ahmed halawa - Academia.edu (original) (raw)
Papers by ahmed halawa
Experimental and Clinical Transplantation, 2021
OBJECTIVES Organ trafficking has emerged worldwide as an important medical and ethical concern. I... more OBJECTIVES Organ trafficking has emerged worldwide as an important medical and ethical concern. In this study, we reviewed the literature presented on this matter to evaluate the global practices, ethical standards, and legal aspects of organ transplantation. MATERIALS AND METHODS We adopted a qualitative study design to perform this study, which included conduct of a literature review. The main focus was organ transplantation. RESULTS Our review suggested a dire need to adopt ethical principles and implement equitable distribution of organs around the globe as per the respective need. CONCLUSIONS Further studies are needed to evaluate the role and status of organ recipients to create a much more organized environment for safe and effective implantation of evidence-based principles of clinical transplantation globally.
Transplant International, 2021
This prospective study reports the design and results obtained after the EMPODaT project implemen... more This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre-and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.
World Journal of Education, 2017
Background: Good performance in a summative assessment does not always equate to educational gain... more Background: Good performance in a summative assessment does not always equate to educational gain following acourse. An educational programme may focus on improving student’s performance on a particular test instrument.For example, practicing multiple choice questions may lead to mastery of the instrument itself rather than testing theknowledge and its application. We designed an assessment strategy that consistently valid and reliable that would fitwith the students with a range of 27 nationalities with a different institutional, cultural and educational background inthis totally online masters programme in transplantation.Methods: Based on the published evidence, we analyzed 2 main assessment domains: (a) self-assessment and (b)peer-assessment. We compared them with traditional teacher-led assessment considering the diversity of students.Conclusion: We conclude that traditional teacher-led assessment supplemented by self-assessment is a strong drivein the learning process in this ...
Renal transplantation [RT] is associated with a significant rate of surgical complications which ... more Renal transplantation [RT] is associated with a significant rate of surgical complications which contribute to patient morbidity and can result in graft loss. Urological complications occur in 9% of RT and account for a significant proportion of surgical problems. They are thought to be related to the quality of the ureterovesical anastomosis and that of the donor ureter. Urological problems can occur in the early postoperative period [most often comprising of urinary leaks and ureteric obstruction/compression] or occur late [mainly comprising of ureterovesical anastomosis stenosis or vesicoureteric reflux]. From a clinical perspective, an elevated drain output in the early postoperative phase should alert to the possibility of a surgical complication [including haematoma, lymphocele or urinary fistula]. Biochemical analysis of the drain fluid is vital to confirm the diagnosis of urinary fistula. Imaging studies including ultrasonography, computed tomography and cystography can be h...
Journal of The Egyptian Society of Nephrology and Transplantation, 2021
Background Cytomegalovirus (CMV) is among the most prevalent opportunistic pathogens sequencing s... more Background Cytomegalovirus (CMV) is among the most prevalent opportunistic pathogens sequencing solid-organ transplantation. Viral immunomodulatory effect can result in the deleterious indirect impacts of CMV over the patient and the graft. The aim of this work was to study the risk factors and the outcomes of CMV viremia in kidney-transplantation recipients. Patients and methods Via a retrospective cohort analysis, we tracked 320 kidney-transplantation recipients’ archives who had their kidney grafts from the beginning of January 2008 to the end of December 2013. The data of 307 recipients were recorded. The study groups were tracked for 10 years post kidney transplantation for the cumulative incidence of CMV viremia, possible risk factors, and incidence of significant post-transplant clinical events. Results One-hundred twenty-seven recipients were CMV-positive, with the first year’s cumulative incidence 36.3% post kidney transplantation. The recipient’s age, pretransplant hypertension, and CMV serostatus mismatch were independent CMV viremia risk factors. CMV was not an independent predictor for the decreased patient survival in this study, but was associated with a significantly reduced graft function as assessed by estimated glomerular-filtration rate. Conclusion Screening, prophylaxis, and prompt treatment have negated the negative outcomes of CMV viremia on patient and graft survival.
