Objectives: We aimed at creating a clinical profile of end-stage renal disease patients' gonadal function and assessing the impact of renal transplant on gonadal dysfunction. We studied the influence of age, vascular anastomosis, dialysis vintage, and immunosuppression on sexual dysfunction. Materials and Methods: Twenty adults were included. Hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], testosterone, prolactin (PRL), and estrogen), menstrual history and International Index of Erectile Function (IIEF)-5 questionnaires were assessed before and after renal transplantation. Hormone evaluation was done by chemiluminescent microparticle immunoassay technology. Results: Seventeen patients were male and three patients were female. Native kidney diseases were chronic glomerulonephritis (10%), IgA nephropathy (20%), autosomal dominant polycyctic kidney disease (5%), diabetic nephropathy (5%), focal segmental glomerulosclerosis (5%), renal calculus disease (5%), membranous nephropathy (5%), and pauci-immune vasculitis (5%). Fifteen males had erectile dysfunction (ED) before transplant. Eleven patients showed an increase and six patients showed a decrease in IIEF scores posttransplantation. Statistically significant changes were observed in the mean levels of testosterone, LH, PRL, and FSH. Age at transplant showed a negative correlation with IIEF score. In five patients with an end to side anastomosis to the external iliac artery, all had an increase in IIEF score posttransplant. In 12 patients with an end to end anastomosis to the internal iliac artery, 5 patients (42%) had a decrease in IIEF score posttransplant. Conclusions: Incidence of ED was 88% in our study. About 65% patients showed an increase in IIEF score posttransplantation. Increasing age at the time of transplant was a significant risk factor for the presence of ED. Renal transplantation corrected hormonal abnormalities in men. About 100% of patients with an end to side arterial anastomosis showed improvement in IIEF scores. There was no effect of dialysis vintage and immunosuppression regimes on sexual dysfunction.

Aim: Over the last decade, the number of liver transplantations and centers that provide this service in India have grown exponentially. However, not all practices relevant to liver transplantation are uniform across the country. We decided to get the opinion from living donor liver transplant (LDLT) centers across the country on four specific aspects relating to LDLT. Methods: We formulated four specific questions that were carefully worded to incorporate aspects of “routine practice” and also answerable in the negative or affirmative, so as to make comparison possible. We collected the data of LDLT centers in India from popular resources such as MOHAN Foundation, from our institutional memory, and also by inquiring with respondents. The following questions were asked: (1) Do you routinely use N-acetyl cysteine for LDLT donors? (2) Do you use routinely use prostaglandin E1 (alprostadil) to facilitate hepatic artery flow in recipients? (3) Do you routinely use antiplatelets to prevent hepatic artery thrombosis in adult LDLT recipients? (4) Do you routinely use low molecular weight heparin for deep vein thrombosis prophylaxis after donor hepatectomy? Results: We received a total of 38 responses, of which 34 were complete. Conclusions: There is no consensus among practitioners regarding the studied aspects of the practice pertinent to immediate postoperative care in liver transplantation. This is primarily because there is neither evidence nor clear guidance from learned societies regarding these issues.

Objective: The objective of this study was to determine the perception and knowledge of health-care providers to the challenges of sustaining the growth of kidney transplantation programs in Nigeria. Materials and Methods: We conducted a survey of 166 health-care providers. A pretested questionnaire was administered on all participants. Information obtained were demographics, characteristics of end-stage renal disease (ESRD) patients, and prospective kidney donors encountered and perception of the barriers to the growth of kidney transplantation program. Results: The respondents returned 134 questionnaires out of 166 (response rate: 80.7%) and only 121 with complete responses were included in the analysis. The mean age was 42.5 ± 0.8 years and 47.9% were females. A quarter of the health-care providers encountered ESRD patients who were more likely to refuse kidney transplantation and 34.1% reported that most of the prospective kidney donors were unwilling to donate. Most of the health-care professionals (71.1%) preferred centers outside Nigeria for their patient's kidney transplantation, while three leading barriers to the growth of kidney transplantation program reported were lack of patients' trust (58.8%), failure of interprogram collaborations (55.0%), and absent of governmental supports (48.1%). Conclusions: The health-care professionals reported that more than a third of ESRD patients were not likely to accept kidney transplantation and an equal proportion of prospective donors will not agree to kidney donation. Majority of the health-care professionals preferred centers outside Nigeria for patients' kidney transplantation.

