Background and aims:India witnessed the exponential rise of antibiotic resistance due to the high burden of communicable disease. The Indian Council of Medical Research reported Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae (PEAK organisms) as the most common gram-negative isolates, constituting 65.5% of total isolates. The present study aimed to observe the demographics and clinical outcomes of patients infected with these four common gram-negative bacteria in ICUs across India. Patients and methods:This prospective multicentric observational study was conducted in ICUs of 19 hospitals across India. The data collected for each patient included: demography, diagnosis, disease severity score, site of infection, PEAK organism, risk factors for multidrug resistance, antibiotic sensitivity, resistance pattern, total ventilator days, and 28-day mortality. Subgroup analysis of 28-day mortality was done for community-acquired vs hospital-acquired infection, appropriate empirical antibiotic, Carbapenem- and Colistin-resistant infections. Results:A total of 936 patients were included in the analysis. Resistance to Cephalosporin, Fluroquinolones, Piperacillin Tazobactam, Carbapenem, Aminoglycosides, and Colistin was observed in 84, 68, 55, 47, 37, and 4.2% of patients, respectively. The 28-day crude mortality rate was 23.5%, which was higher in the subgroup with isolates resistant to empiric antibiotics compared to those with sensitive isolates (29.6 vs 21.4%, p > 0.05). Moreover, 32 and 27% mortality rates were observed in patients who were infected with Carbapenem-resistant and Colistin-resistant PEAK organisms, respectively. Conclusion:The present study observed a high prevalence of antibiotic resistance in Indian ICUs, contributing to a crude mortality rate of 23.5%. Patients with Carbapenem and Colistin resistance may exhibit higher 28-day crude mortality. How to cite this article:Das SK, Joshi Z, Govil D, Shah MS, Jakaraddi GN, Sinha S, et al. Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study. Indian J Crit Care Med 2025;29(6):504-509.CTRI identifier: CTRI/2023/01/049121.

Objective: The objective of the study is to evaluate the outcomes of live-donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live-related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One-year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant.

Objectives: Management of bladder perforation during TURBT and to evaluate the need for open exploration? Materials and Methods: A retrospective study design was done and 1550 patients underwent TURBT for bladder mass from January 2005 to November 2023. 52 patients were identified with bladder perforation. 20 patients with T2 tumour on biopsy were excluded from final analysis. Parameters recorded on occurrence of a perforation included patient age and sex, tumor stage, grade, multiplicity, size, location, type of bladder perforation and management undertaken. Results: Of a total of 32 patients, 20 were male and 12 patients were female. The mean age of presentation was 65±12.34yrs. 19 patients had T1 tumors. The site of urinary bladder associated with the highest perforation was postero-lateral wall seen in 14 patients. None of the patients had past history of TURBT or were previously operated. A total of 10 patients (31.25%) had intra-peritoneal perforation and 22 patients (68.75%) had extra-peritoneal perforation. Conclusion: We conclude from our study that open exploration is seldom required for bladder perforation during TURBT unless there are signs of peritonism.

Introduction: Kidney transplantation has emerged as a preferred method for improving survival and quality of life for patients with end-stage renal disease in comparison with dialysis. Living donation provides a better patient and allograft survival when compared with deceased-donor transplantation, specifically when the live donor transplant is accomplished before the onset of dialysis. The present study aimed to create and add data for the long-term survival, complications occurred in donor as well as in recipient both in single study in India. Materials and Methods: We performed a retrospective cohort study of all adult patients undergoing renal transplantation. Data on kidney transplantation and operative variables, as well as follow-up data, were obtained retrospectively from the Internal Medical Record Department. The primary outcomes examined were both donor and recipient and graft survival after 2 years and 5 years. Secondary outcomes included the presence of acute rejection and delayed graft function, as well as the rate of postoperative complications. Results: A total of 500 donors and 500 recipients participated in the research overall. The mean warm ischemia time was 3.1 ± 1.4 min and cold ischemia time was 44.3 ± 23.4 min. Surgical complications were encountered in 32.8% (164/500) of patients. The 2-year and 5-year graft survival rates were 90.2% and 84.8%, respectively. Conclusion: Our patients’ rate of complications was not greater than that noted in the previous publications. A thorough and meticulous medical assessment of the donor and recipient is required, as well as a rigorous and responsible evaluation of the indications.