Journal of The Egyptian Society of Nephrology and Transplantation, 2021
With increasing numbers of renal transplants performed globally, there is also an increase in the... more With increasing numbers of renal transplants performed globally, there is also an increase in the incidence of patients with failed transplants. Management of these patients with a failed graft needs special attention, as they represent a unique patient cohort with specific medical issues and high degree of morbidity and mortality. The primary aim should be to prolong the function of the existing graft and plan for eventual return to dialysis or early retransplantation. Minimization of immunosuppression to avoid unnecessary adverse effects while stabilizing cardiovascular risk factors and associated comorbidities is paramount. Individualized decision making is required in terms of graft nephrectomy versus leaving the graft in situ. Furthermore, an informed decision needs to be taken regarding the optimum plan of definitive management in terms of return to dialysis, retransplantation, or conservative management.
European Medical Journal, 2021
Transplant clinicians need to be watchful of several potential surgical complications in the earl... more Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especi...
Trends in Transplantation, 2020
Background: Since the discovery of BK Virus (BKV) in 1971, it became a growing challenge in the r... more Background: Since the discovery of BK Virus (BKV) in 1971, it became a growing challenge in the renal transplant field. Many hypotheses over the latest years have been made to justify the increased risk of acquiring BKV infection post-renal transplantation. Excessive immunosuppression remains the primary risk factor. Risk factors such as older recipients, male gender, prolonged cold ischemia time, ureteric stent insertion, degree of HLA mismatching and others have all been linked as additional risks for acquiring BKV infection. Nevertheless, the current literature on risk factors are inconclusive and no single identifiable risk factor can determine recipients who at risk. Objective: The objective of this review is to delineate and contemplate the potential risk factors published in the literature and leads to BKV nephropathy. Methodology: For this review, a variety of sources were utilised including EMBASE, Scopus, PubMed/Medline database and Google Scholar for observational studies on probable risk factors predisposing to BK viremia and/or nephropathy. Results: almost 22 distinctive risk factors were identified. Discussion: Over immunosuppression remains the major risk factor for acquiring BKV infection post-renal transplant, though it is uncertain whether the occurrence of BKVN (BKV Nephropathy) is owing to quantitative and/or qualitative differences in immune suppressants. Besides immunosuppression, other probable risk factors for BKV infection were recognized. Whilst some of them were reproducible in many of these studies, they were denied by others. For instance, ureteric stents, recipient's age, race, deceased-donor type and acute rejection episodes, were inconsistently recognised as significant risk factors for BKV infection. Conclusions: Over immunosuppression remained the reproducible risk factor for BKV infection in all studies, never the less published data on other risks factors varies. This may mirror the patient's geographical area, genetic vulnerability and probably a different BK gene variant with different risk susceptibility, these warrant further investigation.
Archives of Clinical Nephrology, 2017
Induction therapy has established itself as an integral component of modern-day renal transplanta... more Induction therapy has established itself as an integral component of modern-day renal transplantation. Carefully selected induction therapy helps not only to avoid early rejection of grafts but also allows grafts with delayed function to recover prior to introduction of potentially nephrotoxic immunosuppressants. While the place of induction therapy and reduction in early acute rejection is well established, its overall impact on long-term graft and patient survival is still unclear, especially in the 'lowrisk' transplant recipient. Considering the substantial initial costs of induction therapy and their potential adverse reactions, transplant clinicians in developing countries have had to weigh the true advantages in induction against affordability and sustainability in the 'free' state health care systems. This review looks at the place of induction therapy in the current clinical setting with special emphasis on the 'low-risk' transplant candidates in limited resource settings.
Renal Failure, 2020
Introduction: The aim of our study is to explore the relationship of rabbit anti-thymocyte globul... more Introduction: The aim of our study is to explore the relationship of rabbit anti-thymocyte globulin (R-ATG) on development of post-transplant lymphoproliferative disease (PTLD) and its aggressive forms (monomorphic PTLD and Hodgkin lymphoma) in renal transplant recipients. Methodology: All patients diagnosed with PTLD post-renal transplant in the United States' Organ Procurement and Transplantation Network from 2003 till 2013 and followed up till 2017 were retrospectively reviewed. Multi-variable logistic regression analysis assessed association of R-ATG to development of PTLD and its aggressive form. Results: Risk of developing PTLD post renal transplant is 1.35%. In comparison to interleukin-2 blocker induction therapy, R-ATG is associated with increased risk of development of PTLD (Odds Ratio ¼ 1.48, confidence interval ranges from 1.04 to 2.11, p ¼ .02) and is associated with higher risk of development of aggressive PTLD (Odds Ratio ¼ 1.83, confidence interval ranges from 1.001 to 3.34, p ¼ .04). Conclusion: We conclude that R-ATG induction is associated with a higher risk of PTLD and its aggressive form (monomorphic PTLD and Hodgkin lymphoma). Careful monitoring for development of PTLD in renal transplant recipients receiving R-ATG induction therapy is advised.
