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Drowning causes 236,000 deaths annually worldwide and is the third leading cause of accidental child death (1). Hospitalization from near-drowning occurs 2-20 times more frequently than fatal drownings (2). Near-drowning [...]

Background: Postoperative pain remains a significant problem in patients undergoing donor nephrectomy despite reduced tissue trauma following laparoscopic living donor nephrectomy (LLDN). Inadequately treated pain leads to physiological and psychological consequences, including chronic neuropathic pain. Materials and methods: This randomized controlled double-blinded trial was conducted in sixty-nine (n = 69) participants who underwent LLDN under general anesthesia. Participants were randomized into Group B (n = 34) and Group C (n = 35). Group B received ultrasound-guided bilateral erector spinae plane block (ESPB) with bupivacaine 0.125% 20 ml on the surgical side and 10 ml on the contralateral side before extubation, while Group C received wound infiltration with bupivacaine 0.125% 15 ml. The primary objective of the study was to compare cumulative 24-hour morphine consumption postoperatively. The secondary objectives were time to first rescue analgesia, visual numeric rating scale (VNRS) pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), and complications associated with ESPB. Results: Participants in Group B required significantly less median (IQR) 24-hour morphine compared to Group C [6 (6–9) mg vs. 15 (12–15) mg; median difference 9; 95% CI in median difference 6–12; p < 0.001), longer median (IQR) time to first rescue analgesia [6 (6–8) hours vs. 1 (1–2) hours; p < 0.001], and lower VNRS at rest and during movement at baseline, 0.5, 1, 2, 4, 6, 8, 12, 24 hours. Conclusion: Ultrasound-guided ESPB provided effective pain relief compared to wound infiltration with local anaesthetic in patients who underwent LLDN. Trial registration: INT/IEC/2021/SPL-514; CTRI/2021/07/045909. [ABSTRACT FROM AUTHOR]

Transplant Renal Artery Stenosis (TRAS) is the leading vascular complication following kidney transplantation (KT), causing premature allograft loss and increased post-KT mortality. While risk factors for TRAS, such as prolonged cold ischemia time and delayed graft function, are well-documented in deceased donor-KT, the risk factors remain less clearly defined in living donor-KT. This matched case-control study, conducted at a leading national transplant center predominantly performing living donor-KT, evaluated risk factors and long-term outcomes of clinical TRAS (cTRAS). cTRAS cases diagnosed from January 2009 to December 2022 were matched with four control kidney transplant recipients (KTRs) in a study powered to assess whether ex-vivo arterial vascular reconstruction of multiple renal arteries (VR-MRA) increases the risk of cTRAS. Among 2,454 KTs, 28 KTRs (1.14%) were diagnosed with cTRAS around 3.62 ± 1.04 months post-KT, with renal allograft dysfunction (92.86%) as the most common presenting feature. Notably, 27 cTRAS cases were successfully treated with endovascular intervention, yielding favorable outcomes over a 6–180 months follow-up period. The study identified ex-vivo VR-MRA as an independent risk factor for cTRAS (P < 0.001). cTRAS cases receiving timely treatment exhibited long-term outcomes in graft and patient survival similar to control KTRs. Early screening and timely intervention for cTRAS post-KT may improve graft and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous pancreas–kidney transplantation (SPK) is the preferred treatment for individuals with type‐1 diabetes and end‐stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. Methods: This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain‐dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20 kg. Results: All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re‐exploration. During a 5–27‐month follow‐up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%–5.2%), with 100% graft and patient survival. Conclusion: This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk–benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates. [ABSTRACT FROM AUTHOR]

Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a serious concern with poor allograft outcomes. Possible circulating permeability factors are postulated as pathogenetic factors leading to recurrence. Genetic FSGS is said to have a negligible risk of posttransplant recurrence. Here, we describe an unfortunate patient of genetic FSGS (pathogenic genetic variant) who had a recurrence within hours after transplant and presented with a sudden onset of anuria. The patient did not respond to plasma exchange and subsequently underwent allograft nephrectomy. [ABSTRACT FROM AUTHOR]

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries.

