COVID-19 Mortality in Vaccinated vs. Unvaccinated Liver & Kidney Transplant Recipients: A Single-Center United States Propensity Score Matching Study on Historical Data.

Introduction: Existing studies report variable impact of vaccination on Coronavirus Disease (COVID-19) morbidity and mortality in solid organ transplant (SOT) recipients. This study aimed to perform a propensity score matching (PSM) analysis on COVID-19 survival of vaccinated and unvaccinated SOT patients who contracted the disease at a single US academic transplant center. Methods: All consecutive COVID-19 positive cases on adult liver, kidney or combined liver-kidney recipients were identified and demographics, comorbidities, immunosuppression, COVID-19 treatment and hospitalization status, COVID-19 vaccination status, and early mortality recorded. PSM study was performed on age and sex for completed vaccination status at time of infection, followed by multivariable analysis and survival curve plotting. Results: 144 SOT patients were diagnosed with COVID-19, with 98 unvaccinated. PSM reduced study number to 101. Matched data multivariable analysis for 60-day mortality identified age and post-kidney transplant status to significantly increase 60-day mortality odds (OR 1.22, p < 0.001 and OR 40.93, p < 0.001, respectively). Kaplan−Meier analysis showed inferior post-infection survival in the unvaccinated group [(30 days; vaccinated vs. unvaccinated 97.8% vs. 89.1%, respectively; p = 0.089) (60 days; 97.8% vs. 83.6%, respectively; p = 0.019)]. Conclusions: Matched data survival analysis demonstrated inferior survival in the unvaccinated group, supporting COVID-19 vaccination in SOT recipients.

Impact of Prolonged Cold Ischemia Time on One Year Kidney Transplant Outcomes.

BACKGROUND: Prolonged cold ischemia times (CIT) of kidney allografts remains a significant reason for graft refusal in the new allocation system. We sought to investigate the effect of prolonged CIT on kidney transplant outcomes at a center without an international airport. METHODS: Retrospective study of kidney transplant patients treated at an academic medical center from January 1, 2018 to May 1, 2020. The 117 patients were divided into 2 categories. Fifty-four patients (46%) had CIT of 30-35.99 hours, and 63 (54%) had CIT of 36± hours. Kidney function was evaluated using creatinine and at 12 months, which was the primary endpoint. RESULTS: All of the transplanted allografts were carefully selected and had ≤ 20% glomerulosclerosis and an average kidney donor profile index of 54%. Among the 117 patients analyzed in this study, there was no significant difference in creatinine at 12 months between groups with CIT above 36 hours and < 35.99 hours (2.07 vs 1.78; P value .2339). There were a total of 18 rejection events (15%) and no cases of primary non-function in either group. Patients that were able to be maintained on calcineurin inhibitors had improved graft function at 12 months (1.69 vs 2.96; P value .0267). CONCLUSIONS: Our study indicated that prolonged CITs over 36 hours were not associated with poorer patient outcomes at 1 year when using creatinine as an endpoint. They also had similar rates of rejection, consistent with previously published rates for kidney transplantation.

Nepal measles outbreak response immunization during COVID-19: A risk-based intervention strategy.

In 2020, National Immunization Programme (NIP) of Nepal implemented a measles outbreak response immunization (ORI) campaign, which was additional to an ongoing preventive measles-rubella SIA campaign. Both campaigns were implemented during ongoing COVID-19 transmission. By April, 220 measles cases and two deaths were confirmed from eight districts of Nepal. The NIP triangulated information from surveillance (measles and COVID-19), measles immunization performance and immunity profile, programme capacities and community engagement and applied a logical decision-making framework to the collated data to inform 'Go/No-Go' decisions for ORI interventions. This was reviewed by the National Immunization Advisory Committee (NIAC) for endorsement. Outbreak response with non-selective immunization (ORI), vitamin-A administration and case management were implemented in affected municipalities of four districts, while in the remaining districts outbreak response without ORI were undertaken. The structure and iterative application of this logical framework has been described. ORI was implemented without interrupting the ongoing measles-rubella vaccination campaign which had targeted children from 9 to 59 months of age. The age group for ORI was same as SIA in one sub-district area, while for the other three sub-district areas it was from 6 months to 15 years of age. More than 32,000 persons (97% coverage) were vaccinated in ORI response. Overall measles incidence decreased by 98% after ORI. The daily incidence rate of measles was 94 times higher (95% confidence interval: 36.11 - 347.62) before the ORI compared to two weeks after ORI until year end. Close attention to surveillance and other data to inform actions and seamless collaboration between NIP and core immunization partners (WHO, UNICEF), with guidance from NIAC were key elements in successful implementation. This was an example of feasible application of the global framework for implementation of a mass vaccination campaign during COVID-19 through application of a simple decision-making logical framework.

