34 results on '"Kohli, H."'
Search Results
2. Conversion from tacrolimus to cyclosporine in patients with new-onset diabetes after renal transplant: an open-label randomized prospective pilot study.
- Author
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Rathi M, Rajkumar V, Rao N, Sharma A, Kumar S, Ramachandran R, Kumar V, Kohli HS, Gupta KL, and Sakhuja V
- Subjects
- Adult, Diabetes Mellitus etiology, Female, Follow-Up Studies, Graft Rejection complications, Humans, Immunosuppressive Agents therapeutic use, Incidence, India epidemiology, Kidney Failure, Chronic surgery, Male, Pilot Projects, Prospective Studies, Cyclosporine therapeutic use, Diabetes Mellitus epidemiology, Graft Rejection prevention & control, Kidney Transplantation adverse effects, Tacrolimus therapeutic use
- Abstract
Background: New-onset diabetes after transplant (NODAT) is associated with serious morbidity and mortality. The incidence of NODAT is higher with tacrolimus (Tac) compared with cyclosporine (CsA); however, the effects of switching from Tac to CsA in NODAT have not been studied well., Materials and Methods: This was a single-center, open-label, prospective, randomized study, including renal transplant recipients who were on Tac-based immunosuppression and developed NODAT. Those with pretransplant diabetes, hypersensitivity to CsA or Tac, severe infections, and denying consent were excluded. Subjects were randomized to either switch to CsA or to continue on Tac. Fasting and postprandial plasma glucose, fasting insulin and C-peptide levels, insulin and oral hypoglycaemic agents (OHA) use were monitored monthly for 3 months, whereas glycosylated haemoglobin (HbA1c) was checked at baseline and 3 months., Results: Sixty-seven subjects were randomized to switch to CsA (n = 32) or continuation of Tac (n = 35). Both groups had similar baseline characteristics. After randomization, there was significant improvement in fasting plasma glucose, fasting insulin levels, C-peptide levels, and insulin requirement in both groups, whereas HbA1c improved significantly only in the CsA group. The decline in fasting plasma glucose and insulin requirement was more significant in subjects on CsA. An equal number of subjects in each group (59.4% in CsA group and 40% in Tac group, P = ns) had resolution of NODAT. Weight gain was more significant in the CsA group; however, there was no difference in other side effects or rejection episodes., Conclusions: A switch from tacrolimus to cyclosporine is a safe and effective strategy in patients with NODAT., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
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3. Tear flow study in renal transplant patients receiving cyclosporine A.
- Author
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Jain AK, Sukhija J, Sakhuja V, Kohli HS, and Sud K
- Subjects
- Adolescent, Adult, Female, Graft Rejection metabolism, Graft Rejection prevention & control, Humans, Kidney Failure, Chronic metabolism, Male, Middle Aged, Transplantation, Homologous, Cyclosporine therapeutic use, Immunosuppressive Agents therapeutic use, Kidney Failure, Chronic surgery, Kidney Transplantation, Tears metabolism
- Abstract
We studied tear flow in 23 renal transplant patients receiving cyclosporine A. Four minute Schirmer test was done once before and three times after starting cyclosporine A. Average tear flow was 9.7+/-0.9 before treatment and 15.9+/-1.1 at 1-2 months after renal transplant, 16.5+/-1.3 at 3-5 months and 17.6+/-1.4 at 8-10 months. Tear flow was significantly increased following oral cyclosporine treatment.
- Published
- 2008
4. The utility of 1- and 3-month protocol biopsies on renal allograft function: a randomized controlled study.
- Author
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Kurtkoti J, Sakhuja V, Sud K, Minz M, Nada R, Kohli HS, Gupta KL, Joshi K, and Jha V
- Subjects
- Adult, Cyclosporine adverse effects, Cyclosporine therapeutic use, Female, Follow-Up Studies, Histocompatibility Testing, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Kidney Function Tests, Kidney Transplantation immunology, Male, Middle Aged, Monitoring, Intraoperative, Time Factors, Biopsy, Kidney Transplantation pathology, Kidney Transplantation physiology, Living Donors
- Abstract
Identification of pathological events in the renal allograft using protocol biopsies at predetermined time intervals may yield useful information and improve outcomes. We examined the influence of decisions taken on the basis of 1- and 3-month protocol biopsies findings on 1-year renal allograft function in a prospective randomized study. Out of 102 living-donor allograft recipients, 52 were randomized to undergo protocol biopsies and 50 controls had only indicated biopsies. All acute rejection (AR) episodes (clinical and subclinical) were treated. Calcineurin inhibitor (CNI) dose adjustments were made on clinical judgment. Baseline recipient and donor characteristics, immunosuppressive drug usage, HLA matches and 2-h cyclosporine levels were similar in both groups. At 1 and 3 months, protocol biopsies revealed borderline (BL) changes in 11.5% and 14% patients, AR in 17.3% and 12% and chronic allograft nephropathy (CAN) in 3.8% and 10%. The incidence of clinically evident AR episodes was similar in the two groups, but biopsy group had lower serum creatinine at 6 months (p = 0.0003) and 1 year (p < 0.0001). The renal functions were similar in those with normal histology and BL changes. Protocol biopsies are helpful in detecting subclinical histological changes in the graft and improving short-term renal allograft function.
- Published
- 2008
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5. Treatment of oropharyngeal cancer in renal transplant recipients without cessation of immunosuppressive therapy.
- Author
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Singh SK, Gupta AK, Jha V, Kohli HS, Gupta KL, Minz M, and Sakhuja V
- Subjects
- Adolescent, Adult, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Immunosuppressive Agents adverse effects, Kidney Transplantation immunology, Oropharyngeal Neoplasms therapy
- Abstract
Introduction: Renal transplantation and immunosuppression are associated with an increased incidence of malignancy. Reduction or cessation of immunosuppressive therapy has been advocated in these cases to prevent tumor progression and recurrence. We evaluated the outcome of treatment of oropharyngeal cancer (OC) after renal transplantation without cessation of immunosuppressive therapy., Methods: The database of patients with OC after renal transplantation was analyzed with respect to age, sex, type of immunosuppression, interval between transplantation and diagnosis of cancer, as well as method of treatment and survival., Results: Thirty one (2.06%) renal transplant recipients developed malignancy including 6 (20%) with OC. Lingual cancer was seen in three, and one each showed an isolated tonsillar lymphoma, a parotid carcinoma, or a carcinoma of the larynx with only the last having had two other malignancies in the past. Three subjects were on immunosuppression with azathioprine and prednisolone, and the others were prescribed cyclosporine and prednisolone. Average time from transplantation to diagnosis of OC was 106 months. The interval was the shortest (2 years) for tonsillar lymphoma in an 18-year-old patient who received cyclosporine and showed features of left follicular tonsillitis. The patient with advanced carcinoma of the larynx did not receive any treatment and succumbed within 3 months. The dose of cyclosporine was reduced in the lymphoma case but immunosuppression was not altered in the other patients. All subjects were treated with a standard protocol. During a mean follow-up of 33 months, one had local recurrence of parotid carcinoma and the others showed well functioning renal grafts., Conclusion: Comprehensive treatment of OC after renal transplantation without withdrawing the immunosuppression prolonged the life of these patients with functioning grafts.
- Published
- 2006
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6. Unusual causes of ureteral obstruction in renal allografts: case reports.
- Author
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Singh SK, Sakhuja V, Sharma SK, Mandal AK, Gupta KL, Kohli HS, Sud K, and Jha V
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- Adult, Aged, Female, Humans, Male, Middle Aged, Kidney Transplantation adverse effects, Nephrostomy, Percutaneous methods, Ureteral Obstruction etiology, Ureteral Obstruction surgery
- Published
- 2003
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7. Evaluation of different sampling times for best prediction of cyclosporine area under the curve in renal transplant recipients.
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Sud K, Singh B, Kohli HS, Jha V, Gupta KL, and Sakhuja V
- Subjects
- Adult, Area Under Curve, Creatinine blood, Cyclosporine blood, Female, Humans, Immunosuppressive Agents blood, Immunosuppressive Agents pharmacokinetics, Kidney Transplantation immunology, Male, Regression Analysis, Time Factors, Cyclosporine pharmacokinetics, Kidney Transplantation physiology
- Published
- 2002
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8. Postrenal transplant erythrocytosis: risk factors and effectiveness of angiotensin receptor antagonists.
- Author
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Singh V, Sud K, Mittal BR, Kohli HS, Gupta KL, and Sakhuja V
- Subjects
- Angiotensin-Converting Enzyme Inhibitors adverse effects, Azathioprine adverse effects, Azathioprine therapeutic use, Blood Pressure physiology, Creatinine blood, Cyclosporine adverse effects, Cyclosporine therapeutic use, Erythrocyte Count, Female, Graft Rejection epidemiology, Hematocrit, Hemoglobins analysis, Humans, Kidney Transplantation physiology, Male, Polycythemia drug therapy, Postoperative Complications drug therapy, Prospective Studies, Renal Artery Obstruction epidemiology, Retrospective Studies, Risk Factors, Smoking, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Kidney Transplantation adverse effects, Polycythemia epidemiology, Postoperative Complications epidemiology
- Published
- 2002
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9. Visceral leishmaniasis: a rare cause of post-transplant fever and pancytopenia.
- Author
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Rajaram KG, Sud K, Kohli HS, Gupta KL, and Sakhuja V
- Subjects
- Adult, Animals, Humans, Leishmaniasis, Visceral drug therapy, Male, Antimony Sodium Gluconate therapeutic use, Antiprotozoal Agents therapeutic use, Kidney Transplantation adverse effects, Leishmania donovani isolation & purification, Leishmaniasis, Visceral diagnosis, Leishmaniasis, Visceral therapy, Pancytopenia therapy
- Abstract
Despite the endemic distribution of visceral leishmaniasis in certain parts of our country, there are only a few reports of this infection in renal transplant recipients. We report one renal transplant recipient from non-endemic area with visceral leishmaniasis and graft dysfunction that responded to treatment with stibogluconate. The infection should be considered in the differential diagnosis of a febrile transplant recipient with pancytopenia and allograft dysfunction.
- Published
- 2002
10. Increasing incidence of cytomegalovirus disease in Indian renal transplant recipients on cyclosporine immunosuppression.
- Author
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Sakhuja V, Jha V, Joshi K, Nada R, Sud K, Kohli HS, Gupta KL, and Sehgal S
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- Humans, Incidence, India epidemiology, Organ Specificity, Postoperative Complications epidemiology, Postoperative Complications immunology, Postoperative Complications virology, Retrospective Studies, Cyclosporine therapeutic use, Cytomegalovirus isolation & purification, Cytomegalovirus Infections epidemiology, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology
- Published
- 2001
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11. Central nervous system complications in renal transplant recipients in a tropical environment.
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Sakhuja V, Sud K, Kalra OP, D'Cruz S, Kohli HS, Jha V, Gupta K, and Vasishta RK
- Subjects
- Adolescent, Adult, Chi-Square Distribution, Humans, Kidney Transplantation mortality, Retrospective Studies, Central Nervous System Infections etiology, Kidney Transplantation adverse effects, Lymphoma etiology, Postoperative Complications, Tropical Climate adverse effects
- Abstract
Renal transplant recipients are at risk of developing various infectious and non-infectious complications affecting the central nervous system (CNS). There is paucity of data regarding the spectrum of CNS complications and the epidemiology of infective agents varies according to geographical location. We retrospectively studied the spectrum of CNS complications seen in 792 renal allograft recipients followed up at this tertiary care centre in north India over a 19-year period. Autopsy findings of 78 allograft recipients who died in the hospital were also reviewed and included. The brain was examined in 22 of these patients. Overall, 79 (10%) patients developed some form of CNS dysfunction with a mortality rate of 60.8%. CNS infections occurred in 31 renal allograft recipients (3.9% of total) and accounted for the largest group (39.2%). Fungi were the commonest etiological agents (21 patients) and were associated with a 70% mortality, with cryptococcal meningitis occurring in 12, mucormycosis in six, aspergillosis in one, and other unusual fungal infections in the remaining two patients. All patients with mucormycosis had a fatal outcome. The second largest group comprised of patients with non-uremic encephalopathies (23 patients, 29.1%) with metabolic encephalopathy occurring in 13, toxic encephalopathy in nine and hypertensive encephalopathy in one patient) and was associated with an overall mortality rate of 60.9%. Cerebrovascular accidents occurred in 12 patients (15.2%) and were associated with a mortality of 91.7%. Other CNS complications included treatment related complications in four (5.1%), primary CNS lymphomas in three (3.8%), and miscellaneous complications in six patients (7.6%). Patients with non-cryptococcal fungal infections of the CNS, hepatic and toxic encephalopathy and those with cerebrovascular accidents had the worst outcome. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. We conclude that complications involving the CNS occur in 10% of all renal transplant recipients and are associated a with high mortality, warranting early diagnosis and aggressive treatment.
- Published
- 2001
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12. Impact of cyclosporine withdrawal on living related renal transplants: a single-center experience.
- Author
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Jha V, Muthukumar T, Kohli HS, Sud K, Gupta KL, and Sakhuja V
- Subjects
- Adult, Azathioprine administration & dosage, Cause of Death, Creatinine blood, Cyclosporine economics, Drug Costs, Female, Follow-Up Studies, Graft Rejection mortality, Humans, Immunosuppressive Agents economics, India, Male, Muromonab-CD3 administration & dosage, Prednisolone administration & dosage, Retrospective Studies, Treatment Outcome, Cyclosporine administration & dosage, Immunosuppressive Agents administration & dosage, Kidney Transplantation
- Abstract
High treatment costs force the discontinuation of cyclosporine (CSA) in a vast majority of renal transplant recipients in India. The impact of CSA withdrawal among 108 living related renal transplant recipients 12.54 +/- 4.2 months after transplantation was studied retrospectively. In 83 patients, CSA was withdrawn over a 12-week period (group I). Azathioprine dosage was increased to 2 to 2.5 mg/kg/d, and prednisolone, to 30 mg/d 2 weeks and 1 week before starting CSA withdrawal, respectively. In the other 25 patients, CSA had to be withdrawn faster (mean, 28.52 +/- 14.18 days; group II). Twenty-nine rejection episodes (26.9%) were noted in 22 patients (20.4%; 19% in group I and 52% in group II; P: = 0.008). Fifteen group-I patients (18%) and 11 group-II patients (44%) died or lost their grafts (P: = 0.017). There was no difference in age, donor source, HLA matches, pretransplantation cross-match positivity, delayed graft function, immunosuppressive drug doses, rejection episodes, or prewithdrawal serum creatinine levels between the patients who did or did not develop acute rejection after CSA withdrawal. On follow-up, 10 patients (50%) died or returned to dialysis among the rejection group compared with 16 patients (18%) in the nonrejection group (P: = 0.007). The mean creatinine level at last follow-up was greater in the rejection group (3.97 +/- 2.54 versus 1.65 +/- 1.1 mg/dL; P: < 0.001). CSA withdrawal because of economic constraints carries a significant risk for acute rejection and death and/or graft loss in Indian living donor renal transplant recipients, even after 12 months.
- Published
- 2001
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13. Isoniazid does not affect bioavailability of cyclosporine in renal transplant recipients.
- Author
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Sud K, Muthukumar T, Singh B, Garg SK, Kohli HS, Jha V, Gupta KL, and Sakhuja V
- Subjects
- Acetylation drug effects, Acetyltransferases metabolism, Adolescent, Adult, Area Under Curve, Biological Availability, Cyclosporine blood, Drug Interactions, Humans, Immunosuppressive Agents blood, Metabolic Clearance Rate, Middle Aged, Tuberculosis drug therapy, Antitubercular Agents pharmacology, Cyclosporine pharmacokinetics, Immunosuppressive Agents pharmacokinetics, Isoniazid pharmacology, Kidney Transplantation physiology
- Abstract
Transplant recipients are predisposed to develop opportunistic infections such as tuberculosis, and isoniazid (INH) is used in most antitubercular therapeutic and prophylactic protocols. Cyclosporine (CyA) bioavailability increases with the concomitant use of drugs that inhibit hepatic cytochrome P-450 enzymes. There are conflicting reports on a possible interaction between the two drugs. Seven renal transplant recipients on CyA (Sandimmun Neoral) with slow acetylation status and also requiring concomitant INH prophylaxis (300 mg/day) against tuberculosis were studied. There were no significant changes in CyA pharmacokinetic parameters including CyA trough levels, total CyA exposure and CyA clearance before and 2 weeks after instituting INH prophylaxis. There was also no statistically significant correlation between INH levels and changes in CyA pharmacokinetic parameters before and after administration of INH. Even after all post-INH pharmacokinetic parameters were adjusted for INH levels, the differences in the above pre- and post-INH parameters did not reach statistical significance. Renal function during the study period remained constant and there were no episodes of CyA toxicity or acute rejection during and up to 4 weeks of INH treatment. We conclude that concomitant administration of INH and CyA is safe and is not associated with any appreciable alterations in the bioavailability of CyA.