The determination of Brain Death (BD)/Death by neurological criteria (DNC) is now widely accepted among various international societies following the World Brain Death project recommendation. As per the World Brain Death project, ancillary testing should be performed when standard brain-death examination components are inconclusive or cannot be performed. BD was defined legally in 1994 under the Transplantation of Human Organs Act (THOA). However, even after 27 years of the formulated law, there are no guidelines in the THOA regarding the determination of BD using ancillary tests. The present brief report describes two instances where ancillary tests like four-vessel angiography and transcranial doppler-aided brain-death certification were done. It is the first available literature from our country where ancillary tests aided in confirmation of BD when the standard clinical components of DNC could not be performed. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation is the treatment of choice for most of the patients with end-stage renal disease. Transplantation brings many responsibilities related to medication adherence, immunosuppression, prevention of infection, regular follow-ups, etc. To meet the challenges faced by postkidney transplant patients, there is a need for deeper understanding of how people with kidney transplant learn to adapt to life posttransplant. Aim: The present study aims to explore the lived experiences of postkidney transplant patients. Materials and Methods: A phenomenological research design was adopted. By using purposive sampling technique, 18 postkidney transplant patients were enrolled. Data were collected through unstructured interviews and analyzed by using descriptive statistics for quantitative and Colaizzi's method for qualitative data. Results: Based on participants' responses, total 9 themes and 26 subthemes were extracted after data analysis. The main themes emerged were as follows: relief from dialysis-associated problems, perceived social neglect before and after transplant, burden of posttransplant regimen, impact on occupation, attitude toward donor, posttransplant lifestyle modifications, concerns about future quality of life, effect on family and children, and facilitating agents in transplant process. Conclusion: The present study concluded that the quality of life of participants after transplantation had improved in terms of relief from the dialysis-associated suffering. Worries about duration of graft function, future health, and cost were prevalent. There is a need to provide additional information, multidimensional support, and interventions following transplantation that target these concerns. This may support kidney recipients, better prepare for adaptation to life after transplant, and lead to improvements in the patient experience. [ABSTRACT FROM AUTHOR]

Subcapsular hematomas are not uncommon after renal transplantation but they rarely cause parenchymal compression or graft dysfunction. They occur following trauma during kidney retrieval or benching, and appear soon after reperfusing the graft kidney. Significant subcapsular hematoma may present with flank pain and tenderness, hypertension, increased drain output and decreased urine output. Duplex ultrasonography and computed tomography help in diagnosis. Early recognition and surgical intervention are important to restore graft function. We report successful outcome after hematoma evacuation in three patients with post-transplant subcapsular hematomas that caused renal allograft dysfunction. [ABSTRACT FROM AUTHOR]

Ipsilateral acute iliofemoral deep venous thrombosis (DVT) after a renal transplantation, although rare, has a high morbidity, causing complications such as allograft failure, rupture, or death. Treatment modalities are limited due to the risk of bleeding and impaired renal function. We report successful treatment of a case of iliofemoral DVT in a 58-year-old male recipient of a living donor renal transplantation. The immediate postoperative course of the patient was uneventful, and he was discharged on 6th postoperative day (POD) with serum creatinine of 0.8 mg/dl. On POD 26, the patient was admitted with diarrhea, dehydration, and decreased urine output. His serum creatinine rose from 0.8 mg/dl to 2.6 mg/dl and he developed pain and swelling of the right lower extremity. Duplex ultrasonography was suggestive of acute DVT with noncompressible right distal external iliac vein, common femoral, superficial femoral and popliteal veins, absence of color flow from the right femoral vein to the common iliac vein, dilatation of allograft renal vein and an increased renal graft resistive index of 0.97. After inferior vena cava filter insertion, initial treatment with percutaneous balloon angioplasty and catheter-directed thrombolysis could not restore blood flow. Subsequently, percutaneous transluminal pharmacomechanical aspiration was performed with complete removal of the thrombus leading to restored renal allograft vein patency and normalization of allograft function and Duplex findings. [ABSTRACT FROM AUTHOR]