Anti-Inflammatory Activity of Artemisia vulgaris Leaves, Originating from Three Different Altitudes of Nepal.

This study aimed to evaluate and compare the in vivo chronic anti-inflammatory efficacy, from the ethyl acetate and ethanolic extracts of Artemisia vulgaris leaves, grown at three different altitudes in Nepal, by formalin-induced paw edema in Swiss albino mice. Edema was induced on the mice paw by administering 0.2% of formalin injection. Indomethacin was used as a standard drug at the concentration of 5 mg/kg of body weight. Ethyl acetate and ethanolic leaves extract, at the concentration of 200 mg/kg and 400 mg/kg, were used as test drugs. Standard drug and all the extracts were administered 30 min before formalin injection. The paw thickness was measured at 0, 1, 2, 3, 24, 48, and 72 hours after formalin injection, using a Vernier caliper. It was observed that both ethyl acetate and ethanolic extract from all the altitudes exhibited significant inhibition of paw edema (p < 0.05) induced by formalin. Maximum activity was shown by 400 mg/kg of the plant leaf extract taken from the temperate zone, with 54.05% of paw edema inhibition, and it is almost similar to the inhibition of standard drug (56.75%). Moreover, the ethanolic extract was found to be more effective than ethyl acetate extract in all the plant samples. The results suggested that the anti-inflammatory effect of A. vulgaris leaves increases with an increase in altitudes and this plant can be used as a useful source of medicine to treat chronic inflammation.

Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol.

The impact of subclinical inflammation (SCI) noted on early kidney allograft biopsies remains unclear. This study evaluated the outcome of SCI noted on 3-month biopsy. A total of 273/363 (75%) kidney transplant recipients with a functioning kidney underwent allograft biopsies 3-months posttransplant. Among those with stable allograft function at 3 months, 200 biopsies that did not meet the Banff criteria for acute rejection were identified. These were Group I: No Inflammation (NI, n = 71) and Group II: Subclinical Inflammation (SCI, n = 129). We evaluated differences in kidney function at 24-months and allograft histology score at 12-month biopsy. SCI patients had a higher serum creatinine (1.6 ± 0.7 vs 1.38 ± 0.45; P = .02) at 24-months posttransplant, and at last follow-up at a mean of 42.5 months (1.69 ± 0.9 vs 1.46 ± 0.5 mg/dL; P = .027). The allograft chronicity score (ci + ct + cg + cv) at 12-months posttransplant was higher in the SCI group (2.4 ± 1.35 vs 1.9 ± 1.2; P = .02). The incidence of subsequent rejections within the first year in SCI and NI groups was 24% vs 10%, respectively (P = .015). De novo donor-specific antibody within 12 months was more prevalent in the SCI group (12/129 vs 1/71, P = .03). SCI is likely not a benign finding and may have long-term implications for kidney allograft function.

Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy.

Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices.

Comparison of the outcome of implantation of hydrophobic acrylic versus silicone intraocular lenses in pediatric cataract: prospective randomized study.

OBJECTIVE: To compare the postoperative performance of hydrophobic acrylic and silicone square-edge intraocular lenses in pediatric cataract. DESIGN: Prospective randomized study. PARTICIPANTS: Forty-one eyes of 41 children (age 1 month to 8 years) with congenital or developmental cataract. METHODS: Children were randomly divided into 2 groups. All participants underwent phacoaspiration, primary posterior capsulotomy, and anterior vitrectomy. Group A (n = 21) eyes were implanted with acrylic hydrophobic AcrySof SA60AT intraocular lenses (IOLs), and those of Group B (n = 20) were implanted with silicone Tecnis Z9000 IOLs. The children were evaluated for anterior chamber reaction, IOL position, posterior capsular opacification PCO), intraocular pressure, best-corrected visual acuity (BCVA), corneal status, and refractive errors. RESULTS: Postoperatively, 2 eyes in each group had significant anterior chamber reaction with fibrin membrane formation. IOLs were in the capsular bag in all but 1 eye in both groups. Seven eyes in the acrylic group and 6 eyes in the silicone group achieved visual acuity of 20/40 or better. None of the eyes showed glaucoma. BCVA at 1 year was similar in both groups. In the acrylic hydrophobic group, 14 eyes needed hypermetropic correction and 7 eyes were myopic, and in the silicone group 10 eyes had myopia and 10 eyes had hypermetropia at 1 year postoperatively. PCO at 1 year follow-up was more common in eyes implanted with acrylic hydrophobic IOLs (5 eyes) than silicone IOLs (2 eyes). CONCLUSIONS: Both square-edge hydrophobic acrylic and silicone IOLs were found to be compatible and safe for use in pediatric cataract surgery with similar visual axis clarity and postoperative outcome.