Comparison of estimated glomerular filtration rate of marginal versus standard renal allograft: A prospective cohort study.

INTRODUCTION: The end-stage renal disease (ESRD) population is increasing worldwide and organ shortage is an important issue. The disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidney donors. We assess and compare postoperative estimated glomerular filtration rate (eGFR) in patients who received a graft from marginal renal donor (MRD) versus those who received a graft from standard renal donor (SRD). METHODS: A total of 214 patients with ESRD underwent open live donor renal allografting from September 2015 to September 2017. Out of 214 donors, 165 (77.1%) were SRD and 49 (22.9%) were MRD. Post-transplant eGFR was calculated at 2 months for donors and at days 1, 3, 5, and 7 and month 1, 3, 6, and 12 for recipients. RESULTS: There was no statistically significant difference in eGFR of recipients at preoperative and postoperative period between SRD and MRD groups. Although at 12 months of follow-up eGFR was relatively high in SRD group, it did not show any statistically significant difference. The recipient survival rate at 1-year follow-up was 98.2% in SRD and 100% in MRD group. CONCLUSIONS: Renal transplant recipients using MRDs have a comparable glomerular filtration rate to SRDs at the end of 1 year. Short-term outcomes in recipients receiving marginal renal grafts were similar when compared to the allograft from standard donors.

A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic led to a sudden drop in renal transplant numbers across India in the initial months of 2020. Although the transplant numbers increased with easing of lockdown, the outcome of these transplants remains unknown. METHODS: This was a retrospective, observational, multi-center study done across eight different transplant centers in India. All the transplants done from January 30, 2020 to December 31, 2020 were included. The primary outcomes studied were patient and death censored graft survival as well as incidence of COVID-19 infection and its outcomes. RESULTS: During the study period a total of 297 kidney transplants were done. After a median follow up of 265 days the patient and death censored graft survival was 95.3% and 97.6%, respectively. Forty-one patients (13.8%) developed COVID-19 post-transplant. Majority (58.5%) were asymptomatic to mildly symptomatic and the case fatality ratio was 14.6%. On multivariable logistic regression analysis older age was associated with higher likelihood of COVID-19 infection (odds ratio 1.038; CI 1.002-1.077). CONCLUSIONS: Patient and graft outcome of kidney transplants done during the COVID-19 pandemic in India was acceptable. The incidence of COVID-19 was 13.8% with a high case fatality ratio.

Robotic Kidney Transplantation with Regional Hypothermia versus Open Kidney Transplantation for Patients with End Stage Renal Disease: An Ideal Stage 2B Study.

PURPOSE: We report on comparative effectiveness of minimally invasive versus traditional open kidney transplantation. MATERIALS AND METHODS: We undertook a prospective cohort study of 654 patients who underwent open or robotic kidney transplantation at a single tertiary care hospital between January 2013 and December 2015. Primary outcome was delayed graft function, defined as the need for dialysis within 1 week of surgery. Secondary outcomes included postoperative complications, pain, graft rejection, and graft and patient survival. Nonparsimonious propensity score and Ding-VanderWeele analytical methods were used to account for confounding bias. RESULTS: Within the 1:3 matched cohort (robotic 126, open 378; well matched with standardized mean difference ∼10%), the robotic approach was associated with lower rates of wound infections (0% vs 4%, p=0.023) and symptomatic lymphoceles (0% vs 7% at 36 months, p=0.003), as well as reduced postoperative pain, requirement for narcotic analgesia and blood loss. There were no differences between the 2 groups, robotic versus open, with respect to graft function (delayed graft function 0% vs 2.4%, p=0.081), hospital stay (median 8 days for both, p=0.647), graft rejection (16.2% vs 18.6% at 36 months, p=0.643), and graft (95.2% vs 96.3% at 36 months, p=0.266) and overall survival (94.5% vs 98.1% at 36 months, p=0.307). Ding-VanderWeele analysis suggested minimal influence of unknown confounders on study findings. CONCLUSIONS: Robotic kidney transplantation with regional hypothermia was associated with a lower rate of postoperative complications and improved patient comfort in comparison to open kidney transplantation. Graft function, and graft and overall survival were comparable between the 2 techniques.

