Experiences of performing ABO-incompatible kidney transplantation in Bangladesh

Nura Afza Salma Begum,Tasnuva Sarah Kashem,Farnaz Nobi,Shakib Uz-Zaman Arefin,Harun Ur Rashid 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.2

Background: The number of end-stage renal disease (ESRD) patients is increasing in Bangladesh. Currently, living kidney donation is the only viable option for transplan- tation in Bangladesh, and it is further restricted by ABO compatibility issues. We have performed ABO-incompatible kidney transplantations (ABOi KTs) in Bangladesh since 2018. This study examines our experiences with seven cases of ABOi KT. Methods: The desensitization protocol included low-dose rituximab (100 mg/body) fol- lowed by plasma exchange (PEX), which was followed by a 5-g dose of intravenous im- munoglobulin. Immunosuppression was undertaken using tacrolimus (0.1 mg/kg/day), mycophenolate mofetil (1,500 mg/day), and prednisolone (0.5 mg/kg/day). All patients received basiliximab for induction therapy. Results: The median baseline anti-ABO antibody titer was 1:64 (range, 1:32–1:128). Transplantation was performed at a titer of ≤1:8. Our patients attended three to five PEX sessions before transplantation. Graft survival was 100% in the seven cases over a mean period of 22 months. The mean creatinine level was 204.6±47.4 μmol/L. Two patients were suspected of having developed acute rejection and received intravenous methylprednisolone, resulting in improved kidney function. One patient required post- transplant hemodialysis due to delayed graft function and subsequently improved. In- fection was the most common complication experienced by ABOi KT patients. Two pa- tients developed severe cytomegalovirus pneumonia and died with functioning grafts. Conclusions: ABOi KT in Bangladesh will substantially expand the living kidney donor pool and bring hope to a large number of ESRD patients without ABO-compatible do- nors. However, the high cost and risk of acute rejection and infection remain major con- cerns.

Mycobacterial infections in solid organ transplant recipients

Harun Ur Rashid,Nura Afza Salma Begum,Tasnuva Sarah Kashem 대한이식학회 2021 Korean Journal of Transplantation Vol.35 No.4

Mycobacterium tuberculosis (MTB) infection in solid organ transplant (SOT) recipients remains a major challenge for physicians and surgeons. Active tuberculosis (TB) is associated with increased morbidity and mortality in SOT recipients. MTB usually develops after transplantation in a recipient with latent TB infection (LTBI) before transplantation and may also be transmitted from the donor or acquired from the community. Therefore, screening for LTBI in donors and recipients before transplantation is very important in preventing active disease after transplantation. This review article is based on recently published data, case series, and expert recommendations. We reviewed updated information about the epidemiology, diagnosis, and treatment of latent and active TB before and after transplantation. We also reviewed recent treatments for multidrug-resistant TB.

Transplantation in Asia during the coronavirus disease-19 (COVID-19) pandemic: briefs from member countries of the Asian Society of Transplantation

Terence Kee,정종철,하종원,Harun Ur Rashid,Nura Afza Salma Begum,Maggie K.M. Ma,Vivek Kute,Kenji Yuzawa,Rosnawati Yahya,Ghazali Ahmad,Lkhaakhuu Od-Erdene,Dibya Singh Shah,Romina A Danguilan,Curie Ahn,Devinde 대한이식학회 2020 Korean Journal of Transplantation Vol.34 No.2

