VENKATESH KUMAR ARIYAMUTHU

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Scholarly Contributions

Chapters

• Abdulrahim, N., Tanriover, B., & Ariyamuthu, V. K. (2019). Post Kidney Transplant: Cardiovascular Complications. In Kidney Transplant Management: A Guide to Evaluation and Comorbidities, 55-71. Springer, Cham. doi:10.1007/978-3-030-00132-2_6
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  Renal transplantation remains the gold standard treatment to improve survival in end-stage renal disease. Cardiovascular disease, as in the general population, is the front-runner cause of mortality in renal transplant recipients. Congestive heart failure, ischemic heart disease, cerebrovascular disease, arrhythmias, and peripheral arterial disease constitute common causes of cardiovascular events and deaths. Post-transplant inflammatory milieu, immunosuppressive agents, episodes of graft rejection, post-graft failure renal replacement therapy, as well as traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, smoking, obesity, chronic kidney disease, proteinuria, and diabetes mellitus, add to a transplant recipient’s cardiovascular risk profile. Medical management of risk factors include strategies employed in the chronic kidney disease population with credence given to approaches specific for transplant recipients, such as choice of maintenance immunosuppression, steroid tapering or withdrawal, and particular anti-hypertensive regimens. Overall cardiovascular morbidity and mortality in renal transplant recipients has declined, over the last few decades, likely secondary to improved detection and timely management of risk factors. However, this requires delicate balancing of robust induction and maintenance immunosuppression to avoid rejection episodes with meticulous treatment of all cardiovascular risk factors in a transplant recipient.
• Regunath, H., Chaudhary, K., & Ariyamuthu, V. K. (2014). Pathogenesis and Management of Dialysis Access Infections. In Microbiology for Surgical Infections, 135-152. Elsevier Inc. doi:10.1016/B978-0-12-411629-0.00008-8
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  Infections related to dialysis access devices are a common cause of morbidity and mortality in dialysis dependent end-stage renal disease patients. Catheter related blood stream infections and their related complications in hemodialysis, and peritonitis in peritoneal dialysis are a significant threat to the continued use of the respective dialysis access devices. They lead to interruption of regular dialysis, increased hospitalization rates and health care costs for their management. The incidence of infectious complications can be decreased as the factors that confer an increased risk of such access device infections are potentially modifiable. This chapter discusses the epidemiology, pathogenesis, risk factors, clinical manifestations, treatment and prevention of both hemodialysis and peritoneal dialysis access device related infectious complications.

Journals/Publications

• Sridhara, S., Gungor, A. B., Erol, H. K., Al-Obaidi, M., Zangeneh, T. T., Bedrick, E. J., Ariyamuthu, V. K., Shetty, A., Qannus, A. A., Mendoza, K., Murugapandian, S., Gupta, G., & Tanriover, B. (2023). Lack of effectiveness of Bebtelovimab monoclonal antibody among high-risk patients with SARS-Cov-2 Omicron during BA.2, BA.2.12.1 and BA.5 subvariants dominated era. PloS one, 18(4), e0279326.
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  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N = 1,091) compared to propensity score (PS) matched control (N = 1,091). The primary composite outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary composite outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p = 0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (
• Al-Obaidi, M. M., Gungor, A. B., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K. M., Low-Adegbija, N. E., Alam, R., Rangan, P., William Heise, C., Ariyamuthu, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M. M., Anand, P. M., & Tanriover, B. (2022). Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection. Open forum infectious diseases, 9(7), ofac186.
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  Real-world data on the effectiveness of neutralizing casirivimab-imdevimab monoclonal antibody (Cas-Imd mAb) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among high-risk patients may inform the response to future SARS-CoV-2 variants.
• Al-Obaidi, M., Gungor, A. b., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K., Nicole, A., Alam, R., Rangan, P., Heise, C. W., ARIYAMUTHU, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M., Anand, P. M., & Tanriover, B. (2022).

  Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection

  . Open forum infectious diseases.
• Al-Obaidi, M., Gungor, A. b., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K., Nicole, A., Alam, R., Rangan, P., Heise, C. W., ARIYAMUTHU, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M., Anand, P. M., Tanriover, B., Al-Obaidi, M., Gungor, A. b., , Nematollahi, S., et al. (2022). Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection. Open forum infectious diseases.
• Batra, R. K., Ariyamuthu, V. K., MacConmara, M. P., Gupta, G., Gungor, A. B., & Tanriover, B. (2022). Outcomes of Simultaneous Liver-Kidney Transplantation Using Kidneys of Deceased Donors With Acute Kidney Injury. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 28(6), 983-997.
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  Outcomes from simultaneous liver-kidney transplantation (SLKT) when using kidneys from donors with acute kidney injury (AKI) have not been studied. We studied 5344 SLKTs between May 1, 2007, and December 31, 2019, by using Organ Procurement and Transplantation Network registry data supplemented with United Network for Organ Sharing-DonorNet data. Designating a donor as having AKI required by definition that the following criteria were met: (1) the donor's condition aligned with the Kidney Disease: Improving Global Outcomes (KDIGO) international consensus guidelines and the terminal serum creatinine (Scr) level was ≥1.5 times the minimum Scr level for deceased donors before organ recovery and (2) the terminal Scr level was ≥1.5 mg/dL (a clinically meaningful and intuitive Scr threshold for defining AKI for transplant providers). The primary outcomes were liver transplant all-cause graft failure (ACGF; defined as graft failures and deaths) and kidney transplant death-censored graft failure (DCGF) at 1 year after transplant. The donors with AKI were young, had good organ quality, and had a short cold ischemia time. In the study cohort, 4482 donors had no AKI, whereas 862 had AKI (KDIGO AKI stages: 1, n = 521; 2, n = 202; and 3, n = 138). In the group with AKI and the group with no AKI, respectively, liver ACGF at 1 year (11.1% versus 12.9% [P = 0.13]; hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.97-1.49) and kidney DCGF at 1 year (4.6% versus 5.7% [P = 0.18]; HR, 1.27; 95% CI, 0.95-1.70) did not differ in the full multivariable Cox proportional hazard models. Selected kidneys from deceased donors with AKI can be considered for SLKT.
• Mete, M., Ayvaci, M. U., Ariyamuthu, V. K., Amin, A., Peltz, M., Thibodeau, J. T., Grodin, J. L., Mammen, P. P., Garg, S., Araj, F., Morlend, R., Drazner, M. H., AbdulRahim, N., Kim, Y., Salam, Y., Gungor, A. B., Delibasi, B., Kotla, S. K., MacConmara, M. P., , Mohan Anand, P., et al. (2022). Predicting Post-Heart Transplant Composite Renal Outcome Risk in Adults: A Machine Learning Decision Tool. Kidney international reports, 7(6), 1410-1415.
• Shetty, A., Ariyamuthu, V. K., Gungor, A. B., & Tanriover, B. (2022).

