RESUMEN
Introduction: In view of ever-increasing end-stage renal disease (ESRD) population but inadequate availability of suitable donors, ABO-incompatible (ABOi) transplantation can be an important void filler. However, at present, ABOi transplantation is limited to a few centers in India and there is a lack of adequate experience and expertise to guide this program to other centers in the country. Methods: Data of all the ABOi transplants performed from 2012 to 2021 in a tertiary care hospital was retrospectively analyzed. The anti-ABO antibody (IgG) titers (≤1:4) were considered safe before transplantation. Desensitization included rituximab, plasma exchange, or selective immunoadsorption column. Tacrolimus and mycophenolate mofetil were initiated at day -7. Induction agents included ATG, ATLG, basiliximab, or no induction. Postoperatively, anti-ABO titers were done daily for 2 weeks. Results: A total of 202 patients underwent transplantation; of these, 195 patients whose data were for available for 12 months were included in the study. Mean duration of follow-up was 28.9 ± 21.7 months. UTI was the most common source of infection, occurring in almost half (46.1%) of the patients. Antibody-mediated rejection (ABMR; 15%) was common in the first year. Patient survival was 86.6% (169/195) at 1 year. Sepsis was the most common of death in more than two-thirds of the population, including coronavirus disease 2019 (COVID-19)-associated mortality in nine patients (4.6%). Death-censored graft survival was 89.3% (174/195). AMR was the leading cause of graft loss in almost half of the patients. Conclusion: ABOi should be considered in ESRD patients for whom suitable ABO-compatible donor is not available. Higher rate of rejection and infection are still a major concern.
RESUMEN
BACKGROUND: COVID-19 is a novel acute infection that is mainly manifested as acute respiratory disease. Information on coronavirus disease-2019 (COVID-19) in CKD patients who are not on dialysis is very limited. We are reporting a single-center observational study on the effect of COVID-19 in CKD patients. METHODS: A single-center retrospective study with consecutive patients who had eGFR <60 mL/min/1.73 m2 (CKD-EPI) admitted with COVID-19, from April to July 2020 were included. RESULT: A total of 30 patients were included in the study. Patients of CKD stage 5, 4 and 3 were 50%, 13.3%, and 36.6%, respectively. The mortality rate was 53.3%. Category wise, 9 were in mild; 3 in moderate, and 18 were in the severe COVID category. Twenty-five patients (83.3%) developed acute on CKD. Twenty patients (67%) required renal replacement therapy (RRT). The prognosis of patients who required RRT was poor. High LDH and IL-6 were significantly associated with mortality. Lymphopenia, present in 50% of cases was associated with fatal outcome. There was a 100% survival rate in mild to moderate cases and 11% in severe cases. CONCLUSION: Mortality among hospitalized CKD patients is high.