Transplantation Reviews, 2020
Journal of The Egyptian Society of Nephrology and Transplantation, 2017
Corticosteroid use to prevent rejection is ancient but pivotal in transplant immunotherapy. Its b... more Corticosteroid use to prevent rejection is ancient but pivotal in transplant immunotherapy. Its benefits are worrisomely being negated by its numerous side effects that affect the quality of life and add to the cost of treatment among transplant patients. The past three decades has witnessed an important dynamism with the advent of many other immunosuppressive agents in various combination protocols, which has led to reports of reduction in episodes of acute rejection. This, in addition to side effects, has raised the question of the need for chronic use of steroid or its avoidance from outset. The benefits of steroid-sparing are compelling especially in low-risk recipients and, recently, paediatric patients. The burden of cardiovascular diseases, the major cause of death in transplant patients, osteopenia and impaired growth among paediatrics confront both patients and their carers. Of concern, however, has been the variation and quality of study designs, which has made the report not only inconsistent but with weak evidence as well. The question still remains whether corticosteroid is disposable. We review corticosteroid use in transplant immunotherapy in the era of improved immunosuppression.
Journal of The Egyptian Society of Nephrology and Transplantation, 2019
Urological complications can cause significant morbidity after kidney transplant but can be preve... more Urological complications can cause significant morbidity after kidney transplant but can be prevented by following well-known good surgical principles and techniques. The key is early identification and appropriate intervention. This article discusses clinical presentation, investigations, and principles of management of a urine leak after kidney transplant on the background of a clinical case. The presence of a ureteric catheter, double J ureteric anastomotic stent, vascularity of transplanted ureter, and bladder capacity is critical for differential diagnosis, choice of investigation, and management of ureteral leak. The given case demonstrates an early extraperitoneal high-volume urinary leak. Additional information about the surgery, graft quality, and postoperative clinical course may help in differential diagnosis. Drain fluid creatinine and potassium analysis compared with serum can confirm the leak, whereas radiological imaging can localize it. Depending on the cause and site of leak identified, a conservative management approach using maximal decompression or surgical repair or reconstruction may be appropriate.
Archives of Organ Transplantation, 2017
Medicinal Chemistry Research, 2017
New amide linked bis-indoles 10a, b, and 12 have been synthesized by treatment of tryptamine (9) ... more New amide linked bis-indoles 10a, b, and 12 have been synthesized by treatment of tryptamine (9) or 5aminoindole (11) with oxalyl chloride or adipoyl chloride. In addition, a newly indole derivatives 14-16 incorporated or fused with coumarin moieties have been prepared through the reaction of 9 or 11 with 4-chloro-3formylcoumarin (13a) or 4-chloro-3-nitrocoumarin (13b). Further, 13-(3-nitrophenyl)-6,13-dihydrochromeno[4,3-b] pyrrolo[3,2-f]quinolin-12(3H)-one (20) has been produced via one-pot Mannish reaction of 11, 4-hydroxycoumarin (17), and 3-nitrobenzaldehyde (18) in the presence of N-chlorosuccinimide (NCS) as a catalyst. A mixture of 3-[(3H-indol-3-ylidene)methyl]-4-hydroxy-2H-chromen-2one (24A), and 3-[(1H-indol-3-yl)methylene]chroman-2,4dione (24B) has been obtained with ratio 1:1 through Knoevenagel condensation reaction of indole-3carboxaldehyde (21) and 17. Structures of the obtained compounds have been assigned by sophisticated spectroscopic techniques (1 H-NMR, 13 C-NMR, and 2D NMR) and mass spectrometry. All the synthesized compounds have been screened for their cytotoxic activity against the human cervix carcinoma cell line (KB-3-1), where compounds 14a, 16, and 20 exhibit the highest potent activity (IC 50 = 1.8, 2.2, and 7.9 µM, respectively) in comparison with the positive control (+)-Griseofulvin (IC 50 = 19.2 µM), whereas the tautomeric mixture 24A, B show moderate activity (IC 50 = 71.3 µM). Moreover, molecular docking study of the synthesized compounds toward the matrix metalloproteinase-8 (MMP-8) (PDB ID: 1MNC) has also discussed.
Medicinal Chemistry Research, 2017
In the present study, a series of 4H-chromene and 5H-chromeno[2,3-d]pyrimidine derivatives was sy... more In the present study, a series of 4H-chromene and 5H-chromeno[2,3-d]pyrimidine derivatives was synthesized and evaluated as potential cytotoxic agents. The cytotoxic activities of the target compounds were evaluated against four cancer cell lines MCF-7, HCT-116, HepG-2, and A549 in comparison with vinblastine and colchicine as reference drugs. We explored the structure–activity relationship of 4H-chromenes with modification at the 2-,4- or 7-position, and fused pyrimidine ring at 2,3-position. Most of the screened compounds showed marginal antitumor activity against the different cell lines in comparison to the standard drugs. The structure–activity relationship study revealed that the antitumor activity of the synthesized compounds was significantly affected by the lipophilicity of the substituent at the 2-,4- or 7-position for the 4H-chromenes, and 5,8-position or fused pyrimidine ring at 2,3-positions for 5H-chromeno[2,3-d]pyrimidines. Structure–activity relationship was elaborated with the help of molecular docking studies. The structures of the synthesized compounds were established on the basis of the spectral data, infrared, proton nuclear magnetic resonance, 13-Carbon nuclear magnetic resonance and mass spectroscopic data.
Nephrology Dialysis Transplantation, 2018
The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associat... more The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associated with worse overall outcomes compared with DSA-negative transplantation. A positive complement-dependant cytotoxic crossmatch presents a high immunological risk, while a negative flow cytometry crossmatch is at the lower end of the risk spectrum. Yet, the presence of low-level DSA detected by Luminex alone, that is, positive Luminex and negative flow (PLNF) cytometry crossmatch lacks robust scientific exploration. In this systematic review and pooled analysis, we investigate the glomerular filtration rate, acute rejection (AR), graft survival and patient survival of PLNF transplants compared with DSA-negative transplants. Our analysis identified seven retrospective studies consisting of 429 PLNF transplants and 10 677 DSA-negative transplants. Pooled analysis identified no significant difference in the incidence of AR at 1 year [relative risk (RR) = 1.35, 95% confidence interval (CI) 0...
World journal of transplantation, Jan 28, 2018
Due to the increased burden of infectious complications following solid organ transplantation, va... more Due to the increased burden of infectious complications following solid organ transplantation, vaccination against common pathogens is a hugely important area of discussion and application in clinical practice. Reduction in infectious complications will help to reduce morbidity and mortality post-transplantation. Immunisation history is invaluable in the work-up of potential recipients. Knowledge of the available vaccines and their use in transplant recipients, donors and healthcare providers is vital in the delivery of quality care to transplant recipients. This article will serve as an aide-memoire to transplant physicians and health care professionals involved in managing transplant recipients as it provides an overview of different types of vaccines, timing of vaccination, vaccines contraindicated post solid organ transplantation and travel vaccines.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2018
Although they are not common, urologic complications after renal transplant are associated with r... more Although they are not common, urologic complications after renal transplant are associated with risk of graft loss. Fluid collection during the postoperative period can be caused by urine leak or lymph leak of seroma. Biochemical analysis of the drained liquid is essential and should be compared with a concomitant serum sample. Surgical exploration is indicated if suspected urine leak is significant. Reimplantation of the ureter to the bladder can be challenging if there is extensive ureteral necrosis due to compromised vascularization.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Dec 26, 2017
Correction of structural urologic disorders and optimization of emptying and storage function of ... more Correction of structural urologic disorders and optimization of emptying and storage function of the bladder should be achieved before renal transplant in patients with abnormal urinary bladders to protect the new transplanted kidney. The aim of this study was to determine the outcomes of renal transplant among the differently treated abnormal bladder patients. This was a retrospective study of 30 renal transplant recipients with abnormal bladders who were divided into 2 groups based on abnormal bladder management. Group A included 12 patients who required surgical procedures for their bladder, including 6 with augmentation cystoplasty, 1 with Mitrofanoff procedure, 2 with ileal conduit, 1 with vesicostomy, and 2 who required artificial urinary sphincter. Group B included 18 patients who were treated with oral anticholinergics or beta-3 sympathomimetic drugs, clean intermittent catheterization, suprapubic catheterization, or a combination of these options. Graft function, survival, ...
