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  Most popular articles (Since June 09, 2017)

 
 
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REVIEW ARTICLES
Transplantation of human organs and tissues Act-“Simplified”
Manisha Sahay
April-June 2018, 12(2):84-89
DOI:10.4103/ijot.ijot_31_18  
Human organ and tissue transplantation was started in India in 1962. Initially, the organ transplant was unregulated, and organ trafficking was rampant. The act governing the transplantation was passed in 1994. This has been subsequently amended in 2011, and new rules came into force in 2014. Many of the students as well as practicing physicians are not aware of the act as it is generally not a part of the curriculum. This article highlights the important components of the act and focuses on what all physicians involved in transplant should know about the legal aspects of transplantation.
  48,705 3,350 15
ORIGINAL ARTICLES
Impact of green corridors in organ donation: A single-center experience
Vipin Koushal, Raman Sharma, Ashok Kumar
April-June 2018, 12(2):110-112
DOI:10.4103/ijot.ijot_11_18  
With the onset of 21st century, organ donation (OD) has taken a big stride, still waiting for organ transplants is higher than its availability. Donating a life after one's death to someone you even do not know is one of the noble humanity causes. In Indian scenario, with the inception of Transplantation of Human Organs Act, 1994, multiple active initiatives were undertaken time to time for promoting OD; similarly, green corridors have also come in a big way for transfer of organs for interinstitutional transplantation. The institute undertook its first green corridor for OD in 2015 when liver was sent to one of the hospitals, and till date, 25 green corridors have been established where 27 organs have been shared with other institutes nationwide besides intrainstitute transplantations. Although this noble cause has taken its initial steps, still, innovations, and opportunities for promoting OD should be explored in a continuum for foreseeable better future.
  16,419 394 3
A study on knowledge and attitude about organ donation among medical students in Kerala
GS Adithyan, M Mariappan, KB Nayana
July-September 2017, 11(3):133-137
DOI:10.4103/ijot.ijot_49_17  
Background: The knowledge and attitude of medical students regarding organ donation is quintessential for the success of the organ donation program in a country. Objective: This study aimed to assess the knowledge and attitude of medical students regarding organ donation at Government Medical College, Trivandrum, Kerala, India. Methodology: Data of this cross-sectional study were collected by self-administered questionnaire from 194 final-year MBBS students during 2016, who were selected by convenient sampling. The questionnaire had three sections to gather information of sociodemographic details of the students, knowledge on organ donation, and the attitude toward organ donation. Results: The findings showed that a majority of the students had adequate knowledge regarding organ donation, but it is not translated into their willingness for donation – both cadaveric and live. Conclusion: The study reiterates the need for educational interventions for medical students which cut across various disciplines to make them understand the nuances of the issue in a holistic way.
  12,759 872 -
Awareness, knowledge, and attitude regarding organ donation among final year students of medical, Dental, Engineering, and Arts and Science Colleges in Thiruvallur and Chennai City, India
Naina Sam, R Ganesh, V Indrapriyadarshini, S Jeyamarthan, CK Nandhini
January-March 2018, 12(1):25-29
DOI:10.4103/ijot.ijot_60_17  
Background: Organ donation (OD) is the process of surgically removing an organ or tissue from one person (donor) and placing it into another person (recipient). Of the overall deaths occurring annually in India, nearly one lakh deaths occur due to organ failure. Shortage of donor organs can be resolved by raising awareness and educating the youth about various aspects of OD since they comprise of the majority of the population. The purpose of our study is to determine the level of awareness, knowledge and attitude regarding OD among pupils related to both medical and non-medical fields. Objective: To assess the awareness, knowledge, and attitude regarding OD among final year students of medical, dental, engineering, and arts and science students in Thiruvallur and Chennai. Materials and Methods: A cross-sectional study was conducted among 486 undergraduate students belonging to medical, dental, engineering, and arts and science from various colleges in Thiruvallur and Chennai. A 30 item self administered English questionnaire was given which assessed levels of awareness from Q1-Q7, knowledge from Q8- Q20 and attitude from Q21-Q30 among the study population regarding organ donation. Results: A total of 486 students participated in the study, out of which 183 (37.7%) were males and 303 (62.3%) were females. Among the study population, 455 (94%) were aware and 31 (6.4%) were not aware of the term OD. A total of 261 (54%) students were aware and 225 (46%) were not aware of the “organ transplantation act”. A total of 240 (49.4%) students had the knowledge about the risks involved in OD. A total of 329 (68%) students felt the need for laws to govern the process of OD. Knowledge about the human donor card was observed among 169 (35%) students among the study population. Three hundred and eight (63.4%) wanted to be a part of any OD group and also motivate others for OD. Conclusion: A well-organized approach is required to raise awareness among the youth about various aspects of OD which is necessary to eliminate the setbacks that affect the rate of availability of donor organs. Motivational messages and facts are some of the means of intervention to bring about changes regarding perceptions and intentions about OD among the students.
