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Aim To monitor B cell subsets in peripheral circulation to find a distinctive phenotypic signature of rejection in our cohort. Methods The study population consisted of 211 consecutive first renal allograft recipients who were followed up for 12 months post-transplant. One ml of EDTA peripheral venous blood was collected pre- transplant, 1 month, 3 months, 6 months, 12 months post-transplant and at the time of graft rejection. A multicolour flowcytometry was performed to monitor the percentage of peripheral Plasma cells (CD20-CD38+CD138+), Total B-cells (CD20+), Naïve B-cells (CD20+CD27-CD38-), Activated B-cells (CD20+CD38+CD138-) and Memory B-cells (CD20+CD138-CD27+). Results Of 211 cases of first kidney allograft recipients, 35 (16.58%) recipients had 38 episodes of acute allograft rejection. Percentage of activated B cells and Memory B-cells were found to be significantly higher in uremic patients ( n = 78) than those of healthy persons ( n = 40) (20.81 ± 0.7616 % vs. 14.37 ± 0.5972%, p < 0.0001 and 10.56 ± 0.5813% vs 7.658 ± 0.6626%, p = 0.0025 respectively). On the contrary, the percentage of naïve B- cells was found to be significantly lower in the patients than normal controls (61.04 ± 1.691% vs 73.62 ± 1.320%, p < 0.0001). Acute rejection episodes ( n = 38) were associated with increase in peripheral percentage of total B-cells (19.02 ± 1.457 vs. 10.80 ± 0.6338, P < 0.0001) and activated B-cells (33.92 ± 1.756 vs. 23.26 ± 1.113, P < 0.0001). On the contrary, the percentage of plasma cells and memory B-cells and naïve B- cells was significantly lower during rejection episodes (0.7447 ± 0.09 vs. 2.363 ± 0.1529, P < 0.0001, 5.871 ± 0.6677 vs. 12.12 ± 0.6584, P < 0.0001 and 44.53 ± 2.504 vs. 52.61 ± 2.488, P = 0.0311 respectively). Conclusion The percentage of activated B-cells and Memory B-cells were persistently high in uremic patients suggesting that these patients are always in a stage of immune activation. Acute rejection episodes were associated with increased percentage of activated B-cells but decrease in the percentage of plasma- and memory-B cells in the peripheral blood. Therefore, post- transplantation, periodic measurements of B-cell subsets may serve as an important marker in the prediction of acute allograft rejection. [ABSTRACT FROM AUTHOR]

Background: Surgical construction of an arteriovenous fistula is preferred for end-stage renal failure patients requiring long-term haemodialysis. Methods: Patients were randomised into two groups: brachial plexus group (n = 30) or local infiltration group (n = 30). In all patients, a radiocephalic arteriovenous fistula was created by an experienced surgeon using a standard surgical technique. In both groups 20 ml of 0.375% ropivacaine was used. Doppler assessment of vessels was performed at fixed time intervals. Results: Primary patency rate was 100% in the brachial plexus block group whereas there was 10% fistula failure rate in the local infiltration group (p-value = 0.237). Diameter of the vessels, peak systolic velocity, mean diastolic velocity, and blood flow at 30 minutes, 48 hours, 2 weeks, and 6 weeks after the fistula creation was significantly greater than the preoperative diameter in all patients (p-value < 0.05). Intergroup comparison revealed that vascular parameters were significantly better in the brachial plexus analgesia group versus local infiltration group at all observation points up to and including six weeks post fistula creation (p-value < 0.05). Conclusion: Brachial plexus anaesthesia significantly dilates the vessel diameter and increases blood flow whereas local infiltration has a negligible effect on vessel diameter and blood flow. [ABSTRACT FROM AUTHOR]