Experimental and Clinical Transplantation, 2021
OBJECTIVES Organ trafficking has emerged worldwide as an important medical and ethical concern. I... more OBJECTIVES Organ trafficking has emerged worldwide as an important medical and ethical concern. In this study, we reviewed the literature presented on this matter to evaluate the global practices, ethical standards, and legal aspects of organ transplantation. MATERIALS AND METHODS We adopted a qualitative study design to perform this study, which included conduct of a literature review. The main focus was organ transplantation. RESULTS Our review suggested a dire need to adopt ethical principles and implement equitable distribution of organs around the globe as per the respective need. CONCLUSIONS Further studies are needed to evaluate the role and status of organ recipients to create a much more organized environment for safe and effective implantation of evidence-based principles of clinical transplantation globally.
Transplant International, 2021
This prospective study reports the design and results obtained after the EMPODaT project implemen... more This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre-and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.
World Journal of Education, 2017
Background: Good performance in a summative assessment does not always equate to educational gain... more Background: Good performance in a summative assessment does not always equate to educational gain following acourse. An educational programme may focus on improving student’s performance on a particular test instrument.For example, practicing multiple choice questions may lead to mastery of the instrument itself rather than testing theknowledge and its application. We designed an assessment strategy that consistently valid and reliable that would fitwith the students with a range of 27 nationalities with a different institutional, cultural and educational background inthis totally online masters programme in transplantation.Methods: Based on the published evidence, we analyzed 2 main assessment domains: (a) self-assessment and (b)peer-assessment. We compared them with traditional teacher-led assessment considering the diversity of students.Conclusion: We conclude that traditional teacher-led assessment supplemented by self-assessment is a strong drivein the learning process in this ...
Renal transplantation [RT] is associated with a significant rate of surgical complications which ... more Renal transplantation [RT] is associated with a significant rate of surgical complications which contribute to patient morbidity and can result in graft loss. Urological complications occur in 9% of RT and account for a significant proportion of surgical problems. They are thought to be related to the quality of the ureterovesical anastomosis and that of the donor ureter. Urological problems can occur in the early postoperative period [most often comprising of urinary leaks and ureteric obstruction/compression] or occur late [mainly comprising of ureterovesical anastomosis stenosis or vesicoureteric reflux]. From a clinical perspective, an elevated drain output in the early postoperative phase should alert to the possibility of a surgical complication [including haematoma, lymphocele or urinary fistula]. Biochemical analysis of the drain fluid is vital to confirm the diagnosis of urinary fistula. Imaging studies including ultrasonography, computed tomography and cystography can be h...
Journal of The Egyptian Society of Nephrology and Transplantation, 2021
Background Cytomegalovirus (CMV) is among the most prevalent opportunistic pathogens sequencing s... more Background Cytomegalovirus (CMV) is among the most prevalent opportunistic pathogens sequencing solid-organ transplantation. Viral immunomodulatory effect can result in the deleterious indirect impacts of CMV over the patient and the graft. The aim of this work was to study the risk factors and the outcomes of CMV viremia in kidney-transplantation recipients. Patients and methods Via a retrospective cohort analysis, we tracked 320 kidney-transplantation recipients’ archives who had their kidney grafts from the beginning of January 2008 to the end of December 2013. The data of 307 recipients were recorded. The study groups were tracked for 10 years post kidney transplantation for the cumulative incidence of CMV viremia, possible risk factors, and incidence of significant post-transplant clinical events. Results One-hundred twenty-seven recipients were CMV-positive, with the first year’s cumulative incidence 36.3% post kidney transplantation. The recipient’s age, pretransplant hypertension, and CMV serostatus mismatch were independent CMV viremia risk factors. CMV was not an independent predictor for the decreased patient survival in this study, but was associated with a significantly reduced graft function as assessed by estimated glomerular-filtration rate. Conclusion Screening, prophylaxis, and prompt treatment have negated the negative outcomes of CMV viremia on patient and graft survival.
