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Background: There is a scarcity of data comparing the consequences of first and second COVID‐19 waves on kidney transplant recipients (KTRs) in India. Methods: We conducted a single‐centre retrospective study of 259 KTRs with COVID‐19 to compare first wave (March 15–December 31 2020, n = 157) and second wave (April 1–May 31 2021, n = 102). Results: KTRs during second wave were younger (43 vs. 40 years; p‐value.04) and also included paediatric patients (0 vs. 5.9%; p‐value.003). Symptoms were milder during the second wave (45 vs. 62.7%; p‐value.007); COVID‐19 positive patients had less frequent cough (32 vs. 13.8%; p‐value.001), fever was less frequent (58 vs. 37%; p‐value.001), and we observed fewer co‐morbidities (11 vs. 20.6%; p‐value.04). The percentages of neutrophils (77 vs. 83%; p‐value.001) and serum ferritin (439 vs. 688; p‐value.0006) were higher during second wave, while lymphocyte counts were reduced (20 vs. 14%; p‐value.0001). Hydroxychloroquine (11 vs. 0%; p‐value.0001) and tocilizumab (7 vs. 0%; p‐value.004) were more frequently prescribed during first wave, while utilization of dexamethasone (6 vs. 27%; p‐value.0001) and remdesivir (47 vs. 65%; p‐value.03) increased during the second wave. Mucormycosis (1.3 vs. 10%; p‐value.01) and ICU admissions (20 vs. 37.2%; p‐value.002) were more frequent during second wave. The 28‐day mortality rate (9.6 vs. 10%; p‐value 1) was not different. Conclusions: There has been a different clinical spectrum of COVID‐19 amongst KTR with similar mortality between the two waves at a large Indian transplant centre. SUMMARY AT A GLANCE: A large single centre study from India reporting on the health outcomes of COVID‐19 infected kidney transplant recipients during the two waves of between 2020 and 2021. The rate of intensive care admission was more frequent during the second wave of infection although mortality rates were similar in both waves. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection is still incompletely understood in transplantation, and there have been a few reports of multisystem inflammatory syndrome in adults (MIS-A) like illness in transplant patients. Herein, we report a case of MIS-A in a renal transplant that ultimately was successfully managed. The case was a 32-year-old man, transplanted 3 years ago, with chronic graft dysfunction and no other comorbidities. He presented with a 3-day history of fever and abdominal pain with no respiratory complaints. The patient had multi-organ involvement in the form of acute pancreatitis, severe diarrhea, acute kidney injury, and shock. Inflammatory markers including D-dimer and C-reactive protein were elevated. Chest radiology showed bilateral haziness on admission. The patient had two consecutive SARS CoV 2 reverse transcription–polymerase chain reaction (RT PCR) tests negative initially but eventually SARS CoV 2 antibody test came positive. The patient was managed initially with broad-spectrum antibiotics, and after confirmation of MIS-A, steroids, intravenous immunoglobulin, and anticoagulation were administered. The patient survived and was discharged on the 29th day of admission. Our reports highlight that MIS-A should be suspected in atypical cases irrespective of COVID-19 tests and should be confirmed with repeated RT-PCR and SARS-CoV-2 antibody tests. [ABSTRACT FROM AUTHOR]

Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at −20°C. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV. [ABSTRACT FROM AUTHOR]

The other report with Oxford vaccine in SOT was reported by a national registry of UK,4 in which around 350 KTR were tested for antibody response. Of a total of 48 KTR receiving vaccine, 31 completed the second dose schedule of vaccine and were analysed for antibody response. The efficacy of coronavirus (COVID-19) vaccine in solid organ transplantation (SOT) has not remained encouraging.1,2 Additionally, the data about Oxford/AstraZeneca (ChAdOx1 nCoV-19 vaccine) is understudied in SOT.3 We intended to measure the antibody response and safety of this vaccine in kidney transplant recipients (KTR) in this prospective observational study conducted at the Department of Nephrology, IKDRC-ITS, Ahmedabad, India. [Extracted from the article]

Aim Methods Results Conclusion In India, 85% of organ donations are from living donors and 15% are from deceased donors. One‐third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost‐effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%–35%.We report our experience with 539 KET cases and the evolution of a single‐centre program to increase the use of LDKT.Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2‐way (n = 2 × 202 = 404), 16.2% 3‐way (n = 3 × 29 = 87), 3% 4‐way (n = 4 × 4 = 16), 1.8% 5‐way (n = 5 × 2 = 10), 2.2% 6‐way (n = 6 × 2 = 12), and 1.8% 10‐way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow‐up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high‐volume LDKT programs, non‐anonymous allocation and teamwork.This is the largest single‐centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs. [ABSTRACT FROM AUTHOR]

Competing Interests: We declare no competing interests.

Outcomes of severe acute respiratory syndrome coronavirus 2 in kidney transplant recipients (KTR) compared with matched cohort are certainly lacking for different pandemic waves and geographic regions. In this single-center retrospective study of coronavirus disease-2019 (COVID-19) cases admitted during March 26, 2021 to June 7, 2021, a propensity-matched analysis in a 1:1 ratio was performed to compare the clinical profile and outcomes between KTR and non-KTR. A Cox proportional hazard model from the whole study population to analyze risk factors for severe disease and mortality was calculated. We identified 1052 COVID-19 cases, of which 107 (10.1%) were KTR. In propensity-matched analysis, KTR had higher fever (81.6 % vs. 60%; P = 0.01), lymphopenia (30% vs. 11.7%; P = 0.02), higher neutrophil-to-lymphocyte ratio (43.3% vs. 25%; P = 0.05), and acute kidney injury (66.6% vs. 36.7%; P = 0.001). In Kaplan-Meier survival analysis, there was no difference in mortality or severity of COVID-19. In Cox hazard proportional analysis, the European cooperative oncology group (ECOG) score of 1 to 2 [Hazard ratio (HR) 95% lower confidence interval (CI), upper CI = 4.9 (1.8-13.5); P <0.01], ECOG of >2 [HR = 20 (7.5, 54.7); P <0.01] and waitlisted status [HR = 1.9 (1.1-3.3); P = 0.02] was associated with significant mortality. Kidney transplantation [HR = 0.8 (0.47-1.44); P = 0.5] was not associated with mortality in the analysis. In our report, kidney transplantation status had a different spectrum but was not found to be independently associated with COVID-19 severity or mortality., Competing Interests: None