- Published
- 2000
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14. First report of tropical myositis and crescentic glomerulonephritis in a renal transplant recipient.
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Jha V, Swaminathan S, Joshi K, Kohli HS, Sud K, Gupta KL, and Sakhuja V
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- Adult, Disseminated Intravascular Coagulation etiology, Fatal Outcome, Glomerulonephritis pathology, Humans, Kidney pathology, Male, Glomerulonephritis etiology, Kidney Transplantation pathology, Myositis etiology
- Abstract
We describe a renal transplant recipient who presented with tropical myositis and acute allograft dysfunction 2(1/2) years after transplantation. Graft biopsy showed immune-complex crescentic glomerulonephritis. He was receiving only 7.5 mg/d of prednisolone for more than 2 months before presentation. Renal function did not improve despite treatment with antibiotics, methylprednisolone pulse therapy, and cyclophosphamide. He died of septicemia.
- Published
- 1999
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15. Successful management of pulmonary tuberculosis in renal allograft recipients in a single center.
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Jha V, Sakhuja V, Gupta D, Krishna VS, Chakrabarti A, Joshi K, Sud K, Kohli HS, and Gupta KL
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- Adolescent, Adult, Cytomegalovirus Infections etiology, Female, Humans, Male, Middle Aged, Pneumonia, Pneumocystis etiology, Prospective Studies, Radiography, Time Factors, Transplantation, Homologous, Tuberculosis, Pulmonary diagnostic imaging, Tuberculosis, Pulmonary etiology, Kidney Transplantation adverse effects, Tuberculosis, Pulmonary drug therapy
- Abstract
Background: Pulmonary infections, especially tuberculosis, are responsible for significant mortality and morbidity among renal transplant recipients in developing countries. Conventional diagnostic modalities are associated with a low yield, delaying specific therapy., Methods: All patients transplanted within a 1.5-year period were prospectively followed-up for one year. Patients were on a cyclosporine-based triple immunosuppressive regimen. None received isoniazid prophylaxis, and those transplanted in the last seven months of the study period received daily cotrimoxazole. Patients exhibiting unequivocal evidence of pulmonary infections underwent further evaluation. Search for offending organisms was made by sputum examination and bronchoalveolar lavage (BAL)., Results: . Thirty-nine infection episodes were recorded in 34 patients. M. tuberculosis was isolated during 10 episodes, pyogenic bacteria and Pneumocystis carinii in 6 each, candida in 4, aspergillus in 3, cytomegalovirus (CMV) in 3, and nocardia and mucor in one episode each. More than one organism was isolated during five episodes. Bacterial pneumonia and tuberculosis were diagnosed in another seven and two patients, respectively, on the basis of a therapeutic response to specific chemotherapy. Over two thirds of the organisms were identified by examination of BAL fluid. BAL was useful in the diagnosis of tuberculosis and P. carinii pneumonia but was relatively insensitive for CMV and bacterial infections. An increased frequency of acute rejection and higher serum creatinine were factors that predisposed to infections. All patients with pulmonary tuberculosis made a full recovery., Conclusions: Tuberculosis and P. carinii are the most common nonpyogenic infections in the first year after transplantation in developing countries. An aggressive search for tubercle bacilli should be made using bronchoscopy and examination of BAL fluid in patients not responding to a short trial of antibiotics. A four-drug regime without rifampicin given for 18 months is effective for pulmonary tuberculosis in patients on cyclosporine. We recommend routine prophylactic use of one single-strength tablet of cotrimoxazole daily for at least six months after transplantation.
- Published
- 1999
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16. Laryngeal tuberculosis in renal transplant recipients.
- Author
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Jha V, Kohli HS, Sud K, Gupta KL, Minz M, Joshi K, and Sakhuja V
- Subjects
- Adult, Humans, Male, Middle Aged, Opportunistic Infections complications, Kidney Transplantation adverse effects, Tuberculosis, Laryngeal complications
- Abstract
Background: Tuberculosis is the most common non-pyogenic infection encountered among renal transplant recipients in India. Although the lung is the most common site of involvement, a number of extrapulmonary organs can be involved. There is often a delay in diagnosis and institution of effective chemotherapy when there is an unusual site of involvement., Methods and Results: We report two renal transplant recipients with laryngeal tuberculosis who presented with prolonged hoarseness of voice and painful dysphagia. Acid-fast bacilli were demonstrated on laryngeal biopsy and smear. Fever and pulmonary involvement were seen in only one patient. This is the first report of laryngeal tuberculosis in renal transplant recipients., Conclusions: Laryngeal tuberculosis should be suspected in renal transplant recipients who develop hoarseness of voice and odynophagia. Demonstration of acid-fast bacilli on biopsy or smear obtained by direct laryngoscopy helps in determining the diagnosis.
- Published
- 1999
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17. Unpredictable cyclosporin--fluconazole interaction in renal transplant recipients.