Objective: The objective of the study was to evaluate the patients undergoing renal transplants for urological complications and their management. Materials and Methods: A total of 239 renal transplant surgeries were done at our center between January 2021 and December 2021. Out of these 239 transplants, 196, 14, and 29 were ABO-compatible, swap, and ABO-incompatible, respectively. Clinical signs and symptoms, kidney function tests, ultrasound whole abdomen, computed tomography (CT) abdomen/CT urography, magnetic resonance imaging pelvis, and retrograde pyelography helped to diagnose and assess the severity of ureteric complications. These complications that occurred either in the early postoperative period or in follow-up were analyzed retrospectively. The severity of symptoms, patient status and grading, and type of complication determined the modality that would be used to treat the patients. Results: Out of 239 patients who underwent a kidney transplant, 10 (4.18%) cases developed ureteric complications. The variables that showed a significant statistical difference for the development of ureteric stenosis were older female donors, inferior polar artery, diabetic donors, and prolonged cold ischemia time. Conclusion: Ureteric complications can occur following renal transplantation. This can be reduced by minimally handling the ureter during graft removal and carefully anastomosing it to the bladder. Early diagnosis and prompt intervention increase the chances of graft and patient survival.

Introduction: The traditional open live-donor nephrectomy (OLDN) was intended to be replaced when the laparoscopic live-donor nephrectomy (LLDN) was introduced in 1995. The aim of the study is to analyze the effect of warm ischemia time (WIT) in open versus laparoscopic donor nephrectomy. Materials and Methods: The study included 200 consecutive donor transplants. Kidneys were retrieved by open donor nephrectomy vs. laparoscopic donor nephrectomy. We prospectively recorded the operative data, warm–cold ischemia time, graft function, hospital stay, return to work, and donor recovery. Results: A total of 200 participants were enrolled in the study dividing 100 per group in open and laparoscopic renal transplantation. The demographic data were comparable in both groups. The average WIT was 4.63 ± 1.4 min for the open group and 4.98 ± 1.82 min for the laparoscopic group (P < 0.05). In both groups, the average cold ischemia time was comparable. Both groups' postoperative urinary output, serum creatinine, and graft function exhibited no significant changes. Conclusion: The study demonstrates that varied degrees of WIT within the scope of this study have no negative impact on the outcomes of allografts obtained laparoscopically or openly. As a result, rushing renal artery ligation and division and kidney extraction to reduce WIT at the price of hurting the kidney transplant and donor are not realistic. However, it is uncertain how long the WIT safety window will stay open. This discovery may enable more urologists to undertake LLDN without the previously considered detrimental impact of WIT in compared to OLDN.

: Male sexual disorders remain taboo, particularly in a developing country like India. The affected census is under-depicted as of privacy issues, unawareness about the disease complex, a phobia about being affected, and many more counting on it, with advancing digitalization and many friendly social media platform, the affected individual logs onto the cybernet for perception, and here comes the role of content reliability. : In April 2022, we seek the most accountable social media platforms - with keywords of "Male Sexual Disorders", "Erectile Dysfunction", "Premature Ejaculation" and "Male sex Problems" using BuzzSumo, an online analytic tool. The collected content was evaluated by two urology residents on ground of European Association of Urology(EAU) Guidelines 2022, and for discrepancies, the final decision was established by a senior specialist. : Out of 191 included videos, 62.3% were videos uploaded by specialist and their mean duration was 7.2 minutes. 67.53% of uploaded videos explained general information (n=129, 67.53%) and provide information about diagnosis (28.7%) and treatment (78.01%), among which maximum videos favored medical management (97.9%). 158 inclusion videos (82.72%) were following EAU guidelines. In excluded videos, videos on alternative medicines shared maximum number (45.63%). Videos with animation and sound were more appealing based on views and likes, although the contribution of animated videos was rather less in number (25.65%). : The content with delusive information, small size samples, and individual opinion are having more luring appeasement. so, this study firms its ground by stressing verity of content and need for scrutiny by medical community.

Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. Mostly graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. The exact pathogenesis of RAR is still not clear. Acute cellular rejection causes inflammatory reaction that leads to interstitial edema. Capsule tension due to edema leads to tension and tearing and may lead to RAR. COVID-19 infection in patient on immunosuppression like post-renal transplant is a worrisome disease with high morbidity and mortality. This posttransplant patient developed fever and decreased urine output, for which biopsy was done. On exploration, the graft was found to be ruptured. Graft salvage was tried with argon beam laser, surgical glue, and pressure but failed. The renal graft was then salvaged using buttressing rectus sheath graft in this COVID-19 patient.