Feasibility and Functional Outcome of Robotic Assisted Kidney Transplantation Using Grafts With Multiple Vessels: Comparison to Propensity Matched Contemporary Open Kidney Transplants Cohort.

Introduction: The aim of the study was to report the perioperative and functional results of Robotic assisted kidney transplantation (RAKT) in Grafts with multiple vessels (GMVs) and compare it to the results of Open kidney transplantation (OKT) with GMVs. Materials and Methods: Patients undergoing RAKT from living donors using GMVs were reviewed from prospectively collected RAKT database at our institution between March 2013 and March 2018. Patient undergoing Open kidney transplantation (OKT) using GMVs served as controls. Ex-vivo bench surgical reconstruction of GMVs was done according to specific anatomy. Propensity score matching was used to balance the sample size in the two groups. Results: Of 153 RAKT and OKT procedures, 86 cases were eligible for propensity score matching for the statistically significant variables (standardized difference >0.10) and 43 procedures were assigned to each group. Median anastomoses, total and cold ischemia and rewarming times did not differ significantly between the RAKT and OKT groups. In comparison with OKT in GMVs we found that RAKT with GMVs had less pain score on post op 2nd day (p = 0.03). There was also a significant difference in mean analgesic requirement (p = 0.02), hospital stay (p = 0.05) and incision length (p = 0.04). Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups except for wound related events (p = 0.002). Conclusion: Multiplicity of renal vessels in RAKT does not adversely affect patient or graft survival compared with the OKT. Satisfactory functional outcome can be achieved by RAKT similar to OKT in GMVs. RAKT seems to have advantage over OKT in that it is less invasive and has the potential to cause fewer low grade complications. Small sample size and short follow-up are the main limitations of the study.

Pediatric ABO-incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single-center experience.

Recent literature has endorsed favorable outcomes following ABOi kidney transplantation in pediatric population. Nevertheless, reluctance to pursue an ABOi still remains pervasive. This could be ascribed to various legitimate reasons, namely less extensive pediatric ABOi data, technical difficulties encountered during PP, cost restraints, and concerns regarding higher rates of antibody-mediated rejection, infectious complications, and post-transplant lymphoproliferative disorder as compared to adults. However, given the similar excellent outcomes of both ABOi and ABOc kidney transplantation, clinicians should consider this option sooner if a compatible donor or swap is not available. Here, we describe the outcomes of three pediatric ABOi performed at our institute in India (from 2014 till now), wherein distinct apheresis modalities had been employed in each desensitization protocol, and our techniques evolved with advancing science in apheresis. This case series includes India's first published pediatric ABO-incompatible transplant (Case 2) and the youngest child to undergo ABO-incompatible renal transplant in SAARC nations (Case 3).

Synergistic Configuration of Diols as Brønsted Bases.

As viscous hydroxylic organic compounds, diols are of interest for their functional molecular conformation, which is based on inter- and intramolecular hydrogen (H)-bonds. By utilising steady-state electronic and vibrational spectroscopy, time-resolved fluorescence spectroscopy, and computational analyses, we report the association of the hydroxyl groups of diols via intra- or intermolecular H-bonds to enhance their reactivity as a base. Whereas the formation of an intermolecularly H-bonded dimer is requisite for diols of weak intramolecular H-bond to extract a proton from a model strong photoacid, a well-configured single diol molecule with an optimised intramolecular H-bond is revealed to serve as an effective Brønsted base with increased basicity. This observation highlights the collective role of H-bonding in acid-base reactions, and provides mechanistic backgrounds to understand the reactivity of polyols in the acid-catalysed dehydration for the synthesis of cyclic ethers at the molecular level.

Minimally invasive kidney transplantation: perioperative considerations and key 6-month outcomes.