  12,891 673 4
REVIEW ARTICLES
Legal aspects of transplantation in India
Sunny B Shah, Bharat Vallabhdas Shah
July-September 2018, 12(3):169-173
DOI:10.4103/ijot.ijot_43_18  
The shortage of organ donors for patients with end-stage organ diseases requiring transplant is a global problem. This led to organ trafficking with exploitation of poor people who were made to sell their organs. To address the issue of organ trafficking and to ensure fair allocation of organs from cadaver donors, most countries have passed laws to regulate transplants. In India, the law (THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994) was passed in 1994 and the rules framed in 1995. The most important aspect of the Act was that it legalized brain-stem death as death allowing organs to be retrieved from brain-stem dead patients. Other important aspects of the Act include the following: (1) regulation of removal of organ/s for transplantation from cadaver donors, (2) regulation of removal of organ from living donors, (3) regulation of hospitals, (4) regulation of medical practitioners, and (5) punishment for those flouting the Act. The Act has significantly regulated living and cadaver donor transplant but made the process of obtaining approval for living donor transplant difficult even in genuine-related cases. Swap transplant or paired donation between related pairs is treated as unrelated donor transplant, making the process of obtaining approval very lengthy and tedious. For reasons that cannot be understood, although living unrelated transplant can be performed if there is no commercial dealing, swap transplant between unrelated pairs is not permitted. Punishment is harsh for anyone who contravenes any provision of the Act and unfortunately, transplant team doctors are made liable in most cases.
  12,020 686 1
ABO-incompatible kidney transplantation: Indian working group recommendations
AK Bhalla, BT Anil Kumar, Munish Chauhan, Pratik Das, Bhupendra Gandhi, Umapati Hegde, Tarun Jeloka, Manish Mali, Pranaw Kumar Jha, Ajay Kher, Kamal Kiran Mukkavilli, Raja Ramachandran, Vivekanand Jha
October-December 2019, 13(4):252-258
DOI:10.4103/ijot.ijot_39_19  
Expanding use of ABO-incompatible kidney transplant (ABOiKT) globally and in India demands harmonized protocols. With an aim to provide unified and standardized consensus for ABOiKT in Indian setting, a 14-member working group formulated this document on key critical areas to guide ABOiKT. The recommendations include the following: (i) Gel column agglutination test is a method of choice for antibody (Ab) titer assessment with tube method as acceptable alternative. Immunoglobulin G measurement is advised for clinical decision making. (ii) Assessment of one Ab titer before subjecting patient to Ab removal is recommended. Postplasmapheresis (PP) titers to be monitored anywhere between 2 and 12 h. (iii) Target Ab titer recommended is ≤1:16 irrespective of the method used for titer assessment. (iv) If cost and availability are not a concern, immunoadsorption (IA) should be preferred. (vi) Choice of replacement fluid depends on the method employed for Ab removal. (vii) Donor or AB-positive plasma transfusion can be considered to avoid coagulopathy and bleeding in posttransplant period. It also decreases the risk of coagulopathy associated with greater number of PP cycles performed during and after transplant. (viii) IA column can be reused if cleaned, sterilized and stored properly. (ix) Intravenous immunoglobulin (IVIG) is optional for use in ABOiKT. Choose IVIG batch with lowest ABO- Ab titers and use in low dose (~ 100 mg/kg). (x) Rituximab in a low dose of 100–200 mg is effective and its use (at-least 2 weeks prior to transplant) is at the discretion of treating renal transplant physician. (xi) Avoid, if possible, the combined used of antithymocyte globulin and rituximab as it increases risk of infections significantly. (xii) Posttransplant PP is needed if there is Ab mediated rejection with increasing titers. (xiii) Standard immunosuppression should be followed. These recommendations are first of a kind that aims to standardize the practice of ABOiKT, serve as a guiding tool to the transplant physicians in India.
