Browsing by Author "Bhurtyal, Nishan"
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Publication COVID-19 Infection in Renal Transplant Recipients: Experience from a Tertiary Care Center in Nepal(Institute of Medicine, 2022) Bhurtyal, Nishan; Shah, Dibya SABSTRACT Introduction: COVID-19 pandemic has challenged the health system globally specially the low to middle income countries. Renal transplant recipient is at risk due to immunosuppressed state. The course of the disease and its outcome is not completely known and there is scarcity of information from developing world. Methods: The study was carried out at Tribhuvan University Teaching Hospital, Kathmandu from May 2020 till May 2021. All of the renal transplant recipients infected with COVID-19 virus were included in the study. Duration of transplantation, recipient’s comorbidities, clinical presentation including laboratory investigations and outcome in terms of hospitalization, need of intensive care, and need of mechanical ventilation, organ failure and mortality were studied. Results: There were 71 patients (male/female: 60/11, mean age 42.6±10.4) were included in the study. 72% patients (n=51) required hospitalization. There were 15 patients (21%) who expired. Patients requiring mechanical ventilation were 14 (19.7%), 24 (33.8%) required intensive care, 10 (14%) required hemodialysis support during admission. A prior history of rejection, presence of diabetes, graft dysfunction at baseline, and a higher creatinine at baseline was associated with mortality. Hypoxia, leucopenia, lymphopenia was predictive with mortality. Raised inflammatory markers as d-Dimer, LDH, development of acute kidney injury was associated with mortality. Presence of acute kidney injury was associated with increased risk of mortality, need of intensive care and prolonged hospitalizations. Conclusion: COVID-19 infection in renal transplant recipients carries a high risk for mortality. The factors that correlated with risk for mortality were hypoxia, leucopenia, high inflammatory markers and need of mechanical ventilation. Keywords:COVID-19, mechanical ventilation, mortality, renal transplantationPublication Transplant Renal Artery Stenosis in Living Donor Kidney Transplant Recipients: A Single Center Experience from Nepal(Institute of Medicine, 2022) Dhakal, Niraj; Sigdel, Mahesh R; Chalise, Pawan R; Bhurtyal, Nishan; Shah, Dibya SABSTRACT Introduction: Transplant renal artery stenosis (TRAS) is the most common preventable vascular complication in kidney transplantation with significant rates of graft loss and mortality. We aimed to study the demographics, prevalence, clinical presentation, and outcome of TRAS. Methods: We retrospectively reviewed medical records of all living donor kidney transplant recipients at Tribhuvan University Teaching Hospital from August 2008 to May 2021. Cases diagnosed with TRAS by ultrasound Doppler and/or renal CT angiogram were included. Data on demographics, clinical presentation, management, and outcomes were collected and analyzed. Among patients who underwent revascularization, pre and post-procedure creatinine, blood pressure (BP), and antihypertensive medicine burden were compared. Results: Among 620 living donor kidney transplantation, TRAS was present in 17 recipients (Male:Female = 16:1) (2.6%); mean age was 35.47±12.71 years. The median duration at diagnosis was one-month post-transplant (range: 5 days-9 months). The most common clinical features of TRAS were graft dysfunction and uncontrolled hypertension. Diagnosis of TRAS was confirmed with CT angiography in 13 patients. Ten patients underwent revascularization. Pre and post-revascularization mean serum creatinine was 356±210.49 μmol/L and 122.8±30.48 μmol/L (p=0.007) respectively, mean systolic BP was 200±12.47 mmHg and 133±13.38 mmHg (p=0.005) respectively and mean diastolic BP was 105±15.09 mmHg and 80±9.43 mmHg(p=0.005) respectively. Significant reduction in anti-hypertensive pill burden was achieved. Conclusion: Prevalence of TRAS was 2.6%. Most cases presented early with hypertension and graft dysfunction. Revascularization of significant stenosis had a favorable outcome in terms of BP control, antihypertensive pill burden, and preservation of renal function. Keywords: Renal allograft outcome, revascularization, TRAS