Journal of The Egyptian Society of Nephrology and Transplantation, 2021
With increasing numbers of renal transplants performed globally, there is also an increase in the... more With increasing numbers of renal transplants performed globally, there is also an increase in the incidence of patients with failed transplants. Management of these patients with a failed graft needs special attention, as they represent a unique patient cohort with specific medical issues and high degree of morbidity and mortality. The primary aim should be to prolong the function of the existing graft and plan for eventual return to dialysis or early retransplantation. Minimization of immunosuppression to avoid unnecessary adverse effects while stabilizing cardiovascular risk factors and associated comorbidities is paramount. Individualized decision making is required in terms of graft nephrectomy versus leaving the graft in situ. Furthermore, an informed decision needs to be taken regarding the optimum plan of definitive management in terms of return to dialysis, retransplantation, or conservative management.
European Medical Journal, 2021
Transplant clinicians need to be watchful of several potential surgical complications in the earl... more Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especi...
Trends in Transplantation, 2020
Background: Since the discovery of BK Virus (BKV) in 1971, it became a growing challenge in the r... more Background: Since the discovery of BK Virus (BKV) in 1971, it became a growing challenge in the renal transplant field. Many hypotheses over the latest years have been made to justify the increased risk of acquiring BKV infection post-renal transplantation. Excessive immunosuppression remains the primary risk factor. Risk factors such as older recipients, male gender, prolonged cold ischemia time, ureteric stent insertion, degree of HLA mismatching and others have all been linked as additional risks for acquiring BKV infection. Nevertheless, the current literature on risk factors are inconclusive and no single identifiable risk factor can determine recipients who at risk. Objective: The objective of this review is to delineate and contemplate the potential risk factors published in the literature and leads to BKV nephropathy. Methodology: For this review, a variety of sources were utilised including EMBASE, Scopus, PubMed/Medline database and Google Scholar for observational studies on probable risk factors predisposing to BK viremia and/or nephropathy. Results: almost 22 distinctive risk factors were identified. Discussion: Over immunosuppression remains the major risk factor for acquiring BKV infection post-renal transplant, though it is uncertain whether the occurrence of BKVN (BKV Nephropathy) is owing to quantitative and/or qualitative differences in immune suppressants. Besides immunosuppression, other probable risk factors for BKV infection were recognized. Whilst some of them were reproducible in many of these studies, they were denied by others. For instance, ureteric stents, recipient's age, race, deceased-donor type and acute rejection episodes, were inconsistently recognised as significant risk factors for BKV infection. Conclusions: Over immunosuppression remained the reproducible risk factor for BKV infection in all studies, never the less published data on other risks factors varies. This may mirror the patient's geographical area, genetic vulnerability and probably a different BK gene variant with different risk susceptibility, these warrant further investigation.
Archives of Clinical Nephrology, 2017
Induction therapy has established itself as an integral component of modern-day renal transplanta... more Induction therapy has established itself as an integral component of modern-day renal transplantation. Carefully selected induction therapy helps not only to avoid early rejection of grafts but also allows grafts with delayed function to recover prior to introduction of potentially nephrotoxic immunosuppressants. While the place of induction therapy and reduction in early acute rejection is well established, its overall impact on long-term graft and patient survival is still unclear, especially in the 'lowrisk' transplant recipient. Considering the substantial initial costs of induction therapy and their potential adverse reactions, transplant clinicians in developing countries have had to weigh the true advantages in induction against affordability and sustainability in the 'free' state health care systems. This review looks at the place of induction therapy in the current clinical setting with special emphasis on the 'low-risk' transplant candidates in limited resource settings.
Renal Failure, 2020
Introduction: The aim of our study is to explore the relationship of rabbit anti-thymocyte globul... more Introduction: The aim of our study is to explore the relationship of rabbit anti-thymocyte globulin (R-ATG) on development of post-transplant lymphoproliferative disease (PTLD) and its aggressive forms (monomorphic PTLD and Hodgkin lymphoma) in renal transplant recipients. Methodology: All patients diagnosed with PTLD post-renal transplant in the United States' Organ Procurement and Transplantation Network from 2003 till 2013 and followed up till 2017 were retrospectively reviewed. Multi-variable logistic regression analysis assessed association of R-ATG to development of PTLD and its aggressive form. Results: Risk of developing PTLD post renal transplant is 1.35%. In comparison to interleukin-2 blocker induction therapy, R-ATG is associated with increased risk of development of PTLD (Odds Ratio ¼ 1.48, confidence interval ranges from 1.04 to 2.11, p ¼ .02) and is associated with higher risk of development of aggressive PTLD (Odds Ratio ¼ 1.83, confidence interval ranges from 1.001 to 3.34, p ¼ .04). Conclusion: We conclude that R-ATG induction is associated with a higher risk of PTLD and its aggressive form (monomorphic PTLD and Hodgkin lymphoma). Careful monitoring for development of PTLD in renal transplant recipients receiving R-ATG induction therapy is advised.