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EDITORIAL
Immunology in transplantation: Basics for beginners
Manisha Sahay
January-March 2018, 12(1):1-6
DOI:10.4103/ijot.ijot_15_18  
  5,746 1,326 1
ABSTRACTS
Abstracts

October-December 2017, 11(4):208-247
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REVIEW ARTICLES
Liver transplant pathology: When the things are grave!
Nalini Bansal
April-June 2018, 12(2):78-83
DOI:10.4103/ijot.ijot_3_18  
Post transplant liver biopsies (PTLB) form a cornerstone in management of transplant cases. They provide critical information regarding rejection or reoccurrence of diseases. With the development in understanding of transplant pathology new updates have come in reporting guidelines of liver transplant biopsy specimens. The recent updates also include criteria for reporting of antibody mediated rejection in liver. This review aims to cover all those aspects.
  4,497 675 -
ORIGINAL ARTICLES
ABO-incompatible renal transplantation: The journey so far on a road less traveled
Pranaw Kumar Jha, Ashish Nandwani, Ajay Kher, Shyam Bihari Bansal, Sidharth Sethi, Reetesh Sharma, Manish Jain, Dinesh Kumar Yadav, Dinesh Bansal, Rajan Duggal, Rajesh Ahlawat, Vijay Kher
July-September 2018, 12(3):177-181
DOI:10.4103/ijot.ijot_23_18  
Introduction: ABO-incompatible (ABOi) renal transplant is the only option for patients who have neither blood group-compatible donors nor a suitable swap available. Published Indian experience of ABOi transplants has been far and few. Materials and Methods: This study was conducted across two different centers. All the consecutive ABOi renal transplants performed from November 2011 onward and who had completed at least 6 months of follow-up were included. Data were accessed retrospectively from the medical records. Results: There were fifty ABOi recipients who had completed at least 6 months of follow-up. Most common recipient blood group was group O. Median baseline antiblood group antibody titer (immunoglobulin G) was 256. Patient and death-censored graft survival were 94% and 88%, respectively, and biopsy-proven acute rejection was 22%. Acute antibody-mediated rejection was seen in 8% of the patients. Mean serum creatinine was 1.12 mg/dl at 1-month posttransplant and infection rate was 22%. Conclusion: The outcomes of ABOi transplant were acceptable and it should be promoted to bridge the demand and supply gap for renal transplant and expand the living donor pool.
  4,529 525 3
REVIEW ARTICLE
Modulation of maintenance immunosuppression during infection in renal transplant recipients
M Edwin Fernando, R Vivek Praveen, A Ishwarya
October-December 2018, 12(4):236-242
DOI:10.4103/ijot.ijot_25_18  
Infection occurs commonly after renal transplantation, and it is associated with significant morbidity and mortality. Infections are commonly associated with changes in the white blood cell count; however, it may be masked in the background of immunosuppression. Immunosuppression modulation during infection is crucial, keeping in mind, the risk of rejection on the one hand and risk of severe infection and mortality on the other hand. Idea about timeline of infection after renal transplantation in a particular geographical area is helpful in management of infection. The approach to modulate immunosuppressive agents will vary depending on the severity of infection. Many infections require specific anti-infective agents which may have significant drug interaction with immunosuppressive agents. It may also necessitate stoppage of immunosuppression either temporarily or permanently in severe infections to salvage the life of the patient.