The coronavirus disease-19 (COVID-19) pandemic has affected 1,029,968 people in Asia as of May 16, 2020. Although Asia was the first continent to be affected, many countries in the region continue to battle COVID-19, which challenges the way transplant programs provide their services. Given the diversity of healthcare systems in Asia, the countermeasures in response to COVID-19 are as potentially diverse. This review reports the experiences of transplant services in member countries of the Asian Society of Transplantation (AST) as well as provides a platform for sharing of best practices during the COVID-19 pandemic. AST invited member countries to provide a short description of their transplant experiences during the COVID-19 pandemic. Whenever information is available, countries were asked to provide information on COVID-19 related statistics, status of transplant programs, mitigation measures taken to prevent COVID-19, and other areas of transplant programs impacted by COVID-19. Ten countries responded to the invitation of which seven still have active transplant programs at varying levels of activity. All countries have protocols for donor/recipient screening and countermeasures to prevent COVID-19 infections in recipients and healthcare providers. Interestingly, these countries report only 16 transplant recipients with COVID-19 infection but no cases of donor-transmitted COVID-19 infection. Despite the diversity of healthcare systems in Asia, transplant centers in Asia have taken appropriate precautions to avoid COVID-19 infections, though the long-term impact of COVID-19 remains unclear.

Clinical characteristics, outcomes, and management of COVID-19 in kidney transplant recipients across Asia: an ASTREGO report

Terence Kee,Jong Cheol Jeong,Harun Ur Rashid,Nura Afza Salma Begum,Mel-Hatra Arakama,Romina Danguilan,Lkhaahuu Od-Erdene,Rosnawati Yahya,김예림,Hersharan Kaur Sran,Becky Ma,Maggie Ma,Devinder Singh Rana 대한이식학회 2021 Korean Journal of Transplantation Vol.35 No.4

Background: Asia is the global epicenter of the coronavirus disease 2019 (COVID-19) pandemic; however, COVID-19–related mortality in Asia remains lower than in other parts of the world. It is uncertain whether the mortality of COVID-19-infected kidney transplant recipients (KTXs) from Asia follows the lower mortality trends of the younger Asian population. Methods: Specific transplant centers from countries in the Asian Society of Transplantation were invited to participate in a study to examine the epidemiology, clinical features, natural history, and outcomes of COVID-19 infections in KTXs. Data were analyzed and compared with those of large cohort studies from other countries. Results: The study population was 87 KTXs from nine hospitals in seven Asian countries. Within the study population, 9% were aged 60 years and older, and 79% had at least one comorbidity. The majority of patients (69%) presented with mild-to-moderate COVID-19 severity. Disease progression was more frequently encountered among those with moderate or severe infection (23%) and non-survivors (55%). The mortality rate was 23% (n=20) and differed according to the level of care: 12% (n=1/8), 15% (n=10/67), and 100% (n=9/9) of patients managed as outpatients, in the general ward, and in the intensive care unit, respectively. Disease severity at the time of presentation was an independent predictor of mortality. Compared with the mortality rates in other studies worldwide, mortality rates in the current study were comparable. Conclusions: Mortality in Asian KTXs who were infected with COVID-19 remains high and could be related to comorbidity burden and the constraints of the general healthcare system when the COVID-19 caseload is high.

Toolkit to Compute Time-Based Elixhauser Comorbidity Indices and Extension to Common Data Models

Shorabuddin Syed,Ahmad Baghal,Fred Prior,Meredith Zozus,Shaymaa Al-Shukri,Hafsa Bareen Syeda,Maryam Garza,Salma Begum,Kim Gates,Mahanazuddin Syed,Kevin W. Sexton 대한의료정보학회 2020 Healthcare Informatics Research Vol.26 No.3