  Utilization of hepatitis C virus-positive donors in kidney transplantation

  . Current Opinion in Organ Transplantation, 28(1), 22-28. doi:10.1097/mot.0000000000001031
• Tanriover, B., Ariyamuthu, V. K., Batra, R. K., MacConmara, M. P., Gupta, G., & Gungor, A. B. (2022). Outcomes of Simultaneous Liver‐Kidney Transplantation Using Kidneys of Deceased Donors With Acute Kidney Injury. Liver Transplantation, 28(6), 983-997. doi:10.1002/lt.26406
• Ariyamuthu, V. K., & Tanriover, B. (2021). Optimizing Utilization of Kidneys from Hepatitis C-Positive Kidney Donors. Clinical journal of the American Society of Nephrology : CJASN.
• Tanriover, B., Lingvay, I., Ahmed, F., Sandikci, B., Mohan, S., Cremers, S., Karmally, W., Mohan, P., Newhouse, J., Ragunathan, S., AbdulRahim, N., Ariyamuthu, V. K., Ratner, L. E., & Cohen, D. J. (2021). Insulin Sensitivity After Living Donor Nephrectomy. Transplantation proceedings, 53(6), 1858-1864.
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  The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs.
• Ariyamuthu, V. K., Sandikci, B., AbdulRahim, N., Hwang, C., MacConmara, M. P., Parasuraman, R., Atis, A., & Tanriover, B. (2020). Trends in utilization of deceased donor kidneys based on hepatitis C virus status and impact of public health service labeling on discard. Transplant infectious disease : an official journal of the Transplantation Society, 22(1), e13204.
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  Kidneys from deceased donors infected with hepatitis C virus (HCV) are underutilized. Most HCV virus-infected donors are designated as Public Health Service increased donors (PHS-IR). Impact of PHS and HCV designations on discard is not well studied.
• AbdulRahim, N., Anderson, L., Kotla, S., Liu, H., Ariyamuthu, V. K., Ghanta, M., MacConmara, M., Tujios, S. R., Mufti, A., Mohan, S., Marrero, J. A., Vagefi, P. A., & Tanriover, B. (2019). Lack of Benefit and Potential Harm of Induction Therapy in Simultaneous Liver-Kidney Transplants. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 25(3), 411-424.
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  The number of simultaneous liver-kidney transplantations (SLKTs) and use of induction therapy for SLKT have increased recently, without much published evidence, especially in the context of maintenance immunosuppression containing tacrolimus (TAC) and mycophenolic acid (MPA). We queried the Organ Procurement and Transplant Network registry for SLKT recipients maintained on TAC/MPA at discharge in the United States for 2002-2016. The cohort was divided into 3 groups on the basis of induction type: rabbit antithymocyte globulin (r-ATG; n = 831), interleukin 2 receptor antagonist (IL2RA; n = 1558), and no induction (n = 2333). Primary outcomes were posttransplant all-cause mortality and acute rejection rates in kidney and liver allografts at 12 months. Survival rates were analyzed by the Kaplan-Meier method. A propensity score analysis was used to control potential selection bias. Multivariate inverse probability weighted Cox proportional hazard and logistic regression models were used to estimate the hazard ratios (HRs) and odds ratios. Among SLKT recipients, survival estimates at 3 years were lower for recipients receiving r-ATG (P = 0.05). Compared with no induction, the multivariate analyses showed an increased mortality risk with r-ATG (HR, 1.29; 95% confidence interval [CI], 1.10-1.52; P = 0.002) and no difference in acute liver or kidney rejection rates at 12 months across all induction categories. No difference in outcomes was noted with IL2RA induction over the no induction category. In conclusion, there appears to be no survival benefit nor reduction in rejection rates for SLKT recipients who receive induction therapy, and r-ATG appears to increase mortality risk compared with no induction.
• Amin, A. A., Araj, F. G., Ariyamuthu, V. K., Drazner, M. H., Ayvaci, M. U., Mammen, P. P., Mete, M., Urey, M. A., & Tanriover, B. (2019). Impact of induction immunosuppression on patient survival in heart transplant recipients treated with tacrolimus and mycophenolic acid in the current allocation era. Clinical transplantation, 33(8), e13651.
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  The practice of induction therapy with either rabbit anti-thymocyte globulin (r-ATG) or interleukin-2 receptor antagonists (IL-2RA) is common among heart transplant recipients. However, its benefits in the setting of contemporary maintenance immunosuppression with tacrolimus/mycophenolic acid (TAC/MPA) are unknown.