  3,926 889 -
ABSTRACTS
Abstracts

October-December 2018, 12(4):254-304
  4,341 203 -
ORIGINAL ARTICLES
Incidence and risk factors for mortality in patients with cirrhosis awaiting liver transplantation
Mayank Jain, Joy Varghese, Chandan Kumar Kedarishetty, Vijaya Srinivasan, Jayanthi Venkataraman
July-September 2019, 13(3):210-215
DOI:10.4103/ijot.ijot_27_19  
Aim: This study aimed to determine the mortality in Indian patients awaiting liver transplantation and to assess the impact of cirrhosis-related complications (CRCs) on mortality. Materials and Methods: This was a prospective study on patients of Indian origin, aged >18 years, with cirrhosis liver (confirmed by imaging and/or liver biopsy), and registered for liver transplant (LTx) between November 2015 and May 2016. Patients were followed up for at least a year. Any admission or day-care procedure for complications after registration was recorded as an event, and outcome was noted as recovered, deterioration, or death. The primary end point of the study was LTx, survival, or death. Patients undergoing transplantation were grouped with survivors for analysis of factors predicting waitlist mortality. Statistics: t-test, Chi-square test, Mann–Whitney U-test, and univariate and logistic regression analyses were used for statistical analysis. P < 0.05 was considered statistically significant. Results: A total of 227 (72.3%) registered patients survived. Waitlist mortality at 1 year was 27.7%, and the waitlist mortality rate was 33.8 deaths/100 patient-years. A significant proportion of nonsurvivors belonged to the Child–Turcotte–Pugh C score (P = 0.031), with higher Model for End Stage Liver Disease (P = 0.002) and greater frequency of CRC (P < 0.001). Hepatic encephalopathy (HE), renal dysfunction (RD), infection, and variceal bleeding were significantly associated with death. A higher proportion of nonsurvivors had combination of more than two CRCs. Conclusion: The waitlist mortality was 27.7%. Complications such as variceal bleed, spontaneous bacterial peritonitis, HE, and RD were significantly high in nonsurvivors.
  4,309 222 -
Did an increase in knowledge and awareness about organ donation improve organ donation rate in India over the past two decades?
Ann Alex, Sunil Shroff, V Britzer Paul, Sumana Navin, Pavithra Ramesh, John Michael, Susmitha Menon
July-September 2019, 13(3):173-178
DOI:10.4103/ijot.ijot_68_18  
Context: The growth in the solid organ transplant has not been able to keep pace with the global requirement for organs, with great differences among countries. No previous studies about public awareness related to organ donation over two-decades have been conducted. Aim: The paper focuses on studying the difference in the knowledge and attitude among the Indian public about organ donation, over two decades. The study further probes into the impact that public knowledge has on organ donation rates. Settings and Design: This is a cross-sectional study conducted from 1998 to 2017. The first 10 years of the study (Group-I) was administered physically, whereas in the next 10 years (Group-II) online tools were used to conduct the survey. The total number of respondents in the two decades was 3914. Subjects and Methods: It contained a structured questionnaire with ten multiple choice questions and basic demographic details. The survey questions were the same for both the periods of the study. Statistical Analysis Used: The data entered was analyzed using SPSS v. 19. The knowledge on organ donation was compared between the two decades and if in any increase in awareness was reflected in the organ donation rate. Results: The increase in awareness on the organs and tissues that can be donated was high among Group-II and it was statistically significant (P < 0.001). More importantly, the proportion of respondents who were aware about the “organ donor card” more than doubled from 23.7% in Group I to 63.7% in Group II; and this was statistically significant (P < 0.001). The deceased donation rate was 0.08 per million population in 2004, whereas it had increased to 0.34 pmp in 2014 and 0.8 pmp in 2016. Conclusions: There has been an increase in awareness in the two decades, and this is also reflected in an increase in the donation rate in the country. Creating more awareness can be one of the factors to increase the organ donation rate in India.