BACKGROUND: Minimally invasive approaches to kidney transplantation (KT) have been described recently. However, information concerning perioperative management in these patients is lacking. Accordingly, in the current study, we describe our perioperative management strategy in patients undergoing robotic KT with regional hypothermia and report its safety and efficacy. Further, we describe key 6-month outcomes in these patients. METHODS: Sixty-seven consecutive end-stage renal disease patients underwent live-donor robotic KT at a single tertiary care institution between January 2013 and June 2014. Outcomes including patient/graft survival, graft function, operative parameters, and perioperative complications are reported in patients with a minimum of 6-month follow-up (n=54). RESULTS: All patients successfully underwent robotic KT with regional hypothermia using a modified intraoperative management protocol. None of the cases required conversion to open surgery (0%). Mean console, warm ischemia, and rewarming times were 130.8 minutes, 2.3 minutes and 42.9 minutes, respectively. Mean graft-surface temperature was 19.2°C with zero incidence of systemic hypothermia. Routine extraperitonealization of the graft insured against graft-torsion (0%) despite a transperitoneal approach to graft placement. There were no instances of graft vascular thromboses/stenoses/leaks (0%). Three patients (5.6%) developed clinical head-neck edema but were successfully extubated on table. There was no delayed graft function (0%). Mean 6-month serum creatinine was 1.2 mg/dL. Patient survival was 96.3% (n=52), and death-censored graft survival was 100% at a median follow-up of 13.4 months. CONCLUSIONS: Significant differences exist in intraoperative management of patients undergoing robotic KT and open KT. By tweaking fluid infusion rates and pneumatic pressures and maintaining core body temperature, optimal patient outcomes can be achieved. Pretransplant and posttransplant management is essentially the same.

Robotic renal transplantation: Current status.

INTRODUCTION: Kidney transplantation (KT) has traditionally been performed by open renal transplantation, but recently, a few groups including our own have described a minimally invasive approach to KT. We aim to discuss the current status of robotic kidney transplantation (RKT) and describe our technique of RKT with regional hypothermia. MATERIAL AND METHODS: We used the search terms "minimally invasive" OR "robotic" OR "robot assisted" AND "kidney transplantation." Papers written in English and concerning technical and/or clinical outcomes following minimally invasive kidney transplantation were selected. Three hundred and eighteen unique articles were retrieved and nine were relevant. Comparative outcomes data following RKT with regional hypothermia versus open KT (OKT) from our own group were also included. FINDINGS: Nine papers, so far, have evaluated the role of robotic approach in KT and have conclusively established the feasibility, safety, and reproducibility of RKT, although these studies have been performed by experienced robotic surgeons/teams. The contemporary published series note that rejection rates were similar in RKT and OKT patients. Mean serum creatinine at 6 months in RKT and OKT patients was equivalent, across the three series. Most of the studies also note a dramatic reduction in the wound-related complication rates. CONCLUSION: RKT appears to be a safe surgical alternative to the standard open approach of KT. RKT is associated with reduced postoperative pain, analgesic requirement, and better cosmesis. RKT, although in its infancy, appears to be associated with lower complication rates.

Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a).

BACKGROUND: We recently reported on preclinical and feasibility studies (Innovation, Development, Exploration, Assessment, Long-term study [IDEAL] phase 0-1) of the development of robotic kidney transplantation (RKT) with regional hypothermia. This paper presents the IDEAL phase 2a studies of technique development. OBJECTIVES: To describe the technique of RKT with regional hypothermia developed at two tertiary care institutions (Vattikuti Urology Institute and Medanta Hospital). We report on the safety profile and early graft function in these patients. DESIGN, SETTING, AND PARTICIPANTS: This is a prospective study of 50 consecutive patients who underwent live-donor RKT at Medanta Hospital following a 3-yr planning/simulation phase at the Vattikuti Urology Institute. Demographic details, and perioperative and postoperative outcomes are reported for the initial 25 recipients who have completed a minimum 6-mo follow-up. SURGICAL PROCEDURE: Positioning and port placement were similar to that used for robotic radical prostatectomy. Allograft cooling was achieved by ice slush delivered through a GelPOINT device. The accompanying video details the operative technique. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was posttransplant graft function. Secondary outcomes included technical success or failure and complication rates. RESULTS AND LIMITATIONS: Fifty patients underwent RKT successfully, 7 in the phase 1 and 43 in the phase 2 stages of the study. For the initial 25 patients, mean console, warm ischemia, arterial, and venous anastomotic times were 135, 2.4, 12, and 13.4 min, respectively. All grafts were cooled to 18-20 °C with no change in core body temperature. All grafts functioned immediately posttransplant and the mean serum creatinine level at discharge was 1.3mg/dl (range: 0.8-3.1mg/dl). No patient developed anastomotic leaks, wound complications, or wound infections. At 6-mo of follow-up, no patient had developed a lymphocele detected on CT scanning. Two patients underwent re-exploration, and one patient died of congestive heart failure (1.5 mo posttransplant). CONCLUSIONS: RKT with regional hypothermia is safe and reproducible when performed by a team skilled in robotic surgery. PATIENT SUMMARY: RKT is safe and effective when performed by surgeons experienced in robotic techniques.

FRET-based characterisation of surfactant bilayer protected core-shell carbon nanoparticles: advancement toward carbon nanotechnology.

Surfactant bilayer protected core-shell carbon nanoparticles (CNPs) have been synthesised. Förster resonance energy transfer (FRET) between the core-shell CNPs and two strategically chosen organic dyes has been exploited to characterise the protective surfactant bilayer.

Protein-templated gold nanoclusters: size dependent inversion of fluorescence emission in the presence of molecular oxygen.

Gold nanoclusters are promising candidates as biological markers without having toxic effects like fluorescent quantum dots. Herein, bovine serum albumin (BSA) protein stabilized gold nanoclusters of two different sizes emitting at 410 and 645 nm have been synthesized. These nanoclusters have been shown to interact with molecular oxygen differentially. Spectroscopic and chemical evidences show that dioxygen molecule gets adsorbed at two different orientations on the nanoclusters. The orientation motifs have been hypothesized to be superoxo and peroxo types on the smaller and the larger gold nanoclusters, respectively. Due to the difference in attachments, the oxygen molecule shows opposite changes in fluorescence intensity for the nanoclusters. The fluorescence intensity of the blue emitting nanocluster shows a profuse enhancement whereas the red emitting species shows quenching of emission. Superoxo type adsorption of the oxygen molecule on the blue emitting gold nanoclusters induce formation of singlet oxygen that in turn enhances the fluorescence intensity of the species. This could be verified by oxidation of diaminobenzidine (DAB) by singlet oxygen. Enhancement in fluorescence intensity of the blue emitting gold nanoclusters with an increase in concentration of molecular oxygen may enable them to be good candidates in bioimaging and detection.

"Extra stabilisation" of a pyrene based molecular couple by γ-cyclodextrin in the excited electronic state.

Two thiosemicarbazide and semicarbazide functionalized pyrene labeled Schiff base compounds have been synthesized. The pyrene moieties in the compounds result in formation of π-π coupled complexes in aqueous medium in the excited electronic state. Added γ-cyclodextrin allows incorporation of the pyrene head inside its less polar core and promotes hydrogen bonding of the thio and oxo groups of the compounds with its rim hydroxyl groups to "stabilise" the monomers. This is confirmed by FT-IR and absorption spectroscopy. The stabilised monomers lead to formation of stabilised excimers as monitored by steady state and time-resolved fluorescence spectroscopy through varying the experimental conditions. The proposed model for the stabilisation of the Schiff base monomers has been evidenced by comparing with the fluorescence spectroscopic changes of two control compounds. The present work reports a step ahead toward proposing a simple host-guest method to extra stabilise the pyrene based excimers that can be biologically utilised.

Förster resonance energy transfer between pyrene and bovine serum albumin: effect of the hydrophobic pockets of cyclodextrins.

The phenomenon of Förster resonance energy transfer (FRET) between pyrene and bovine serum albumin (BSA) protein in presence of cyclodextrins (CDs) is explored in the present work. CDs provide hydrophobic environment and thus the aromatic molecules get encapsulated in them depending on the relative size and space. In this work we revealed that along with pyrene monomer, the side chains of amino acids in BSA can get trapped partly in the hydrophobic cavities of CDs if space permits. While being encapsulated by ß-CD as pyrene monomer, it can interact with the BSA tryptophan moiety exposed toward the aqueous environment to form a dimer through π-π interaction. This, in turn, affects the energy transfer process by reducing the efficiency. On the other hand, pyrene excimer gets encapsulated in a γ-CD molecule due to availability of enough space. The excimer shows a new band at a higher wavelength. This further reduces FRET efficiency due to scarcity of acceptor for the tryptophan moieties in BSA.

Physicochemical perspective of cyclodextrin nano and microaggregates.

''Chemistry beyond the molecule'' is the nickname for supramolecular chemistry. This branch of study is based on molecular recognition that is host-guest chemistry. A number of potential hosts have been defined and applied in scores of studies. Among all potential hosts, cyclodextrins occupy a high position due to their characteristic solubilisation capability and biocompatibility. In the present article we are revisiting the host-guest aspects of cyclodextrins from a physicochemical perspective. We present details of formation and applications of cyclodextrin nanoaggregates induced by guest molecules, the concerned thermodynamics behind the process and also the effect of concentration of the guest molecules on the morphology of the aggregates. This article reviews the topic mainly from the spectroscopic point of view.

Interaction of a new surface sensitive probe compound with anionic surfactants of varying hydrophobic chain length.

The amide derivative of a bis-phenylethynyl compound meta linked to 2,6-pyridine (BPEAP) poses inherent equilibrium between its neutral and zwitterionic forms in the excited state. BPEAP has been found to bind to the surface of anionic micelles instead of penetrating inside. This phenomenon has been exploited to attempt controlling the process of equilibrium using sodium dodecyl sulfate (SDS) at its pre-micellar and near-micellar aggregation concentrations. The anionic surfactant has been found to alter the equilibrium between the said forms of BPEAP depending on its concentration in solution. The process has been further verified by using sodium decyl sulfate (SDeS), which has smaller hydrophobic chain length than SDS as also varies in the critical micellar concentration (CMC) and aggregation number. The binding constant of the probe to the surfactant aggregates varies depending on the extent of surface available to the fluorophore for attachment.

Interaction of a "nido"-ruthenium terpyridylamine complex with charged elongated micellar scaffolds.

Influence on ionic surfactants by a specially designed terpyridylamine ligand and the ruthenium(II) complex formed with it has been studied in aqueous solution. The ligand coordinates to Ru(2+) into an octahedral geometry in such a way that the final form takes a "nido" or nest-like structure. The substitution on the pyridinyl moiety is kept at the ortho position to acquire the specified geometry. Similar complexes have been reported to have anti-tumor properties and thus the ruthenium complexes can effectively replace platinum complexes that serve the same purpose but with certain drawbacks. The "nido" geometry was chosen to minimize the cytotoxicity that creeps in when para substituents of the pyridinyl moiety are used. The latter variety forms a dendridic scaffold. In presence of both the ligand and the complex, ionic surfactants form elongated aggregates. The surface charge of those aggregates decides the nature of interaction of the ligand and the complex formed therefore. Interaction with anionic surfactant scaffold is found to be stronger than the cationic one.

Mechanistic pathway for controlled extraction of guest molecule bound to herring sperm DNA using α-cyclodextrin.

trans-2-[4-(Dimethylamino)styryl]benzothiazole (DMASBT) is known to have dual emitting states where the locally excited (LE) state is responsible for fluorescence in less polar environment and in polar milieu fluorescence is from the twisted intramolecular charge transfer (TICT) state. This compound also undergoes minor groove binding to herring sperm DNA (hsDNA) evidenced by the absorption spectra before and after the binding process and an effect on DMASBT fluorescence by an anionic quencher. The binding occurs efficiently in a 1:1 manner, i.e. one guest molecule binds to one site on the hsDNA. Instead of following the DNA twist, the aromatic part seems to project outward. Thus, the bound molecule can be successfully extracted out from the DNA in a controlled way by the hydrophobic cavity of α-cyclodextrin (α-CD). The extraction starts even with a low concentration of α-CD and increases as the concentration is increased. Absorption, steady-state and time resolved fluorescence spectroscopic methods have been employed to explore the mechanistic pathway of binding of DMASBT to hsDNA. The mechanistic approach toward controlled extraction of the guest molecules from hsDNA by α-CD is reported and is expected to serve a significant purpose in treatment of drug overdose.

Orientation of a TICT probe trapped in the peripheral confined water created by ionic surfactant envelope around silver nanoparticles.

Ionic surfactants are known to aggregate around the surface of a nanoparticle as a single layer in premicellar and a double layer in micellar concentrations. This motif of arrangement indicates the development of a layer of confined water of lower polarity than bulk water around the surface of the nanoparticle. We have demonstrated the behavior of a twisted intramolecular charge transfer (TICT) probe, trans-2-[4-(dimethylamino)styryl]benzothiazole (DMASBT), in the confined aqueous layer developed at the surface of spherical silver nanoparticles (Ag NPs) at and above the critical micellar concentrations (CMC) of a cationic and an anionic surfactant, namely, cetyltrimethylammonium bromide (CTAB) and sodium dodecyl sulfate (SDS). It is observed that the presence of charged surfactant head groups affects DMASBT differentially in the ground and the excited states. In presence of CTAB, DMASBT turns over in the excited state and interacts with the Ag NP surface, whereas in SDS the probe remains in its original orientation during the interaction. Steady-state and time-resolved fluorescence spectral studies provide enough evidence for orientation of the TICT probe in the peripheral water of Ag NP created by the surfactants. The results were confirmed by steady-state anisotropy measurements. The data show the difference between the properties of the confined peripheral water and the bulk aqueous environment. The TICT probe, DMASBT, is proved to be an excellent marker for the phenomenon.

Effect of cyclodextrins on the photophysics of three indoloquinoline derivatives: an intriguing fluorometric study.

Effect of cyclodextrin encapsulation on the photophysics of three indoloquinoline derivatives, namely, 5-methyl-5H-indolo[3,2-c]quinoline (MIQ), 8-chloro-5-methyl-5H-indolo[3,2-c]quinoline (CMIQ), and 2,8-dichloro-5-methyl-5H-indolo[3,2-c]quinoline (DCMIQ), has been studied using steady state and time-resolved fluorescence spectroscopy. The three compounds, which are basically cryptosanguinolentines, exist mainly in their zwitterionic forms in the excited state. Appreciable emission from the π-π* state can be observed on excitation of the compounds at a specific wavelength. The existence of zwitterions in the excited state leads to mutual interaction to form dimers triggered by the presence of the hydrophobic nanocavities of cyclodextrins (CDs) through Coulombic interaction. This is evidenced by steady state fluorescence measurements and treating the fluorophores with CDs of different cavity space. The photophysical behavior of the compounds gets dramatically modulated when they are treated with α-, ß-, and γ-CD hosts. Presence of chloro substituent/s on the parent molecule and the extent of encapsulation by CDs of different dimensions exhibit enormous alterations in the fluorescence characteristics of the compounds. Solvation of the chromophoric moiety by water molecules deviates in character due to the guest-host interaction. Trapped water molecules inside the bigger cavity of γ-CD seem to play a vital role in quenching the fluorescence of the zwitterions of the molecules.