• La Hoz, R. M., Sandıkçı, B., Ariyamuthu, V. K., & Tanriover, B. (2019). Short-term outcomes of deceased donor renal transplants of HCV uninfected recipients from HCV seropositive nonviremic donors and viremic donors in the era of direct-acting antivirals. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 19(11), 3058-3070.
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  The United States opioid use epidemic over the past decade has coincided with an increase in hepatitis C virus  (HCV) positive donors. Using propensity score matching, and the Organ Procurement Transplant Network data files from January 2015 to June 2019, we analyzed the short-term outcomes of adult deceased donor kidney transplants of HCV uninfected recipients with two distinct groups of HCV positive donors (HCV seropositive, nonviremic n = 352 and viremic n = 196) compared to those performed using HCV uninfected donors (n = 36 934). Compared to the reference group, the transplants performed using HCV seropositive, nonviremic and viremic donors experienced a lower proportion of delayed graft function (35.2 vs 18.9%; P < .001 [HCV seropositive, nonviremic donors] and 36.2 vs 16.8% ;  P < .001[HCV viremic donors]). The recipients of HCV viremic donors had better allograft function at 6 months posttransplant (eGFR [54.1 vs 68.3 mL/min/1.73 m2; P = .004]. Furthermore, there was no statistical difference in the overall graft failure risk at 12 months posttransplant by propensity score matched multivariable Cox proportional analysis (HR =  0.60, 95% CI  0.23 to  1.29 [HCV seropositive, nonviremic donors] and HR =  0.85, 95% CI 0.25 to  2.96 [HCV viremic donors]). Further studies are required to determine the long-term outcomes of these transplants and address unanswered questions regarding the use of HCV viremic donors.
• Ariyamuthu, V. K., Amin, A. A., Drazner, M. H., Araj, F., Mammen, P. P., Ayvaci, M., Mete, M., Ozay, F., Ghanta, M., Mohan, S., Mohan, P., & Tanriover, B. (2018). Induction regimen and survival in simultaneous heart-kidney transplant recipients. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 37(5), 587-595.
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  Induction therapy in simultaneous heart-kidney transplantation (SHKT) is not well studied in the setting of contemporary maintenance immunosuppression consisting of tacrolimus (TAC), mycophenolic acid (MPA), and prednisone (PRED).
• Khan, K. N., Saxena, R., Choti, M., & Ariyamuthu, V. K. (2018). Neisseria mucosa Peritonitis in the Setting of a Migrated Intrauterine Device. Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 34(2018), 47-49.
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  Peritonitis is a major complication in peritoneal dialysis (PD) patients, often requiring a switch to hemodialysis (HD). Common sources of bacterial peritonitis are touch contamination and PD catheter-related infection. Intra-abdominal pathology is a less common cause of peritonitis in PD patients, and rarely is Neisseria mucosa the causative organism.We present an uncommon case of N. mucosa peritonitis in a 30-year-old African American female patient treated with nocturnal intermittent PD. The infection occurred in the setting of a translocated intrauterine contraceptive device (IUCD) in the infrahepatic region because of transmural migration. Our patient underwent laparoscopic removal of the IUCD and received empiric intraperitoneal (IP) vancomycin and intravenous ceftriaxone. After the isolate was identified as N. mucosa, her regimen was changed to IP ceftriaxone for a total of 21 days. Cell count after completion of antibiotics showed resolution of the peritonitis. The PD catheter was salvaged and transition to HD was avoided.
• Sanghera, P., Ghanta, M., Ozay, F., Ariyamuthu, V. K., & Tanriover, B. (2017). Kidney Diseases Associated With Alternative Complement Pathway Dysregulation and Potential Treatment Options. The American journal of the medical sciences, 354(6), 533-538.
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  Atypical hemolytic uremic syndrome and C3 glomerulopathy (dense deposit disease and C3 glomerulonephritis) are characterized as inappropriate activation of the alternative complement pathway. Genetic mutations affecting the alternative complement pathway regulating proteins (complement factor H, I, membrane cofactor protein and complement factor H-related proteins) and triggers (such as infection, surgery, pregnancy and autoimmune disease flares) result in the clinical manifestation of these diseases. A decade ago, prognosis of these disease states was quite poor, with most patients developing end-stage renal disease. Furthermore, renal transplantation in these conditions was associated with poor outcomes due to graft loss to recurrent disease. Recent advances in targeted complement inhibitor therapy resulted in significant improvement in disease remission, renal recovery, health-related quality of life and allograft survival.