  4,312 175 -
CASE REPORTS
Coronavirus disease in a renal allograft recipient: A case report
Yuvraj Gulati, Narayan Prasad, Manas R Behera, Manas R Patel, Dharmendra Bhadauria, Anupama Kaul, Monika Yachha, Ravi Kushwaha, Amit Gupta
July-September 2020, 14(3):250-254
DOI:10.4103/ijot.ijot_63_20  
Coronavirus disease-19 (COVID-19) affected everyone on the globe, including renal transplant recipients who are at increased risk of infection. The clinical manifestations, immunosuppressive modifications, and treatment protocol are not well defined. We are reporting a case of renal transplant recipient and reviewed all case reports and series (a total of 100 patients) published to date to comprehend the clinical manifestations, immunosuppression modifications, treatment given, and outcomes of the patients. A 57-year-old male kidney transplant recipient had a fever, headache, weakness, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. He became asymptomatic with the treatment of hydroxychloroquine, azithromycin, and oseltamivir. However, he remained persistently positive by reverse transcriptase-polymerase chain reaction for SARS-CoV-2 for 4 weeks and became negative only after Ivermectin therapy, a safer medicine than antivirals/antiretrovirals used for COVID therapy in renal transplant recipients. Of the 100 patients review of case series, fever was noted in 85%, cough 71%, diarrhea 10%, and radiographic abnormalities in 75% of cases. Only in 3% of cases, steroid was stopped, and in the rest of the cases, 63% either continued in the same doses or changed to methylprednisolone in 34%. Calcineurin inhibitors were temporarily stopped in 42% of cases, reduced in 9% of cases, and continued in the same doses in 49% of cases. The anti-metabolites were discontinued in 83%, reduced in 9% of cases, and not changed in 8% of cases. SARI was observed in 18% and acute kidney injury (AKI) in 26% of cases. Of all the AKI, 11% required renal replacement therapy. Mortality was observed in 21% of cases. COVID in renal transplant recipients may show an unusually longer positivity. Ivermectin may be used in the absence of any conclusive SARS-CoV-2 antivirals. Mortality is high in renal transplant recipients.
  4,154 184 1
Utility of hilson's perfusion index in the evaluation of suspected acute tubular necrosis
Ranadheer Gupta Manthri, K Mehabunnisa Shaik, Kalawat Tek Chand, V Sivakumar
July-September 2017, 11(3):171-173
DOI:10.4103/ijot.ijot_36_17  
Dynamic renal scintigraphy scores above other methods for evaluating grafts as it can demonstrate perfusion, function, and drainage pattern. A difficult scenario in evaluating delayed graft function is excluding rejection. Perfusion indices help in the diagnosis of delayed graft function and ruling out rejection. We report a case of renal transplant recipient presenting with delayed graft function. Renal scintigraphy was performed 2-day posttransplantation. Time-activity curves were obtained for 1st min images to evaluate the perfusion of graft and iliac artery. Normal perfusion index is considered as below 150. The results were suggestive of maintained perfusion, more in favor of acute tubular necrosis. Hilson's perfusion index with appropriate modifications interpretation can rule out rejection.
  4,002 326 -
EDITORIAL
Corona, COVID and kidney transplantation
Manisha Sahay, Vivek Kute, Narayan Prasad
January-March 2020, 14(1):1-4
DOI:10.4103/ijot.ijot_21_20  
Severe acute respiratory syndrome corona virus 2 (SARS CoV2) is responsible for corona virus disease (COVID-19). Many organizations have given guidelines for the prevention of COVID-19. Other societies have given updates regarding living and deceased donor transplantation during the pandemic. This article reviews the literature available on corona virus and its impact on living and deceased donor transplantation.
