Introduction and objective: Renal transplantation has come a long way since its inception in terms of graft and patient survival but the surgical technique has not evolved much. The traditional open approach carries its own problems specially related to wound and lymphatics. Minimal invasive (robot assisted) approaches (RAKT) address these problems but are technically complex and require skill acquisition. Hand Port assisted Renal Transplant (HPoRT) is a novel technique of kidney transplant surgery via a smaller incision providing benefits of both traditional open and minimal invasive approaches. The objective is to assess feasibility of HPoRT and its efficacy in providing benefits of minimally invasive approach, upholding the advantages of traditional open approach. Materials and Methods: All procedures were performed using hand port wound protector/retractor to gain surgical access through a smaller incision. Morbidly obese patients were excluded. We recorded operative time, total ischemia time, perioperative events, hospital stay, graft function, postoperative pain scores, postoperative wound related complications. Results: Mean recipient BMI was 22.08 Kg/m2. Mean incision length was 8.29 cm. Mean total ischemia time was 68.11 minutes. Mean nadir creatinine was 0.9 mg/dL. Median Pain score was 3. There were no perioperative complications. The mean hospital stay was 6.38 days. Graft function was satisfactory in all. There were no re-explorations, wound or lymphatic related complications. Conclusion: HPoRT technique is promising and can be a practice changing approach to overcome problems of conventional open technique while providing benefits of minimal invasive approach.
Context: In the present era, the outcomes of ABO-incompatible kidney transplant are comparable to ABO compatible kidney transplant. The preconditioning protocols and the cutoff anti-A/B antibody titer vary from center to center. There is sparse data regarding the baseline anti-A/B titer which is acceptable for transplant, and its effect on the posttransplant outcomes. Aims: To study whether baseline antibody titer has a significant impact on the outcomes of ABO-incompatible kidney transplant. Settings and Design: Prospective observational study. Subjects and Methods: This is a prospective observational study in ABOiKTR to compare the outcomes of high and low baseline antibody titer in terms of posttransplant graft function, rejections, infections, patient and graft survival. The preconditioning treatment included Rituximab, Plasmapheresis, and intravenous immunoglobulin. The acceptable pretransplant antibody titer was <1:32. One hundred and five patients were included in the study and divided into Group A – low titer (<256), including 59 patients, and Group B – high-titer group (>256), including 46 patients. All patients were followed up for 12 months posttransplant. Statistical Methods: Categorical variables were compared across the groups using Pearson’s Chi-square test for Independence of attributes/Fisher’s exact test. Continuous variables were compared across groups using Mann–Whitney U-test. Comparisons over time were done using the Wilcoxon signed–rank test. The statistical software SPSS version 20 has been used. Results: The graft function at 1, 3, 6, and 12 months was comparable in the low and high antibody titer groups. The graft function did not correlate with the baseline antibody titers. 1.69% recipients in Group A and 10.8% in Group B had antibody-mediated rejection, with no significant difference. Any increase in antibody titer in the follow-up period was not associated with rejection episodes. 18.64% patients in Group A and 26.09%in Group B suffered from serious infections with no significant difference between them. There was no significant difference in the patient survival in both groups, 96.61% in group A and 93.47% in Group B. Conclusions: No statistically significant differences were noted among the low and high-titer groups in terms graft function, rejections, infections, graft survival, and patient survival.
Introduction: Erectile dysfunction (ED) is a common unaddressed health issue in end-stage renal disease (ESRD) patients. Hyperprolactinemia and hypogonadism in chronic kidney disease (CKD) have a prevalence of 30%–65% and 40%–60%, respectively. Kidney transplantation corrects the associated metabolic abnormalities associated with CKD. However, the effects of kidney transplantation on male sexual function are controversial. Materials and Methods: A retrospective analysis of prospectively maintained data was done in male ESRD patients with ED between 2012 and 2023. Using the International Index of Erectile Function 5 (IIEF-5) Questionnaire, changes in erectile function were analyzed preoperatively and at 6 and 12 months after successful kidney transplant. Hormonal evaluation was analyzed with serum prolactin and serum testosterone. Results: Out of 506 male patients evaluated for renal transplant, 372 (73.5%) had ED. Of these, 185 patients underwent renal transplantation, and 107 patients’ data were eligible for analysis. Mild ED was present in 41 (38.3%), mild to moderate 33 (30.84%), moderate 21 (19.6%), and severe 12 (11.21%). Preoperatively, the mean IIEF-5 score was 14.48 (±4.7). Postoperatively, it was 15.37 (±6.12) at 6 months and 15.66 (±6.77) at 12 months. The mean IIEF-5 score showed a significant improvement at 6 months and a nonsignificant improvement for 6 months to 12 months (P = 0.003 between 0 and 6 months and P = 0.071 between 6 and 12 months). Age >40 years, presence of diabetes, and dilated cardiomyopathy were associated with worse erectile function outcomes after transplant. Duration of CKD was not a significant predictor in multivariate analysis. Conclusion: Improvement in ED following renal transplantation is expected in younger patients without comorbidities, and deterioration may be expected in patients with prolonged CKD, older age, and presence of comorbidities.
Background: Organ donation has been recognized as one of the critical healthcare interventions that aim to address the increasing burden of organ failure. The current study has been planned to assess the knowledge of medical students about organ donation and associated medicolegal and ethical issues. Materials and Methods: A cross-sectional descriptive study was conducted for 2 months among a representative population of medical students in a medical college. Based on the findings of a previous study, the sample size was estimated as 216. Stratified random sampling proportionate to their total population for the selection of students from each batch. The medical students from the second to final professional years were included in the study after obtaining their consent. A semi-structured questionnaire was designed following an extensive review of existing literature and subsequently validated by four subject experts. Ethical clearance was obtained from the Institutional Ethics Committee before the start of the study. Data entry was done in Microsoft Excel, while statistical analysis was done using SPSS version 16.0. Descriptive statistics and inferential statistics were used to assess the association between sociodemographic attributes and the knowledge levels with a P-level of < 0.05. Results: The majority of participants, 119 (55%), fell within the 23–25-year age range, with the mean age of 23.1 ± 1.4 years. Regarding sources of awareness among study participants, social media (89 [41.2%]) and academic teaching sessions (59 [27.3%]) emerged as the most cited avenues, followed by peer discussions (31 [14.4%]). A highly statistically significant differences were observed for donation timing and brain death knowledge (P < 0.001). The observed gender gap reached statistical significance only for the life versus death donation concept (P < 0.05). In addition, significant phase-wise differences were observed for several medicolegal aspects, underscoring curricular influence. Awareness regarding the beneficiaries of deceased donation increased significantly in higher phases (P < 0.001). Conclusion: This study highlights that undergraduate medical students possess moderate knowledge about organ donation, with noticeable gaps in understanding its medicolegal and ethical dimensions. There was a significant improvement in the knowledge levels with progression through academic phases, while gender differences were observed in select domains.
