Browsing by Author "Shah, Dibya S"
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Publication Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation(Institute of Medicine, 2019) Nepali, Rabin; Shah, Dibya S; Gyawali, Prem R; Sharma, Uttam; Chalise, Pawan RABSTRACT Introduction Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population. Methods All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors were recorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation. Results A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the study period. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226 years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011). Conclusion Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation. Keywords: Body mass index, donor eGFR, graft outcome, renal transplantationPublication Multiple Nocardial Brain Abscesses in a Renal Transplant Recipient: A Case Report(Institute of Medicine, 2021) Nepali, Rabin; Shah, Dibya S; Sharma, Mohan RABSTRACTNocardia is a rare but life-threatening opportunistic infection, especially in immunocompromised patients, including renal transplant recipients. It can cause intracranial abscess which has a mortality of more than 30%. So, when a renal transplant recipient presents with central nervous system involvement, nocardial brain abscess must be considered in the differential diagnosis. Here, we report a such case with multiple nocardial brain abscesses. This case highlights the importance of early diagnosis and treatment to get a good clinical outcome. Keywords: Brain abscess, nocardia, renal transplantPublication Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Observational Study from Nepal(Institute of Medicine, 2023) Hamal, Saurav S; Nepali, Rabin; Poudyal, Sujeet; Shah, Dibya SABSTRACT Introduction: Kidney transplantation is the most effective treatment for end-stage renal disease (ESRD) patients. However, the increasing number of ESRD patients and the limited availability of living and cadaveric donors has led to a growing waiting list for kidney transplantation. ABO-incompatible transplantation has emerged as an alternative for these patients in Nepal. Methods: This was an observational study of all the patients who underwent kidney transplantation from March 2017-Feb 2019. Data on demography of recipients and donor, blood group, human leukocyte antigen mismatch, induction agent, post-operative complications and creatinine clearance at discharge and one-year post-transplant were collected and analysed. Then we compared patient and kidney graft survival at one year between ABO incompatible and ABO compatible recipients. Results: During the study period, there were total of 124 kidney transplant recipients among them 12 were ABO incompatible and 112 were ABO compatible recipients. The study showed slightly lower patient and graft survival in ABO-incompatible recipients than ABO compatible recipients (83.3% vs 99.2%, p<0.001). However, death-censored graft survival were similar in both groups (100%,p<0.001). The graft function at one year measured by creatinine clearance was better in ABO-incompatible recipients than ABO-compatible recipients (67.1±11.75 vs 61.87±12.82, p<0.001). Postoperative complications were slightly higher, however, complications at one year were lower in ABO-incompatible recipients. Conclusion: The study showed that living donor ABO-incompatible kidney transplant recipients have a good outcome at one year but is associated with greater risks of patient and graft loss at early transplant period compared to ABO-compatible recipients. Keywords: ABO incompatible; graft survival; infection; kidney transplantation; patient survival; rejectionPublication Screening of Kidney Disease in Asymptomatic Female College Students by Urine Dipstick Method(Institute of Medicine, 2019) Chhetri, Santosh; Shah, Dibya SABSTRACT Introduction: Urine examination by urine dipstick method is a useful tool to identify asymptomatic individual for kidney disease. A urine dipstick analysis was conducted on world kidney day to determine the urine abnormalities among asymptomatic female college students. Methods: A cross-sectional study was carried out in a government female college in Kathmandu Nepal. Three hundred asymptomatic female students participated in this study. Fresh midstream urine samples were obtained and tested by urine dipstick method. Random Blood glucose was monitored with glucometer. Blood pressure was measured by manual sphynomanometer. Results: The mean age of the female students was 22.62±2.686 years. Fifteen participants (5%) were found positive for proteinuria and only 1% of participants had glycosuria. The systolic blood pressure of >120 mm Hg was present in 14% of participants while 5% of participants had diastolic blood pressure of >90mm Hg. Participants who were found to have urinary proteinuria detected had both systolic and diastolic blood pressure increased. Only 8% of the participants had random blood sugar of >140 mg/dl. Conclusion: Urinary abnormalities like proteinuria and glycosuria in asymptomatic female students has significant prevalence. Systemic prehypertension and hypertension has alarming rates among adolescents. Hence, screening for blood pressure and early detection of renal disorders will lead to effective interventions and possibly reduce the burden of renal diseases. Keywords: Female adolescents, glycosuria, proteinuria, screening, urinalysisPublication 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