  3,350 583 3
ORIGINAL ARTICLES
Knowledge, attitude, and practice of organ donation among pharmacy students
Prasanna R Deshpande, Preeti Damle, Gopal Bihani, Somshekhar S Khadabadi, Anantha N Naik, Atmaram P Pawar
April-June 2018, 12(2):113-118
DOI:10.4103/ijot.ijot_12_18  
Objective: To assess knowledge, attitude, and practice (KAP) of organ donation (OD) among pharmacy students. Methodology: A web-based, cross-sectional study of students pursuing different pharmacy courses was conducted. A specially designed questionnaire was used to survey the students. Results: A total of 160 students responded to survey. Nearly, three-fourth students wished to donate organs to anyone, 83.1% wanted to donate by considering the health status of the recipient, and 98.1% feel that OD should be promoted. Some negative findings were as follows: less knowledge about some uncommon organs that can be donated, for example, blood vessels, bone, intestine, and heart valves; 76.3% students do not know the process of registering while 84.4% have not registered/pledged for OD. Average knowledge about law related to OD was also poor, i.e., 1.87. Conclusion: Overall KAP for OD was positive for except for a few issues. There is need to add some OD related topic/s in the pharmacy curriculum.
  3,443 318 -
EDITORIAL
Twenty-five years of transplantation law in India – Progress and the way forward
Sunil Shroff
July-September 2019, 13(3):151-153
DOI:10.4103/ijot.ijot_32_19  
  3,163 566 3
REVIEW ARTICLE
Factors that determine deceased organ transplantation in India
GS Adithyan, M Mariappan
April-June 2017, 11(2):26-30
DOI:10.4103/ijot.ijot_13_17  
Extension of life through organ transplantation is indeed a glorious tribute to the progress of science and the progressive mentality of the society at large. It is a sign of our changing times. Even though India has all the potential in becoming the leading nation in the transplantation process, the country lags behind due to multiple determinants. The present paper looks into those determinants that restrict deceased organ transplantation in India, through empirical evidences and literature review. The evidences suggest that the practice of deceased organ transplantation in India is still on the back foot due to various factors such as the lack of awareness among general public as well as medical professionals, sociocultural and religious factors, organizational issues, and legal and ethical aspects.
  3,097 393 -
ORIGINAL ARTICLES
Transient abnormal liver enzyme level in the early stage after renal transplantation in children
Hadas Alfandary, Miriam Davidovits, Amit Dagan
April-June 2018, 12(2):90-94
DOI:10.4103/ijot.ijot_6_17  
Aim: The study aim was to evaluate the prevalence, risk factors, and clinical importance of abnormal elevation in liver enzyme levels in children after renal transplantation. Materials and Methods: The files of all 62 patients (mean age 10.2 years), who underwent renal transplantation at a tertiary pediatric medical center in 2001-2013, were reviewed for clinical data, including: Postoperative liver function, tacrolimus level, and serology for cytomegalovirus (CMV) and hepatitis B and C viruses. Results: The most common indication for transplantation (53%) was dysplastic hypoplastic kidney. Liver enzyme levels were abnormal in 7 patients (11%) before transplantation and 42 (67.7%) during the first 6 months following, with a peak on day 14 (P < 0.001). Seroconversion was documented during the first post-transplantation year in 9 patients (14.5%), of whom 8 (89%) were CMV IgG negative. Post-transplant abnormal levels were highest in patients who also had abnormally high-level pre-transplant levels (100%), CMV seroconversion (89%), and dysplastic kidney or nephronophthisis (80%). An abnormally elevated liver enzyme level was significantly correlated with high blood tacrolimus level, but only on post-transplant day 3 (P < 0.001). Conclusion: High liver enzyme levels are common in pediatric kidney transplant recipients, usually starting in the first post-transplant month. The etiology is probably multifactorial; drug hepatotoxicity, previous liver injury, and acute viral infection or reactivation are all likely possibilities. About 10-20% of cases are related to CMV infection.