- Author
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Sud K, Singh B, Krishna VS, Thennarasu K, Kohli HS, Jha V, Gupta KL, and Sakhuja V
- Subjects
- Adult, Biological Availability, Creatinine blood, Cross-Over Studies, Cyclosporine pharmacokinetics, Drug Interactions, Female, Humans, Male, Middle Aged, Prospective Studies, Antifungal Agents therapeutic use, Cyclosporine therapeutic use, Fluconazole therapeutic use, Immunosuppressive Agents therapeutic use, Kidney Transplantation
- Abstract
Background: Cyclosporin (CsA) is metabolized primarily in the liver by cytochrome P-450 enzymes. Concomitant use of fluconazole can increase CsA concentrations by inhibiting this enzyme system and the effect seems to be dose dependent, with no interaction noted when fluconazole is used in a dose of 100 mg/day. Two previous investigations studying this interaction while using higher doses of fluconazole have provided inconsistent results. Recommendations advising an empirical 50% CsA dosage reduction in these patients have not been tested in a prospective trial., Methods: We studied six renal transplant recipients on CsA immunosuppression in a prospective, unblinded, crossover trial. Baseline renal functions, CsA area under the curve (AUC), Cmax, Cmin, CsA clearance, and Tmax were compared with those 2, 4 and 7 days after starting fluconazole orally in a dose of 200 mg/day. From day 8 onwards, patients reduced CsA dose by 50% and the above parameters were repeated on day 14., Results: CsA AUC increased from 2887 +/- 1729 ng.h/ml on day 0 to 3842 +/- 1975 ng.h/ml on day 2 (P < 0.05), 4750 +/- 1718 ng.h/ml on day 4 (P< 0.01) and then decreased to 4052 +/- 1687 ng.h/ml on day 7 (P<0.01). Following CsA dose reduction by 50%, the mean AUC decreased significantly to 2330 +/- 1602 ng x h/ml (P<0.01). The Cmax showed a significant increase from 701 +/- 345 ng/ml on day 0 to 941 +/- 326 ng/ml (P < 0.01) on day 4 but decreased from 768 +/- 292 ng/ml on day 7 to 498 +/- 289 ng/ml on day 14, P<0.01. The mean Cmin increased from 207 +/- 138 ng/ml on day 0 to 274 +/- 168 ng/ml on day 4. No significant changes were observed in CsA clearance and Tmax. On repeated-measurement ANOVA, only the AUC and Cmax on day 4 of fluconazole were significantly higher than day 0 (P<0.001). There was a large interindividual variability in the degree of drug interaction between patients., Conclusions: Fluconazole given orally in a dose of 200 mg/day is associated with significant increase in bioavailability of CsA. The maximum effect occurs on day 4 after starting fluconazole. Although repeated monitoring of CsA Cmin is convenient as opposed to repeated determination of AUC, changes in Cmin may not be sensitive enough to pick up this interaction. The increase in bioavailability of CsA is unpredictable in individual patients and all patients should be monitored with AUC near day 4 of treatment to guide CsA dosage reductions.
- Published
- 1999
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18. Disseminated histoplasmosis 19 years after renal transplantation.
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Jha V, Sree Krishna V, Varma N, Varma S, Chakrabarti A, Kohli HS, Sud K, Gupta KL, and Sakhuja V
- Subjects
- Adult, Histoplasmosis diagnosis, Humans, Immunocompromised Host, Male, Postoperative Complications, Time Factors, Histoplasmosis etiology, Kidney Transplantation
- Abstract
Infections with fungi like Histoplasma are rarely seen in immunocompromized patients. We report the case of a renal transplant recipient who presented with fever and was diagnosed to have disseminated histoplasmosis 19 years after transplant. The pitfalls in making a diagnosis in non-endemic areas are discussed. The literature on renal transplantation recipients with histoplasmosis has been reviewed.
- Published
- 1999
19. Cyclosporin-induced haemolytic-uraemic syndrome presenting as primary graft dysfunction.
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Kohli HS, Sud K, Jha V, Gupta KL, Minz M, Joshi K, and Sakhuja V
- Subjects
- Adult, Humans, Male, Cyclosporine adverse effects, Hemolytic-Uremic Syndrome chemically induced, Immunosuppressive Agents adverse effects, Kidney Transplantation
- Published
- 1998
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20. Azathioprine-induced hepatic veno-occlusive disease in a renal transplant recipient: histological regression following azathioprine withdrawal.
- Author
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Kohli HS, Jain D, Sud K, Jha V, Gupta KL, Sakhuja V, and Joshi K
- Subjects
- Azathioprine therapeutic use, Hepatic Veno-Occlusive Disease pathology, Humans, Liver pathology, Male, Middle Aged, Azathioprine adverse effects, Hepatic Veno-Occlusive Disease chemically induced, Kidney Transplantation
- Published
- 1996
21. Subcutaneous phaeohyphomycosis in a renal transplant recipient: a case report and review of the literature.
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Jha V, Krishna VS, Chakrabarti A, Sharma PK, Sud K, Kohli HS, and Sakhuja V
- Subjects
- Adult, Dermatomycoses microbiology, Humans, Male, Dermatomycoses immunology, Immunocompromised Host immunology, Kidney Transplantation immunology, Phialophora
- Abstract
Subcutaneous phaeohyphomycosis caused by dematiaceous fungi has rarely been described in immunocompromised patients. We report a case of subcutaneous infection caused by Phialophora parasitica in a renal transplant recipient. The role of early identification of the offending fungal species followed by a wide local excision in the management of such patients has been discussed.
- Published
- 1996
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22. 99m Tc DTPA scan as a diagnostic marker of acute rejection in renal transplantation.
