS. There were no in-field relapses in patients with bulky disease receiving RT doses > 25.2 Gy. Chemotherapy related acute pulmonary toxicity was documented in 21.4% and 4.8% of patients after six and four cycles of ABVD chemotherapy (p = 0.041). Four cycles of ABVD and reduced dose IFRT resulted in optimal outcomes.