Transplantation Reviews, 2020
Journal of The Egyptian Society of Nephrology and Transplantation, 2017
Corticosteroid use to prevent rejection is ancient but pivotal in transplant immunotherapy. Its b... more Corticosteroid use to prevent rejection is ancient but pivotal in transplant immunotherapy. Its benefits are worrisomely being negated by its numerous side effects that affect the quality of life and add to the cost of treatment among transplant patients. The past three decades has witnessed an important dynamism with the advent of many other immunosuppressive agents in various combination protocols, which has led to reports of reduction in episodes of acute rejection. This, in addition to side effects, has raised the question of the need for chronic use of steroid or its avoidance from outset. The benefits of steroid-sparing are compelling especially in low-risk recipients and, recently, paediatric patients. The burden of cardiovascular diseases, the major cause of death in transplant patients, osteopenia and impaired growth among paediatrics confront both patients and their carers. Of concern, however, has been the variation and quality of study designs, which has made the report not only inconsistent but with weak evidence as well. The question still remains whether corticosteroid is disposable. We review corticosteroid use in transplant immunotherapy in the era of improved immunosuppression.
Journal of The Egyptian Society of Nephrology and Transplantation, 2019
Urological complications can cause significant morbidity after kidney transplant but can be preve... more Urological complications can cause significant morbidity after kidney transplant but can be prevented by following well-known good surgical principles and techniques. The key is early identification and appropriate intervention. This article discusses clinical presentation, investigations, and principles of management of a urine leak after kidney transplant on the background of a clinical case. The presence of a ureteric catheter, double J ureteric anastomotic stent, vascularity of transplanted ureter, and bladder capacity is critical for differential diagnosis, choice of investigation, and management of ureteral leak. The given case demonstrates an early extraperitoneal high-volume urinary leak. Additional information about the surgery, graft quality, and postoperative clinical course may help in differential diagnosis. Drain fluid creatinine and potassium analysis compared with serum can confirm the leak, whereas radiological imaging can localize it. Depending on the cause and site of leak identified, a conservative management approach using maximal decompression or surgical repair or reconstruction may be appropriate.
Archives of Organ Transplantation, 2017
Medicinal Chemistry Research, 2017
New amide linked bis-indoles 10a, b, and 12 have been synthesized by treatment of tryptamine (9) ... more New amide linked bis-indoles 10a, b, and 12 have been synthesized by treatment of tryptamine (9) or 5aminoindole (11) with oxalyl chloride or adipoyl chloride. In addition, a newly indole derivatives 14-16 incorporated or fused with coumarin moieties have been prepared through the reaction of 9 or 11 with 4-chloro-3formylcoumarin (13a) or 4-chloro-3-nitrocoumarin (13b). Further, 13-(3-nitrophenyl)-6,13-dihydrochromeno[4,3-b] pyrrolo[3,2-f]quinolin-12(3H)-one (20) has been produced via one-pot Mannish reaction of 11, 4-hydroxycoumarin (17), and 3-nitrobenzaldehyde (18) in the presence of N-chlorosuccinimide (NCS) as a catalyst. A mixture of 3-[(3H-indol-3-ylidene)methyl]-4-hydroxy-2H-chromen-2one (24A), and 3-[(1H-indol-3-yl)methylene]chroman-2,4dione (24B) has been obtained with ratio 1:1 through Knoevenagel condensation reaction of indole-3carboxaldehyde (21) and 17. Structures of the obtained compounds have been assigned by sophisticated spectroscopic techniques (1 H-NMR, 13 C-NMR, and 2D NMR) and mass spectrometry. All the synthesized compounds have been screened for their cytotoxic activity against the human cervix carcinoma cell line (KB-3-1), where compounds 14a, 16, and 20 exhibit the highest potent activity (IC 50 = 1.8, 2.2, and 7.9 µM, respectively) in comparison with the positive control (+)-Griseofulvin (IC 50 = 19.2 µM), whereas the tautomeric mixture 24A, B show moderate activity (IC 50 = 71.3 µM). Moreover, molecular docking study of the synthesized compounds toward the matrix metalloproteinase-8 (MMP-8) (PDB ID: 1MNC) has also discussed.