- Author
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Kohli HS, Gupta A, Arora P, Mishra VK, Kher V, Bhandari M, Ghambir S, Kumar A, Sharma RK, and Das BK
- Subjects
- Adult, Cyclosporine administration & dosage, Female, Follow-Up Studies, Graft Rejection drug therapy, Humans, Kidney Tubular Necrosis, Acute diagnostic imaging, Male, Middle Aged, Postoperative Complications drug therapy, Predictive Value of Tests, Radionuclide Imaging, Technetium Tc 99m Pentetate, Graft Rejection diagnostic imaging, Kidney Transplantation immunology, Postoperative Complications diagnostic imaging
- Abstract
Forty renal transplant recipients were subjected to 99m Technicium Diethylene triamine pentacetic acid (DTPA)scans at regular intervals & whenever there was suspection of rejection. Serial scans of a group of 15 recipients from immediate post transplant period till withdrawal of cyclosporine were analysed separately & the results compared to with single scan analysis. The sensitivity & specificity of DTPA scan in the absence of acute tubular necrosis (ATN) was 94.1% & 87.5%, while the positive & negative predictive values were 88.8 & 93.3% respectively. Sensitivity & specificity of serial scan analysis (88.8% and 75%) in early post transplant period was higher than that of interpretation of single scan (75% & 66%). Serial scan changes predated clinical rejection during cyclosporine withdrawal period. We conclude that DTPA scan is both a sensitive & specific non-invasive diagnostic marker of acute rejection in absence of ATN & serial scans during early post transplant period & at the time of cyclosporine withdrawal are helpful in detecting the rejection accurately & at the earliest.
- Published
- 1994
23. Low-dose dexamethasone--an alternative therapy for acute renal allograft rejection.
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Kher V, Kohli HS, Mishra V, Sharma RK, and Bhandari M
- Subjects
- Acute Disease, Adult, Graft Rejection pathology, Histocompatibility Testing, Humans, Immunosuppressive Agents therapeutic use, Kidney Transplantation pathology, Prospective Studies, Transplantation, Homologous, Dexamethasone therapeutic use, Graft Rejection drug therapy, Kidney Transplantation immunology, Methylprednisolone therapeutic use
- Published
- 1992
24. Missed Monoclonal Disease Manifesting in Early Post-renal Transplant Period.
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Singh, N., Pattanashetti, N., Joshi, K., Kohli, H. S., Gupta, K. L., and Ramachandran, R.
- Subjects
TREATMENT of chronic kidney failure ,BIOPSY ,BLOOD transfusion ,CARDIAC arrest ,CHRONIC kidney failure ,DIABETIC nephropathies ,GRAFT rejection ,HEMODIALYSIS ,KIDNEY transplantation ,MULTIPLE myeloma ,PLASMAPHERESIS ,POSTOPERATIVE period ,SURGICAL complications ,ACUTE kidney tubular necrosis ,DISEASE complications ,SURGERY - Abstract
A 63-year-old diabetic gentleman with microvascular complications presented with advanced azotemia and anemia. He was stabilized with blood transfusion and hemodialysis. With the probable diagnosis of diabetic nephropathy-related end-stage renal disease, he underwent kidney transplantation. He had delayed graft function. Graft biopsy done on the 2
nd postoperative day showed acute tubular necrosis. Graft biopsy repeated after 2 weeks for persistent graft dysfunction showed myeloma cast nephropathy (MCN) and light chain proximal tubulopathy. Work-up for multiple myeloma was positive. He was started on plasmapheresis and chemotherapy. However, he suffered sudden cardiac death during dialysis after 1 week. The presence of MCN in the early graft biopsy implies that it must have been the cause for his native kidney failure. Thus, renal failure in a diabetic should not always be presumed to be due to diabetic nephropathy, and kidney biopsy should be done in diabetics with atypical features. [ABSTRACT FROM AUTHOR]- Published
- 2019
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25. Infection Prevention and Control Guidelines for COVID.
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Mahajan, Sandeep, Kohli, H. S., Gupta, K. L., Prasad, Narayan, and Agarwal, Sanjay K.
- Subjects
- *
TREATMENT of chronic kidney failure , *CHEMOPREVENTION , *PREVENTION of communicable diseases , *HAND washing , *KIDNEY transplantation , *MEDICAL protocols , *PERSONAL protective equipment , *SANITATION , *TRANSPLANTATION of organs, tissues, etc. , *COVID-19 - Published
- 2020
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26. A Single-center Experience of Kidney Transplantation from Donation after Circulatory Death: Challenges and Scope in India.
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Singh, S., Kumar, S., Dasgupta, S., Kenwar, D. B., Rathi, M., Sharma, A., Kohli, H. S., Jha, V., Gupta, K. L., and Minz, M.
- Abstract
Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. The present report describes the initial experience of transplantation of organs from DCD donors in a tertiary care center in India. Between 2011 and 2015, five donors had kidneys retrieved after cardiac arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following cardiopulmonary resuscitation (CPR), which was restarted in three patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 9/10 kidneys were utilized. Mean donor age was 29.6 ± 16.3 years, M:F 4:1 and mean age of recipients was 38.7 ± 10.8 years, M:F 7:2. Seven patients required dialysis in postoperative period. Mean postoperative day 0 urine output was 1.9 ± 2.6 L. Baseline creatinine achieved was 1.38 ± 0.35 mg/dl after a mean duration of 26.12 ± 15.4 days. Kidneys from donors where CPR was continued after the declaration of death (n = 3) had better recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days, baseline creatinine 1.36 ± 0.25 vs. 1.52 ± 0.45 mg%). In donors without CPR, one kidney never functioned and others had patchy cortical necrosis on protocol biopsy, which was not seen in the kidneys from donors with CPR. Kidneys from DCD donors can serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death seems to help in improving outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
27. Intestinal Tuberculosis: A Rare Case of Massive Gastrointestinal Bleed in a Post-Renal Transplant Recipient.
- Author
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Pattanashetti, N., Gupta, S., Rana, S., Dahiya, D., Das, A., Kumar, V., Rathi, M., Kohli, H. S., Gupta, K. L., and Ramachandran, R.