• Tanriover, B., Jaikaransingh, V., MacConmara, M. P., Parekh, J. R., Levea, S. L., Ariyamuthu, V. K., Zhang, S., Gao, A., Ayvaci, M. U., Sandikci, B., Rajora, N., Ahmed, V., Lu, C. Y., Mohan, S., & Vazquez, M. A. (2016). Acute Rejection Rates and Graft Outcomes According to Induction Regimen among Recipients of Kidneys from Deceased Donors Treated with Tacrolimus and Mycophenolate. Clinical journal of the American Society of Nephrology : CJASN, 11(9), 1650-61.
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  IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent for induction therapy in renal transplantation. However, this remains controversial in deceased donor renal transplantation (DDRT) maintained on tacrolimus (TAC)/mycophenolic acid (MPA) with or without steroids.
• Tanriover, B., MacConmara, M. P., Parekh, J., Arce, C., Zhang, S., Gao, A., Mufti, A., Levea, S. L., Sandikci, B., Ayvaci, M. U., Ariyamuthu, V. K., Hwang, C., Mohan, S., Mete, M., Vazquez, M. A., & Marrero, J. A. (2016). SIMULTANEOUS LIVER KIDNEY TRANSPLANTATION IN LIVER TRANSPLANT CANDIDATES WITH RENAL DYSFUNCTION: IMPORTANCE OF CREATININE LEVELS, DIALYSIS, AND ORGAN QUALITY IN SURVIVAL. Kidney international reports, 1(4), 221-229.
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  The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK transplant survival has not been well described in the literature.
• Gallon, L., Traitanon, O., Sustento-Reodica, N., Leventhal, J., Ansari, M. J., Gehrau, R. C., Ariyamuthu, V., De Serres, S. A., Alvarado, A., Chhabra, D., Mathew, J. M., Najafian, N., & Mas, V. (2015). Cellular and molecular immune profiles in renal transplant recipients after conversion from tacrolimus to sirolimus. Kidney international, 87(4), 828-38.
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  Tacrolimus and sirolimus are commonly used maintenance immunosuppressants in kidney transplantation. As their effects on immune cells and allograft molecular profiles have not been elucidated, we characterized the effects of tacrolimus to sirolimus conversion on the frequency and function of T cells, and on graft molecular profiles. Samples from renal transplant patients in a randomized trial of 18 patients with late sirolimus conversion and 12 on tacrolimus maintenance were utilized. Peripheral blood was collected at 0, 6, 12, and 24 months post randomization, with T-cell subpopulations analyzed by flow cytometry and T-cell alloreactivity tested by IFN-γ ELISPOT. Graft biopsy samples obtained 24 months post randomization were used for gene expression analysis. Sirolimus conversion led to an increase in CD4(+)25(+++)Foxp3(+) regulatory T cells. While tacrolimus-maintained patients showed a decrease in indirect alloreactivity over time post transplant, sirolimus conversion increased indirect alloreactive T-cell frequencies compared with tacrolimus-maintained patients. No histological differences were found in graft biopsies, but molecular profiles showed activation of the antigen presentation, IL-12 signaling, oxidative stress, macrophage-derived production pathways, and increased inflammatory and immune response in sirolimus-converted patients. Thus, chronic immune alterations are induced after sirolimus conversion. Despite the molecular profile being favorable to calcineurin inhibitor-based regimen, there was no impact in renal function over 30 months of follow-up.
• Ariyamuthu, V. K., Nolph, K. D., & Ringdahl, B. E. (2013). Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal medicine, 3(1), 71-78.
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  Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD.
• Ariyamuthu, V. K., Balla, S., & Chaudhary, K. (2012). Ischemic heart disease in patients undergoing dialysis. Hospital practice (1995), 40(4), 33-9.