Medicinal Chemistry Research, 2017
In the present study, a series of 4H-chromene and 5H-chromeno[2,3-d]pyrimidine derivatives was sy... more In the present study, a series of 4H-chromene and 5H-chromeno[2,3-d]pyrimidine derivatives was synthesized and evaluated as potential cytotoxic agents. The cytotoxic activities of the target compounds were evaluated against four cancer cell lines MCF-7, HCT-116, HepG-2, and A549 in comparison with vinblastine and colchicine as reference drugs. We explored the structure–activity relationship of 4H-chromenes with modification at the 2-,4- or 7-position, and fused pyrimidine ring at 2,3-position. Most of the screened compounds showed marginal antitumor activity against the different cell lines in comparison to the standard drugs. The structure–activity relationship study revealed that the antitumor activity of the synthesized compounds was significantly affected by the lipophilicity of the substituent at the 2-,4- or 7-position for the 4H-chromenes, and 5,8-position or fused pyrimidine ring at 2,3-positions for 5H-chromeno[2,3-d]pyrimidines. Structure–activity relationship was elaborated with the help of molecular docking studies. The structures of the synthesized compounds were established on the basis of the spectral data, infrared, proton nuclear magnetic resonance, 13-Carbon nuclear magnetic resonance and mass spectroscopic data.
Nephrology Dialysis Transplantation, 2018
The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associat... more The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associated with worse overall outcomes compared with DSA-negative transplantation. A positive complement-dependant cytotoxic crossmatch presents a high immunological risk, while a negative flow cytometry crossmatch is at the lower end of the risk spectrum. Yet, the presence of low-level DSA detected by Luminex alone, that is, positive Luminex and negative flow (PLNF) cytometry crossmatch lacks robust scientific exploration. In this systematic review and pooled analysis, we investigate the glomerular filtration rate, acute rejection (AR), graft survival and patient survival of PLNF transplants compared with DSA-negative transplants. Our analysis identified seven retrospective studies consisting of 429 PLNF transplants and 10 677 DSA-negative transplants. Pooled analysis identified no significant difference in the incidence of AR at 1 year [relative risk (RR) = 1.35, 95% confidence interval (CI) 0...
World journal of transplantation, Jan 28, 2018
Due to the increased burden of infectious complications following solid organ transplantation, va... more Due to the increased burden of infectious complications following solid organ transplantation, vaccination against common pathogens is a hugely important area of discussion and application in clinical practice. Reduction in infectious complications will help to reduce morbidity and mortality post-transplantation. Immunisation history is invaluable in the work-up of potential recipients. Knowledge of the available vaccines and their use in transplant recipients, donors and healthcare providers is vital in the delivery of quality care to transplant recipients. This article will serve as an aide-memoire to transplant physicians and health care professionals involved in managing transplant recipients as it provides an overview of different types of vaccines, timing of vaccination, vaccines contraindicated post solid organ transplantation and travel vaccines.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2018
Although they are not common, urologic complications after renal transplant are associated with r... more Although they are not common, urologic complications after renal transplant are associated with risk of graft loss. Fluid collection during the postoperative period can be caused by urine leak or lymph leak of seroma. Biochemical analysis of the drained liquid is essential and should be compared with a concomitant serum sample. Surgical exploration is indicated if suspected urine leak is significant. Reimplantation of the ureter to the bladder can be challenging if there is extensive ureteral necrosis due to compromised vascularization.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Dec 26, 2017
Correction of structural urologic disorders and optimization of emptying and storage function of ... more Correction of structural urologic disorders and optimization of emptying and storage function of the bladder should be achieved before renal transplant in patients with abnormal urinary bladders to protect the new transplanted kidney. The aim of this study was to determine the outcomes of renal transplant among the differently treated abnormal bladder patients. This was a retrospective study of 30 renal transplant recipients with abnormal bladders who were divided into 2 groups based on abnormal bladder management. Group A included 12 patients who required surgical procedures for their bladder, including 6 with augmentation cystoplasty, 1 with Mitrofanoff procedure, 2 with ileal conduit, 1 with vesicostomy, and 2 who required artificial urinary sphincter. Group B included 18 patients who were treated with oral anticholinergics or beta-3 sympathomimetic drugs, clean intermittent catheterization, suprapubic catheterization, or a combination of these options. Graft function, survival, ...