- Subjects
ANEMIA ,ENDOSCOPY ,GASTROINTESTINAL hemorrhage ,ILEUM ,KIDNEY transplantation ,RECTUM ,TECHNETIUM - Abstract
Massive rectal bleeding is an uncommon presentation of ileal tuberculosis (TB). We report an uncommon cause of anemia in a post-renal transplant patient due to massive lower gastrointestinal (LGI) bleed. The index case had a normal upper and LGI endoscopy, but the 99technetium labeled red blood cell scan showed active bleeding from terminal ileum and caecum. Microscopic examination of the resected specimen revealed tubercular granuloma with acid-fast bacilli. Intestinal TB should be a differential diagnosis for massive LGI bleed in immunosuppressed patients in developing country. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
28. Outcomes of spousal versus related donor kidney transplants: A comparative study.
- Author
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Mittal, T., Ramachandran, R., Kumar, V., Rathi, M., Kohli, H. S., Jha, V., Gupta, K. L., Minz, M., Joshi, K., and Sakhuja, V.
- Subjects
ACADEMIC medical centers ,COMPARATIVE studies ,KIDNEY transplantation ,LONGITUDINAL method ,MEDICAL records ,ORGAN donors ,HEALTH outcome assessment ,SPOUSES ,EXTENDED families ,TREATMENT effectiveness ,RETROSPECTIVE studies - Abstract
This study was designed to compare the outcomes of spousal donor (SD) with related donor (RD) kidney transplants performed at our center between January 2010 and October 2012. A total of 323 adult, ABO-compatible kidney transplants (SD 150 [46.4%], RD 173 [53.6%]) were included. Data on outcomes at 6 months post-transplant was collected retrospectively (2010?2011) and prospectively (January-October 2012). Majority of the donors (SD 88%, RD 72.2%) were females. In the SD group, donors were younger (SD 35.6 ± 8.2 years, RD 45.2 ± 11.5 years; P < 0.0001), whereas recipients were older (SD 42.2 ± 8.3 years, RD 30.0 ± 9.5 years; P < 0.0001). A significantly higher proportion of patients in the SD group were given induction therapy (43% vs 12%; P < 0.001). Biopsy proven acute rejections were more common in the RD group (16% vs 28.3%; P = 0.01). Majority (80.8%) of the acute rejections occurred in the first 2 weeks post-transplant in both groups. Isolated acute cellular rejections (ACRs) and isolated antibody mediated rejections constituted 50% and 25% of rejection episodes in both groups, whereas the remainder had histological evidence of both. The proportion of steroid responsive ACRs was similar in both groups (SD 83.3%, RD 65.4%; P = 0.2). The number of patients with abnormal graft function at the end of the study was higher in the RD group (2.3% vs. 12.3%; P = 0.001). Patient survival and infection rates were similar in the two groups. We conclude that short?term outcomes of SD transplants are not inferior to RD transplants. Lesser use of induction therapy in the RD group may explain the poorer outcomes as compared to the SD group. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
29. Efficacy of basiliximab induction in poorly matched living donor renal transplantation.
- Author
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Gundlapalli, S., Rathi, M., Kohli, H. S., Jha, V., Sharma, A., Minz, M., and Sakhuja, V.
- Subjects
THERAPEUTIC use of monoclonal antibodies ,IMMUNOSUPPRESSIVE agents ,ACADEMIC medical centers ,BIOPSY ,GRAFT rejection ,GRAFT versus host reaction ,INFECTION ,KIDNEY transplantation ,LONGITUDINAL method ,SCIENTIFIC observation ,ORGAN donors ,HEALTH outcome assessment ,TREATMENT effectiveness ,DESCRIPTIVE statistics - Abstract
Non-depleting antibody induction has the best safety profile in transplant recipients without an increased risk of infection or malignancy. This observational study was performed in intermediate immunologic risk live donor renal transplants to assess basiliximab efficacy in patients on tacrolimus, mycophenolate, and prednisolone immunosuppression. A total of 46 patients on basiliximab induction were compared to risk matched 56 controls at the end of 6 and 12 months post.transplant. An additional cost of approximately Rs. 100,000/patient was incurred by the basiliximab group. The incidence of biopsy proven acute rejection in the control group (12.5%, 6 months and 20.5%, 1 year) and the basiliximab group (13%, 6 months and 18.9%, 1 year) was similar. At 6 months, there was a non.significant trend toward more steroid sensitive rejections and better glomerular filtration rate preservation in the basiliximab group (83.3%, 71.9 ml/min) versus the control group (28.6%, 62.2 ml/min). However, this difference was lost at 1 year (70.1 ml/min vs. 67.6 ml/min). The incidence of infections was similar and none of the patients had a malignancy. Death censored graft survival (94.6% basiliximab and 94.8% control) and the mean number of hospitalizations for all reasons at the end of 1 year were not different among the two groups. In our study, basiliximab induction did not confer an additional advantage in the intermediate risk live donor transplants in patients on tacrolimus and mycophenolate based triple drug immunosuppression. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
30. Spectrum of lymphoproliferative disorders following renal transplantation in North India.
- Author
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Sakhuja, V., Ramachandran, R., Kohli, H. S., Jha, V., Gupta, K. L., Rathi, M., Joshi, K., Nada, R., Sharma, A., and Minz, M.