Background: The role of neopterin as a marker of cell mediated immunity for immunological monitoring after transplantation is of great potential interest. Neopterin levels among hepatitis C virus (HCV) positive recipients of living-donor renal transplantatio (LDRT) have not been previously described. Methods: Twenty-two HCV-positive (group I) and 10 HCV-negative (group II) recipients of LDRT were serially monitored for serum neopterin levels by enzyme-linked immunosorbent assay (ELISA). Group I patients were monitored thrice, ie, before transplantation, day 10, and 6 months post transplantation, while group II patients were monitored twice (day 10 and 6 months post transplantation). Peripheral blood T lymphocyte subsets (CD3, CD4, CD8, CD4+CD25+, CD16+56) and Th1/Th2 cytokines were monitored concomitantly by flow cytometry. Results: Ten days post transplantation, there was a significant increase in neopterin and neopterin/creatnine levels among group I patients. There was a positive correlation between activated T lymphocyte (CD4+CD25+) and neopterin early post transplantation (day 10). Th2 cytokines IL-10 and IL-5 showed a positive correlation with neopterin levels on day 10 and 6 months post transplantation, respectively. Neopterin levels did not show association with either HCV viral load or allograft rejection among our study cohort. Conclusion: Increased monocyte/macrophage activation with elevated serum neopterin was detected among group I patients on day 10 post transplantation, but it could not predict rejection. It appears that IL-10 either from a regulatory or nonregulatory source helps in the maintenance of stable graft early post transplantation. Further, it would be of interest to assess the role of neopterin in chronic allograft nephropathy and long-term graft outcome. [ABSTRACT FROM AUTHOR]

Deceased donor organ programme is still in infancy in India. Assessing deceased donation potential and identifying barriers to its utilization are required to meet needs of patients with organ failure. Over a 6-month period, we identified and followed all presumed brainstem dead patients secondary to brain damage. All patients requiring mechanical ventilation with no signs of respiratory activity and dilated, fixed and nonreacting pupils were presumed to be brainstem dead. All events from suspicion of brainstem death (BSD) to declaration of BSD, approach for organ donation, recovery and transplants were recorded. Subjects were classified as possible, potential and effective donors, and barriers to donation were identified at each step. We identified 80 presumed brainstem dead patients over the study period. The mean age of this population was 35.9 years, and 67.5% were males. When formally asked for consent for organ donation (n = 49), 41 patients' relatives refused. The conversion rate was only 8.2%. The number of possible, potential and effective donors per million population per year were 127, 115.7 and 9.5, respectively. The poor conversion rate of 8.2% suggests a huge potential for improvement. Family refusal in majority of cases reflects poor knowledge and thus warrants interventions at community level. [ABSTRACT FROM AUTHOR]

Whether or not completing the hepatitis B vaccination in patients who have undergone kidney transplantation in the middle of incomplete vaccination schedule leads to development of protective antibody titres is not known. This study was designed to determine whether the strategy of completing hepatitis B virus (HBV) vaccination after transplantation is efficacious. Sixty-four end-stage renal disease (ESRD) patients were screened for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B surface antigen (anti-HBs), hepatitis B e-antigen (HBeAg) and HBV DNA. HBsAg negative patients received four doses of 40 µg recombinant HBV vaccine. Schedule was continued in after transplantation period if it was incomplete before transplant. Anti-Hbs titres were evaluated at 1, 3, 6, 9 and 12 months. Past HBV infection was noted in 12 patients: 10 by serology plus viraemia and two by viraemia alone. Of the 46 patients without current or past HBV infection who had received at least two doses of the vaccine before transplant, 17 each had received two and three doses and 12 had completed the schedule. Seventeen (37%) exhibited protective titres. Patients who had completed vaccination were more likely to have protective titres than those incompletely vaccinated ( P = 0.02). Five patients responded to post-transplant vaccination. Partially vaccinated patients do not mount an adequate antibody response despite continued vaccination in the post-transplant period, whereas complete vaccination provides protection in 60%. The present study data highlights the need of administration of a full schedule of HBV vaccination before kidney transplantation. Nucleic acid-based tests can identify occult HBV infection. Patients partially vaccinated against HBV do not mount an adequate antibody response despite continued vaccination in the post-transplant period. The data presented here highlights the need for administration of a full schedule of vaccination before kidney transplantation for maximal protection against HBV infection. [ABSTRACT FROM AUTHOR]