  3,173 259 2
REVIEW ARTICLES
Deceased organ donation in India – Current challenges and scenario
Ansy H Patel, Manish Ramesh Balwani, Himanshu Patel, Amit S Pasari, Utkarsh Rajesh Patel, Priyanka Tolani, Vivek Kute
July-September 2018, 12(3):174-176
DOI:10.4103/ijot.ijot_26_18  
Worldwide, organ transplantation has saved and enhanced the lives of thousands of recipients over the past five decades. Organ transplantation rates are still lower in developing countries including India. The cause of this low rate is attributable to many factors including unawareness about procedure and concerned laws, low education levels, inadequate trained workforce, low socioeconomic status, and costly immunosuppressive drugs. In the last few years, the government has tried positively to increase the organ transplantation by forming the National Organ and Tissue Transplant Organization. Now, the government needs to push for affordable transplantation by strengthening the public sector hospitals and by making the transplant medications more affordable. Moreover, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage, and allocation in an equitable way.
  2,942 402 1
Therapeutic drug monitoring of tacrolimus in kidney transplantation
Shyam Bihari Bansal
January-March 2020, 14(1):8-14
DOI:10.4103/ijot.ijot_4_20  
Calcineurin inhibitors (CNI) are the backbone of present-day immunosuppressive regimen in kidney transplant recipients. Tacrolimus (TAC) has gradually replaced cyclosporine as CNI of choice due to its better potency and side effect profile. One of the key challenges in using TAC is therapeutic drug monitoring (TDM) of TAC, as it is a drug of narrow therapeutic index. Various methods of TDM are available; there are older immunoassay (IA)-based methods and recent liquid chromatogram (LC) based. The problems with older IAs like microparticle enzyme IA (Abbott Diagnostics, Chicago, IL, USA), and enzyme multiplied IA (EMIT, Dade Behring, Glasgow, DE, USA) are; they are not so accurate, there is interference with other substances, they measure inactive metabolite, and their limit of detection is not wide. The LC-based methods such as liquid chromatogram mass spectroscopy or LC-tandem mass spectroscopy overcome these issues; however, they are costly, labor intensive, and require good technical support. Newer IAs, such as chemiluminescent microparticle IA (Abbott Diagnostics) and Quantitative Microsphere System (QMS™, Thermo-Fisher), have functional sensitivity <1 ng/ml, and overcome the disadvantages of older IAs. These newer IA are reported to offer adequate accuracy and precision, and at the same time, they are easy to perform. There is genetic variation in expression of cytochrome p-450 (CYP3A4) and CYP3A5 enzymes, which metabolizes TAC, resulting in different levels with same doses. Patients who are expressers (CYP3A5 1*/1* OR CYP3A5 1*/3*) require higher doses to maintain the same levels compared to nonexpressers (CYP3A5 3*/3*).
  2,860 435 1
SPECIAL ARTICLE
NOTTO COVID-19 vaccine guidelines for transplant recipients
Vivek Kute, Sanjay K Agarwal, Jai Prakash, Sandeep Guleria, Sunil Shroff, Ashish Sharma, Prem Varma, Narayan Prasad, Manisha Sahay, Subhash Gupta, S Sudhindran, Kewal Krishan, Vasanthi Ramesh, Sunil Kumar
January-March 2021, 15(1):1-3
DOI:10.4103/ijot.ijot_2_21  
In December 2019 Novel corona virus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID 19 Vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID -19 infection or atleast diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno compromised patients should not receive live vaccines as they can cause vaccine related disease and hence the guidelines suggest that all transplant recipients should receive age appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.
  2,938 347 1
CASE REPORTS
Anesthetic management for liver transplantation in small children
N Bhadrinath, R Halemani Kusuma
July-September 2017, 11(3):153-156
DOI:10.4103/ijot.ijot_45_17  
Anesthetic and surgical management of small children is challenging because of technical difficulties and repeated re-explorations for vascular or biliary complications. Preoperative optimization and meticulous intraoperative and postoperative management can achieve the survival rates comparable to older children. In our institution, we have successfully managed living donor liver transplant in four small children ≤8 kg, and with these case reports, we have tried to present anesthetic concerns and management of these cases along with surgical and postoperative details.
  2,689 467 -