Introduction: Ureteroscopic Lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones due to its high efficacy and minimal invasiveness. While this procedure is generally considered safe with a low complication rate, febrile Urinary Tract Infection (UTI) after URS is not rare. Aim: The aim of the present study is to analyse the risk factors for sepsis and febrile UTI after URS. Materials and Methods: A prospective observational study was conducted at a tertiary referral centre in Jaipur, Rajasthan, from July 1, 2021, to July 1, 2022. The study included 148 patients with obstructive ureteral stones who underwent Ureteroscopy and Laser Stone Lithotripsy (URSL). The patients were divided into two groups: Group-A consisted of patients who developed urosepsis and fever after URSL, and Group-B consisted of patients who underwent URSL without urosepsis. Various risk factors like history of Percutaneous Nephrolithotomy (PCNL), types and sizes of stones, stone locations, duration of operation, mean catheter removal time, and hospital stays were recorded and compared. Chi-square tests and multifactorial logistic regression analyses were used. Results: The incidence of febrile UTI was 12.16% (18 out of 148 patients). The mean age was 42.2±7.2 years in the postoperative febrile group and 42.75±7.44 years in the postoperative non-febrile group. Statistically significant differences were observed between the groups in terms of stone size (p<0.001), duration of operation (p<0.007), stone number (p=0.002), and stone location (p=0.013), which consequently led to an increase in mean catheter removal time (p<0.001) and length of hospital stay (p<0.001). Conclusion: The present study identified several notable risk factors associated with the development of fever and sepsis following URS. Identifying these factors enables healthcare providers to identify patients who may be at a higher risk of postoperative complications and implement appropriate preventive measures.

OBJECTIVE:The choice of lithotripter is an important part of planning in mini-percutaneous nephrolithotomy (mini perc) as the operating time is prolonged due to reduced sheath size and smaller working channel. Previous studies mostly reported the use of laser lithotripter for stone fragmentation while the literature on pneumatic lithotripter use in miniperc is scant. METHODS:In this study, we compared the efficacy and safety of the laser lithotripter (LL) vs pneumatic lithotripter (PL) in miniperc for small to medium-sized renal/upper ureteric stones (size: 1-2 cm). All consecutive patients who underwent miniperc from September 2020 to August 2022 were included in the study. Laser lithotripter was used in 81 patients (group LL), while pneumatic was used in 75 patients (group PL). The preoperative, operative, and postoperative findings were compared. RESULTS:Baseline patient characteristics (age, sex, body mass index, and co-morbid illness) and stone characteristics (size, stone number, laterality, presence of staghorn calculi, presence of hydronephrosis, Guy's stone scores) were comparable between the two groups (P>0.05). The mean operative time was comparable (P=0.38) while the mean fragmentation time was significantly higher in the PL group (35.42±6.34 vs 28.96±2.82 minutes; P<0.01). 29.3% required forceps/basket for stone removal in PL group as compared to 7.4% in LL group (P=0.02). Mean VAS (Visual Analog Scale) score on the first post-operative day, stone clearance, drop in hemoglobin, average hospital stay, stone clearance at 3 months postoperative, and complications were comparable (P>0.05). CONCLUSION:Lithotripsy with pneumatic lithotripter can be used as an equally effective and safe alternative to laser lithotripter in mini-perc for treatment of small-medium sized renal/upper ureteric calculi.

