Browsing by Author "Bansal, Sukriti"
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Item Comparison of Pre-Transplant Criteria and Outcomes for Living Donor Kidney Transplant Programs in India and the United States(2015-01-26) Bansal, Sukriti; Raja, Hari; Rajora, Nilum; Kher, VijayBACKGROUND: One of the greatest obstacles to treatment of end stage renal disease globally is organ donor shortage. While some nations (i.e. the US), have primarily cadaveric organ donors, developing nations rely heavily on living donors. This project is a comparison of two kidney transplants programs -- one in the US & one in India -- looking at the pre-transplant criteria of each & assessing the patient outcomes. METHODS: This is a cohort study of living donor kidney transplant patients from St. Paul University Hospital in Dallas, TX & kidney transplant patients from Medanta the Medicity in Gurgaon, India. Data for India was collected from a database of all patients who underwent a kidney transplant at Medanta, selected for patients who fit the following criteria: one cohort of patients had been transplanted the previous month (N=29), one cohort had been transplanted one year prior the date of the study (N=29), & one cohort had been transplanted 3 years prior (N=13). Information from the database was used to calculate patient & graft survival rates for the relevant time periods. Data for St. Paul was obtained from the Scientific Registry of Transplant Recipients, which already had the calculated 1 month, 1 year, & 3 year patient and graft survival rates. Information on pre-transplant criteria was obtained from the transplant teams at each respective institution. RESULTS: The majority of medical pre-operative criteria between the two programs are identical. One significant difference is ABO-incompatible transplants are performed at Medanta, while at St. Paul ABO-incompatible donor/recipient pairs are referred for paired donation. Medanta requires all living donors to be related, while St. Paul will accept unrelated donors. The patient survival rates for St. Paul are 100% (1 mo, N=32), 95.23% (1 yr, N=32) and 85.71 % (3 yr, N=21). Graft survival rates are 100% (1 mo, N=32), 95.24% (1 yr, N=32), and 81.82% (3 yr, N=22). The patient survival rates for Medanta are 100% (1 mo., N=29), 100% (1 yr, N=29), and 100% (3 yr, N=13). Graft survival rates are 100% (1 mo. N=29), 100% (1 yr, N=29), and 100% (3 yr, N=13). For all patients transplanted at Medanta, the overall patient survival rate was 98.40% (N=874) and the overall graft survival rate was 98.51% (N=874). Corresponding data wasn't available for St. Paul. CONCLUSION: While it appears that the 3 year survival rates are better for Medanta than for St. Paul, there is a limitation on making conclusions because this data does not encompass the entire program at Medanta. Further study is needed to truly assess if there is a significant difference. The overall conclusion is that transplant programs in both settings have successful outcomes.Item Pregnancy and Lupus Nephritis: A Review(2017-03-31) Bansal, Sukriti; Rajora, Nilum; Nwariaku, Fiemu; Saxena, RameshBACKGROUND: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder often affecting women of reproductive age, whose fertility is typically unaltered by their disease. SLE - and lupus nephritis (LN) in particular - has a significant impact on the course of pregnancy, as well as the outcomes for mother and fetus. Ideally patients have been in remission for a minimum of 6 months prior to conception. LN in pregnancy increases the patient's risk of SLE flare, as well poor outcomes including fetal loss, pre-eclampsia, and maternal death. Good outcomes are achievable for these patients, and have been well documented in the developed world, but less is known about patients in developing nations. METHODS: A literature review was performed of the available literature in regards to lupus nephritis and pregnancy in developing nations. Few studies were available, primarily retrospective case series. A review of these studies was performed, and analyzed for trends in regards to the impact of active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates. The studies were also examined for any notable geographic trends. RESULTS: Based on the studies reviewed, there is a trend observed between active disease at conception and a lower rate of live birth. A trend was observed between high rates of LN and higher rates of flare, which many studies reported as being statistically significant. A relationship between high rates of LN and higher rates of fetal loss was also observed. With regards to geographic trends, lower overall live birth rates and higher rates of active disease at conception were noted in Indian studies. Interestingly, lower rates of pre-eclampsia were also noted in the Indian studies. Higher rates of flare were observed in the Asian studies. CONCLUSION: Good outcomes are possible for patients with lupus nephritis seeking pregnancy, even in low resource settings. More research is necessary to fully understand the relationships between active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates.