Browsing by Author "Vivek B. Kute"

Now showing 1 - 3 of 3

Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients
(Wolters Kluwer Medknow Publications, 2022) Vijay Kher; Vivek B. Kute; Sarbeswar Sahariah; Deepak S. Ray; Dinesh Khullar; Sandeep Guleria; Shyam Bansal; Sishir Gang; Anil Kumar Bhalla; Jai Prakash; Abi Abraham; Sunil Shroff; Madan M. Bahadur; Pratik Das; Urmila Anandh; Arpita Ray Chaudhury; Manoj Singhal; Jatin Kothari; Sree Bhushan Raju; Dilip Kumar Pahari; G. Vishwanath Siddini; G. Sudhakar; Santosh Varughese; Tarun K. Saha
Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type - living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Co-infusion of donor adipose tissue-derived mesenchymal and hematopoietic stem cells helps safe minimization of immunosuppression in renal transplantation - Single center experience
(Informa Healthcare, 2014) Aruna V. Vanikar; Hargovind L. Trivedi; Ashutosh Kumar; Saroj Chooramani Gopal; Himanshu V. Patel; Manoj R. Gumber; Vivek B. Kute; Pankaj R. Shah; Shruti D. Dave
Background: Stem cell therapy (SCT) is used for immunosuppression minimization in renal transplantation (RT). We carried out a prospective study to evaluate the benefits of co-infusion of donor adipose-derived mesenchymal stem cells (AD-MSC) + hematopoietic stem cells (HSC) in living donor RT (LDRT) under non-myeloablative conditioning.; Methods: In a demographically balanced three-armed LDRT trial with 95 patients in each arm, group-1 received portal co-infusion of AD-MSC + HSC, group-2 received HSC and group-3 received no SCT. Lymphoid irradiation and anti-thyroglobulin were used for conditioning.; Results: SCT was safe. At 1 and 5 years post-transplant, patient survival was 100% and 94.7% in group-1, 100% and 95.7% in group-2, and 94.7% and 84% in group-3, death-censored graft survival was 100% and 94.6% in group-1, 100% and 91.3% in group-2, and 98.9% and 94.4% in group-3 with mean serum creatinine (mg/dL) of 1.38 and 1.39 in group-1, 1.48 and 1.51 in group-2, and 1.29 and 1.42 and in group-3. Rejection episodes and immunosuppression requirement were lesser in SCT groups versus controls with best results noted in group-1.; Conclusion: Coinfusion of donor AD-MSC +HSC in portal circulation pre-transplant under non-myeloablative conditioning is safe and effective for immunosuppression minimization in LDRT. © 2014 Informa Healthcare USA, Inc. All rights reserved.
Mesenchymal stem cells and transplant tolerance
(Blackwell Publishing, 2014) Aruna V. Vanikar; Hargovind L. Trivedi; Ashutosh Kumar; Saroj Chooramani Gopal; Vivek B. Kute
Different strategies are being tried to induce transplant tolerance in clinical settings; however, none of them are both safe and effective. Mesenchymal stem cells have been found to be potent immunomodulators and immunosuppressants. We discuss in this review different sources of mesenchymal stem cells and the potent role of adipose tissue-derived mesenchymal stem cells in induction of transplant tolerance including when to use them and how to use them for achieving the Utopian dream of transplant tolerance. Summary at a Glance Transplantation tolerance which means stable graft function with absence of rejection episodes in spite of no immunosuppression requirement while maintaining third party immune response intact" is still not achieved in clinic. Tolerance has been tried to be induced by hematopoietic stem cells with the belief that chimerism resulting from stem cell transplantation will induce tolerance. Other workers believe that deletion of antibodies will lead to tolerance. This review describes mesenchymal stem cells and how they help in inducing tolerance. © 2014 Asian Pacific Society of Nephrology.