Introduction: Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease and health-related quality of life (HRQoL) is routinely used for measuring the outcome. Although the generic HRQoL questionnaire provides useful information on multiple dimensions, they fail to capture emotional and behavioral components of well-being, which is supplemented by the Transplant Effects Questionnaire (TxEQ). The present research studies the impact of these two questionnaires on various parameters affecting the health of kidney transplant recipients. Methodology: This cross-sectional study included 500 postrenal transplant patients within 5 years of transplant (18–70 years) evaluating HRQoL using a Short Form Survey-36 Questionnaire and emotional/behavioral outcomes using a TxEQ. Results: Mean age of participants was 44.92 ± 5.86 years and males constituted the majority (>75%). The mean physical component score (PCS) was 41.3 ± 9.2 and the mental component score (MCS) was 48.1 ± 8.4. The highest score was observed for bodily pain, followed by role limitations attributable to emotional problems (RE). The PCS was significantly higher among younger participants, among males, among participants who have got a transplant >24 months ago, and among participants who had serum creatinine levels <2 mg/dl (*P < 0.05). However, the mental component score did not differ significantly in any of the matched variables. In TxEQ, medication adherence had the highest mean score, followed by perceived responsibility toward others. Conclusion: In our study, we concluded that reduced physical functioning among female gender, illiterate patients, with increasing age, in employed section, and with associated comorbidities such as hypertension and with a history of rehospitalization.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has distorted the health-care system at a global level. Organ donation being a life-saving procedure, it continued even in the COVID era, although at a slow pace. Irrespective of the increase in renal transplants in the later era of COVID-19, the scarcity of literature for a review article in this context resulted in the genesis of this study. A retrospective data collection was conducted over various databases in the English language. The databases were thoroughly searched with keywords COVID-19, Coronavirus, SARS-CoV-2, and renal transplant. The data from various sources including original articles comprising single- and multicenter studies were collected, analyzed, and compiled over various parameters. The data were framed as mean, median, percentage, and standard deviation. We analyzed 10 single-centered studies and 4 multicenter studies conducting renal transplantation during the COVID era. The mean age of donor and recipient in the analysis was 47.6 ± 6.01 years and 47.8 ± 6.65 years, respectively. Two transplant centers used deceased renal donors only and one centre was doing transplant only on live donors and the remaining of the centres were taking both live and deceased donors. We observed that four studies had no COVID-positive recipient in their follow-up and the maximum COVID-positivity rate was 50%. Among reviewed 14 studies, 8 studies had no mortality in recipients who were COVID positive and the maximum mortality was 54%. To reduce morbidity and mortality, strict criteria for COVID-19 workup in donor and recipient patients should be followed. The type of donor has no direct relation to the risk of acquiring COVID-19 infection. The vaccination program has been accepted worldwide to reduce the severity of COVID-19 infection even in transplant patients.

Objectives: The objective of this study is to report the difference in loss of length of the renal artery and vein between an open and laparoscopic renal donor nephrectomy. Methodology: We take 50 open and 50 laparoscopic renal donors for comparison of loss of length of the renal artery and vein. This is a single-blinded study. All patients considered for left donor nephrectomy with a single renal artery and vein are included in the study. Patients considered for right donor nephrectomy, abnormal renal artery and vein anatomy, atherosclerotic renal artery or vein are excluded from the study. Results: In our study, we take 50 open renal donor nephrectomies and 50 laparoscopic renal donor nephrectomies from a total of 115 renal donor nephrectomies from December 2020 to April 2021. For removing bias, we take only the left side nephrectomy which has a single artery and vein. We used study randomizer software which uses cluster randomization which decides case should be operated on either open or laparoscopy. Conclusions: In our study, the difference between preoperative and intraoperative artery length for open donor nephrectomy (ODN) was 0.3 cm, and vein length was 2.3 cm and the difference between preoperative and intraoperative artery length for laparoscopic donor nephrectomy (LDN) was 0.5 cm, and vein length was 2.5 cm. The difference between renal artery length in open versus LDN is 0.2 cm, and the difference between renal vein length in ODN versus LDN is 0.2 cm, which is statistically insignificant.