Aim: Posttransplant hypertension (HTN) is a strong predictor of patient and graft survival. As there is a paucity of data in India, this retrospective analysis was done to look at the blood pressure (BP) in 506 renal transplant recipients, with 240 males, 266 females, mean age 42.90 ± 13.31 years, looking at their BP, at the initial and after 1 year later. Methods: This is a retrospective tertiary care study looking at serial BP measurements in 506 renal transplant recipients, correlating with their body mass index (BMI), graft function, proteinuria, antihypertensive used, erythropoietin usage, echocardiography native kidney disease, and new-onset diabetes mellitus till 1 year after transplantation. Results: According to the Joint National Committee 7 classification, initial BP was normal in 24 (4.74%), pre-HTN in 145 (28.65%), HTN Stage I in 227 (44.86%), and Stage II in 110 (21.73%) patients. One year later, BP was normal in 43 (8.55%), pre-HTN in 153 (30.26%), HTN Stage I in 236 (46.71%), and Stage II in 74 (14.47%) patients. Diabetics had a higher initial systolic BP (SBP) (P = 0.005). Patients with left ventricular hypertrophy had a higher SBP 1 year later (P = 0.001). Patients with BMI > 35 kg/m², had higher initial SBP (P = 0.01), initial diastolic BP (DBP) (P = 0.01) and also higher 1 year posttransplant SBP (P = 0.02) and DBP (P = 0.01). Conclusion: There was a high incidence of HTN in renal transplant recipients, 66.59% patients with HTN and 28.65% with pre-HTN in the initial posttransplant period, and 61.18% with HTN and 30.26% with pre-HTN in the 1-year posttransplant period.

Anesthetic management in patients with end-stage renal disease and cardiac dysfunction coming for renal transplant is very challenging since the maintenance of adequate cardiac output is essential for good graft function. Levosimendan is an inodilator that increases cardiac output without increasing cardiac workload. Hence, it is the drug of choice in patients with ischemic heart disease and congestive cardiac failure. We present successful perioperative management of a renal transplant recipient with left ventricular dysfunction using levosimendan for maintenance of stable hemodynamics. Levosimendan, an inodilator, can be safely used in patients with cardiac dysfunction coming for renal transplantation.

Fungal infections cause morbidity and mortality in renal transplant recipients. The causative agent and risk factors differ depending on the time after transplantation. Invasive aspergillosis (IA) though rare is a life-threatening complication occurring in renal transplant recipients. Although pulmonary involvement is the most common presentation of IA, the spectrum is broad. Spinal cord involvement by aspergillus is rare and can present as paraspinal abscess, epidural abscess, vertebral osteomyelitis, discitis, or spinal cord necrosis. We report here a case of aspergillus epidural abscess in a 24-year-old male renal transplant recipient presented with paraplegia and successfully treated with surgery and antifungals. High index of suspicion and prompt diagnosis is very much essential for better outcome. Emerging fungal infections, different mode of presentation and its management is a great challenge to the treating nephrologist and physician.

Viral infections are common opportunistic infections in renal transplant recipients which can cause allograft dysfunction and are often a major cause of graft dysfunction in the South Asian region. Cytomegalovirus (CMV) and BK viral infections are often seen in the early and late posttransplant periods, respectively. Coinfection of both these viruses is rare and hence early diagnosis is the key to prevent graft loss. We present the cases of two male renal transplant recipients with CMV and BKV coinfection with diverse outcomes.