- Subjects
ACADEMIC medical centers ,BIOPSY ,IMMUNOSUPPRESSIVE agents ,KIDNEY transplantation ,LYMPHOPROLIFERATIVE disorders ,MEDICAL records ,DESCRIPTIVE statistics ,DISEASE risk factors - Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized, but uncommon complication of organ transplantation. This study was a retrospective analysis of 2000 patients who underwent renal transplantation over a period of 30 years (1980-2010). Forty malignancies were diagnosed in 36 patients. Of these, 29 patients (1.45%) had PTLD (7 females, 22 males) accounting for 72.5% of all malignancies after transplantation. Twenty.two (75.8%) developed non-Hodgkin lymphoma and seven patients (24.2%) had myeloma. Diagnosis was made by biopsy of the involved organ in 21 patients (72.4%) and aspiration cytology in five patients (17.2%). In three patients, the diagnosis was made only at autopsy. Mean age at the time of diagnosis of PTLD was 41.9 years (range 21.69 years). Time interval from transplantation to the diagnosis of PTLD ranged from 3 months to 144 months with a median of 48 months. Only five patients (17.2%) developed PTLD within a year of transplantation. Twelve patients developed PTLD 1-5 years and 12 patients 5-10 years after transplantation. Organ involvement was extra nodal in 18 patients (82%). Thirteen (59%) patients had disseminated disease and nine (41%) had localized involvement of a single organ (brain-3, liver-1, allograft-1, perigraft node-1, retroperitoneal lymph nodes-3). Infiltration of the graft was noted in two patients. Patients with myeloma presented with backache, pathological fracture, unexplained anemia or graft dysfunction. PTLD was of B cell origin in 20 cases (70%). CD 20 staining was performed in 10 recent cases, of which 8 stained positive. Of the 26 patients diagnosed during life, 20 (69%) died within 1 year of diagnosis despite therapy. In conclusion, PTLD is encountered late after renal transplantation in the majority of our patients and is associated with a dismal outcome. The late onset in the majority of patients suggests that it is unlikely to be Epstein Barr virus related. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
31. Transmission of human immunodeficiency virus infection by renal transplantation.
- Author
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Mukhopadhyay, P., Kumar, V., Rathi, M., Kohli, H. S., Jha, V., and Sakhuja, V.
- Subjects
DIAGNOSIS of HIV infections ,BLOOD testing ,INFECTIOUS disease transmission ,HIV infections ,KIDNEY transplantation - Abstract
The rare occurrence of human immunodeficiency virus (HIV) transmission through organ transplantation cannot override the huge impact that it has on the patient. We report a case of HIV transmission by renal transplantation in a 33-year-old housewife, who received a living related transplantation from her sister. Both the patient and her donor were negative by HIV antibody testing prior to transplantation, but were found to be infected in the ninth month after transplant. Further testing suggested that the donor was in the window period at the time of organ donation after having acquired the infection from her husband. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
32. Ulcerative colitis after renal transplantation: A case report and review of literature.
- Author
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Parameswaran, S., Singh, K., Nada, R., Rathi, M., Kohli, H., Jha, V., Gupta, K., and Sakhuja, V.
- Subjects
ULCERATIVE colitis diagnosis ,IMMUNOSUPPRESSION ,INFLAMMATORY bowel diseases ,KIDNEY transplantation - Abstract
Diarrhea is common after kidney transplantation and is usually related to immunosuppressive medication or is infective in etiology. Inflammatory bowel disease (IBD) is rare after kidney transplantation and is unexpected because the patient is already immunosuppressed. Specific immunomodulatory actions of calcineurin inhibitors have been hypothesized to play a role in the development of IBD in such patients. We report a case of IBD developing de novo after kidney transplantation. Our case is unique in that the patient was not on calcineurin inhibitors for 8 years prior to the development of IBD. [ABSTRACT FROM AUTHOR]
- Published
- 2011
33. Constrictive pericarditis in a renal transplant recipient with tuberculosis.
- Author
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Sreejith, P., Kuthe, S., Jha, V., Kohli, H. S., Rathi, M., Gupta, K. L., and Sakhuja, V.
- Subjects
PERICARDITIS ,KIDNEY transplantation ,TUBERCULOSIS ,CHRONIC kidney failure - Abstract
Tuberculosis is a common cause of pericarditis in the developing countries and constrictive pericarditis is a serious sequel. There are only three cases of constrictive pericarditis in kidney transplant recipients previously reported in literature. Here, we report a case of constrictive pericarditis developing in a renal transplant recipient while on antituberculous therapy for tuberculous pleural effusion. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
34. Allograft and prostatic involvement in a renal transplant recipient with disseminated tuberculosis.
- Author
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Sreejith, P., Jha, V., Kohli, H. S., Rathi, M., Gupta, K. L., and Sakhuja, V.
- Subjects
HOMOGRAFTS ,KIDNEY transplantation ,TUBERCULOSIS patients ,OPPORTUNISTIC infections ,GENITOURINARY diseases - Abstract
Tuberculosis is a serious opportunistic infection in renal transplant recipients and is disseminated in nature in one-third of patients. Genito urinary tuberculosis is rare in renal transplant recipients. We report a patient presenting 5 years after renal transplantation with disseminated tuberculosis and allograft and prostatic involvement. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
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