Objective: To gain better insight into the extent of secondary bacterial and fungal infections in hospitalized patients in India, and to assess how these alter the course of coronavirus disease 2019 (COVID-19) so that control measures can be suggested. Methods: In this retrospective, multicentre study, the data of all patients who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on reverse transcriptase polymerase chain reaction (RT-PCR), admitted to hospital between March 2020 and July 2021, were accessed from the electronic health records of a network of 10 hospitals across five states in North India. Results: Of 19,852 patients testing positive for SARS-CoV-2 on RT-PCR and admitted to the study hospitals during the study period, 1940 (9.8%) patients developed secondary infections (SIs). Patients with SIs were, on average, 8 years older than patients without SIs (median age 62.6 vs 54.3 years; P <0.001). The risk of SIs was significantly (P <0.001) associated with age, severity of disease at admission, diabetes, admission to the intensive care unit (ICU), and ventilator use. The most common site of infection was urine (41.7%), followed by blood (30.8%) and sputum/bronchoalveolar lavage/endotracheal fluid (24.8%); the least common was pus/wound discharge (2.6%). Gram-negative bacilli (GNB) were the most common organisms (63.2%), followed by Gram-positive cocci (GPC) (19.6%) and fungi (17.3%). Most patients with SIs were on multiple antimicrobials. The most commonly used antibiotics against GNB were beta-lactam/beta-lactamase inhibitors (76.9%), carbapenems (57.7%), cephalosporins (53.9%), and antibiotics against carbapenem-resistant Enterobacteriaceae (47.1%). Empirical use of antibiotics against GPC was seen in 58.9% of patients with SIs, and empirical use of antifungals was observed in 56.9% of patients with SIs. The average length of hospital stay for patients with SIs was almost twice as long as that of patients without SIs (median 13 vs 7 days). Overall mortality among patients with SIs (40.3%) was more than eight times higher than that among patients without SIs (4.6%). Only 1.2% of patients with SIs with mild COVID-19 at admission died, compared with 17.5% of those with moderate COVID-19 at admission and 58.5% of those with severe COVID-19 at admission (P <0.001). The mortality rate was highest in patients with bloodstream infections (49.8%), followed by those with hospital-acquired pneumonia (47.9%), urinary tract infections (29.4%), and skin and soft tissue infections (29.4%). The mortality rate in patients with diabetes with SIs was 45.2%, compared with 34.3% in those without diabetes (P < 0.001). Conclusions: SIs complicate the course of patients hospitalized with COVID-19. These patients tend to have a much longer hospital stay, a higher requirement for oxygen and ICU care, and a significantly higher mortality rate compared with those without SIs. The groups most vulnerable to SIs are patients with more severe COVID-19, elderly patients and patients with diabetes. Judicious empirical use of combination antimicrobials in these groups of vulnerable patients can save lives. It is desirable to have region- or country-specific guidelines for appropriate use of antibiotics and antifungals to prevent their overuse.

Background and Objectives: Bench surgery performed just after donor nephrectomy is known as ex vivo Bench Surgery. We present a case series of Bench Pyelolithotomy in donor's kidney just before transplantation with our surgical experience and follow-up results. Patients and Methods: Fifteen ex vivo Bench Pyelolithotomy on renal graft was performed by an experienced surgeon from January 2018 to August 2020. All these patients underwent standard donor evaluation and metabolic workup. Pre- and post-operative parameters were analyzed for technical feasibility, intraoperative and postoperative complications, stone clearance, and stone recurrence rate. Results: All 15 donors were females with a mean age of 44 years. The mean stone size was 14.3 mm (range 5–30 mm). Stone extraction by pyelolithotomy on the bench was successfully performed, and a stone-free status was accomplished just before the transplantation. Complete stone clearance was achieved in all cases. Mean cold ischemia time was 32 min. Postoperatively, patients were stable with average urine output of 490 ml/h. All patients are in regular follow-up with graft functioning well measured with respect to serial serum creatinine and urine output. Conclusions: Bench surgery is safe, less time-consuming, and equally effective for a stone-bearing renal donor kidney without compromising renal allograft function.

Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1 st March and 15 th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as ‘possible’ mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P < 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.

Introduction: There is a strong temporal association between the increase in coronavirus disease-2019 (COVID-19) infections and a striking reduction in overall solid-organ transplantation procedure. The priority is to select uninfected donors to transplant uninfected recipients while maintaining safety for health-care systems in the backdrop of a virulent pandemic. Our current communication shares a protocol for donor and transplant recipient selection during the COVID-19 pandemic to continue lifesaving kidney transplantation. This protocol was created utilizing the guidelines of various organizations and from the clinical experience of the authors and will continue to evolve as more is understood about severe acute respiratory syndrome coronavirus 2 and how it affects organ donors and transplant recipients. Objectives: In this study, we aimed to review the published literature and compare it with our kidney transplantation is done in 115 patients in our hospital from July 2020 to February 2021 in the time of COVID-19 and what protocols we follow before transplant to reduce the risk of COVID-19 infection. This article also contains currently available immunosuppressive strategies. Methods: A prospective study was done in Mahatma Gandhi Hospital Jaipur for the transplant done from July 2020 to February 2021. A total of 115 patients from 20th July to 28th February were considered for the study. Results: All 115 patients who were COVID negative on reverse transcriptase–polymerase chain reaction assay and high-resolution computed tomography were considered for the transplant. COVID status on discharge for all 115 recipients was negative. During workup, two donors were found COVID-19 positive and were shifted to COVID center for treatment and their transplant postpone. Out of 115 renal transplant patients, only 1 patient became COVID-19 positive after 5 days of operation. Conclusions: Every transplant center should put its local policy about transplantation depending on the state of the epidemic in the country. Nowadays, transplantation programs should be limited to urgent cases. We suggest lowering the threshold for diagnosis of COVID-19 among renal transplant recipients.