Objectives: The time-dependent study of comorbidities provides insight into disease progression and trajectory. We hypothesizethat understanding longitudinal disease characteristics can lead to more timely intervention and improve clinicaloutcomes. As a first step, we developed an efficient and easy-to-install toolkit, the Time-based Elixhauser Comorbidity Index(TECI), which pre-calculates time-based Elixhauser comorbidities and can be extended to common data models (CDMs). Methods: A Structured Query Language (SQL)-based toolkit, TECI, was built to pre-calculate time-specific Elixhauser comorbidityindices using data from a clinical data repository (CDR). Then it was extended to the Informatics for IntegratingBiology and the Bedside (I2B2) and Observational Medical Outcomes Partnership (OMOP) CDMs. Results: At the Universityof Arkansas for Medical Sciences (UAMS), the TECI toolkit was successfully installed to compute the indices from CDRdata, and the scores were integrated into the I2B2 and OMOP CDMs. Comorbidity scores calculated by TECI were validatedagainst: scores available in the 2015 quarter 1–3 Nationwide Readmissions Database (NRD) and scores calculated usingthe comorbidities using a previously validated algorithm on the 2015 quarter 4 NRD. Furthermore, TECI identified 18,846UAMS patients that had changes in comorbidity scores over time (year 2013 to 2019). Comorbidities for a random sample ofpatients were independently reviewed, and in all cases, the results were found to be 100% accurate. Conclusions: TECI facilitatesthe study of comorbidities within a time-dependent context, allowing better understanding of disease associations andtrajectories, which has the potential to improve clinical outcomes.

API Driven On-Demand Participant ID Pseudonymization in Heterogeneous Multi-Study Research

Shorabuddin Syed,Mahanazuddin Syed,Hafsa Bareen Syeda,Maryam Garza,William Bennett,Jonathan Bona,Salma Begum,Ahmad Baghal,Meredith Zozus,Fred Prior 대한의료정보학회 2021 Healthcare Informatics Research Vol.27 No.1

Objectives: To facilitate clinical and translational research, imaging and non-imaging clinical data from multiple disparatesystems must be aggregated for analysis. Study participant records from various sources are linked together and to patient recordswhen possible to address research questions while ensuring patient privacy. This paper presents a novel tool that pseudonymizesparticipant identifiers (PIDs) using a researcher-driven automated process that takes advantage of application-programminginterface (API) and the Perl Open-Source Digital Imaging and Communications in Medicine Archive (POSDA) tofurther de-identify PIDs. The tool, on-demand cohort and API participant identifier pseudonymization (O-CAPP), employsa pseudonymization method based on the type of incoming research data. Methods: For images, pseudonymization of PIDsis done using API calls that receive PIDs present in Digital Imaging and Communications in Medicine (DICOM) headersand returns the pseudonymized identifiers. For non-imaging clinical research data, PIDs provided by study principal investigators(PIs) are pseudonymized using a nightly automated process. The pseudonymized PIDs (P-PIDs) along with other protectedhealth information is further de-identified using POSDA. Results: A sample of 250 PIDs pseudonymized by O-CAPPwere selected and successfully validated. Of those, 125 PIDs that were pseudonymized by the nightly automated process werevalidated by multiple clinical trial investigators (CTIs). For the other 125, CTIs validated radiologic image pseudonymizationby API request based on the provided PID and P-PID mappings. Conclusions: We developed a novel approach of an ondemandpseudonymization process that will aide researchers in obtaining a comprehensive and holistic view of study participantdata without compromising patient privacy.

Identification of Barriers of School ICT Utilization in Developing Countries and Possible Solutions - Case of West Africa and Asia-Pacific Regions

Seyoung Park,Ki-Sang Song,Abdul Md Mokter Hossain,Aboubacaar Jallow,Aristarick Lekule,Mohammed Kamara,Ramvinay Singh,Salma Begum APEC국제교육협력원 2014 Asia-Pacific Cybereducation Journal Vol.10 No.2

Regional education experts from various developing countries (Bangladesh, Nepal, Sierra Leone, Tanzania, The Gambia) of west Africa and Asia-Pacific regions and experts in ICT in education from Korea cooperated to analyze the current situation of ICT utilization for schools in developing countries. From their research and reflections of participants' countries situation following things are recommended to be considered with priorities. Firstly, the expected problems and difficulties of introducing ICT in developing country schools from six levels including (teachers level, schools level and communities level). Then, solutions thereto are derived for the following six aspects: motivation of teachers, awareness building, Funds, ICT training for teachers, ICT equipment for the teachers, transparency and accountability.