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  Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD) who are undergoing chronic dialysis. Diabetes and hypertension, the 2 leading causes of ESRD, contribute to the pathogenesis of ischemic heart disease (IHD) in these patients, as do other traditional risk factors (eg, dyslipidemias, smoking, and sedentary lifestyle). However, patients with ESRD are subject to several unique risk factors that contribute to the development and progression of IHD. Chronic volume overload and anemia, leading to left ventricular hypertrophy, and deranged calcium-phosphate metabolism with vascular and coronary calcification, contribute to the pathogenesis of IHD. Other risk factors that have been implicated include oxidative stress, homocysteine, and myocardial stunning while undergoing dialysis treatment. Additional risk factors include erythropoietin use for treating anemia, as well as use of calcium-based phosphate binders. The complex pathogenesis of IHD in such patients poses unique challenges to its management. Serological biomarkers and sophisticated imaging techniques are being developed to better delineate the pathological process and enhance disease detection. A combination of medical and surgical approaches is necessary to treat IHD. In this article, we discuss the pathogenesis and management of IHD.
• Dalal, P., Bichu, P., Dhawan, V., Ariyamuthu, V., Malhotra, K., Misra, M., & Khanna, R. (2012). Post-transplant Lymphoproliferative Disorder--a case of late-onset T-cell lymphoma after failed renal transplant. Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 28, 94-6.
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  Post-transplant lymphoproliferative disease (PTLD) is a rare but life-threatening complication after solid organ transplantation. The risk of PTLD varies with recipient age, serostatus of the donor and the recipient for Epstein-Barr virus, type of organ transplanted, and intensity of immunosuppression. The risk of PTLD is highest in the early post-transplant period, but the cumulative risk increases with time. We report a case of PTLD occurring 17 years after renal transplantation in a 59-year-old woman.
• Dhawan, V., Ariyamuthu, V., Malhotra, K., Dalal, P., Bichu, P., & Dorairajan, S. (2012). Isolated pleural effusion as a presentation of high cardiac output heart failure in a hemodialysis patient. Hemodialysis international. International Symposium on Home Hemodialysis, 16 Suppl 1, S54-7.
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  Congestive heart failure is a well-recognized complication of hemodialysis arteriovenous fistula. Symptoms of dyspnea are usually associated with signs of congestive heart failure including pulmonary edema, pleural effusions, lower extremity edema, and liver enlargement, to name a few. We present a case of a gentleman with end-stage renal disease on chronic hemodialysis, which developed acute bilateral transudative pleural effusions in the absence of other signs of systemic venous congestion, associated with pulmonary venous congestion. We also discuss the pathogenesis and role of hemodialysis in management of this patient.
• Malhotra, K., Dhawan, V., Dalal, P., Ariyamuthu, V., Bichu, P., Botdorf, J., & Khanna, R. (2012). Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization: a case study. Hemodialysis international. International Symposium on Home Hemodialysis, 16 Suppl 1, S58-61.
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  A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.
• Regunath, H., Ariyamuthu, V. K., Dalal, P., & Misra, M. (2012). Bath salt intoxication causing acute kidney injury requiring hemodialysis. Hemodialysis international. International Symposium on Home Hemodialysis, 16 Suppl 1, S47-9.
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  Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of "bath salts." They are beta-ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the "khat" plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of "bath salt" pills that improved with hemodialysis.
• Athappan, G., & Ariyamuthu, V. K. (2009). Images in clinical medicine. Chvostek's sign and carpopedal spasm. The New England journal of medicine, 360(18), e24.
• Athappan, G., Ariyamuthu, V. K., & Rajamani, V. K. (2008). Bilateral renal halo sign in acute pancreatitis. The Medical journal of Australia, 189(4), 228.

Reviews

• Shetty, A., Ariyamuthu, V. K., Gungor, A. B., & Tanriover, B. (2023. Utilization of hepatitis C virus-positive donors in kidney transplantation(pp 22-28).
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  Direct-acting antivirals (DAA) have transformed kidney transplantation by increasing the donor pool from hepatitis C virus (HCV)-infected donors and allowing HCV nucleic acid amplification testing (NAT) donor-positive/recipient-negative (D+/R-) transplantation over the last 7 years. Willingness to accept kidneys from HCV-infected donors and timing/duration of DAA therapy have been evolving.