International Journal of Organ Transplantation Medicine最新文献

Background: Organ transplant recipients are vulnerable to multiple infectious agents and in a world with a circulating SARS-CoV-2 virus, it would be expected that patients who are immunosuppressed would have higher mortality.

Objective: To determine the COVID-19 mortality in transplant recipients.

Methods: We conducted a search in PubMed and Google scholar databases using the keywords for COVID-19 and transplantation. All related studies between January 1, 2020 and May 7, 2020 were reviewed. All relevant published articles related to COVID-19 in transplant recipients were included.

Results: 46 articles were included; they studied a total of 320 transplant patients-220 kidney transplant recipients, 42 liver, 19 heart, 22 lung, 8 HSCT, and 9 dual organ transplant recipients. The overall mortality rate was 20% and was variable among different organs and different countries. 65 transplant recipients died of complications attributable to COVID-19; 33 were males (15% of males in this cohort), 8 females (8% of females in this cohort), and 24 whose sex was not determined. They had a median age of 66 (range: 32-87) years. The median transplantation duration was 8 years (range: 30 days to 20 years). The most frequent comorbidity reported was hypertensions followed by diabetes mellitus, obesity, malignancy, ischemic heart disease, and chronic obstructive pulmonary disease. The most frequent cause of death reported was acute respiratory distress syndrome.

Conclusion: Transplant recipients in our cohort had a high mortality rate. However, outcomes were not the same in different countries based on outbreak settings. Mortality was noted in elder patients with comorbidities.

Background: Long-term efficiency of attenuated immunosuppressive therapies is not well characterized in pediatric liver transplantation (LT).

Objective: To assess the efficiency of tacrolimus once daily (TAC-OD) and sirolimus once daily (SLR-OD) immunosuppression in pediatric LT.

Methods: We retrospectively evaluated 59 children who underwent LT in our center during 2002 to 2016. Those including children who underwent planned decrease in immunosuppressant dose (stable clinical conditions after 2 years of LT), and those who underwent unplanned decrease in immunosuppressant dose (because of complications such as post-transplant lymphoproliferative disorder [PTLD] and renal failure).

Results: 25 of 59 children underwent planned decrease in immunosuppressant dosage (mean±SD duration of 4.5±1.8, range: 3-11 years); 34 had unplanned decrease (mean±SD of 1.3±0.6, range: 0.5-2.6 years). 19 of 25 children with planned conversion received TAC-OD; 6 received SLR-OD (22 with 1 mg/day dose, and 3 with 1 mg every two days). Of 34 children with unplanned conversion, 27 received TAC-OD, 7 SLR-OD (25 children with 1 mg/day, 7 with 1 mg every two days, 1 with 0.5 mg/day TAC, and 1 with 0.5 mg TAC every two days). We found no adverse events including acute or chronic graft rejection, renal insufficiency, infections, PTLDs, or cardiovascular thrombotic events after initiation of the modified immunosuppression in none of the groups.

Conclusion: TAC-OD or SLR-OD monotherapies are safe and effective for long-term management of LT children with either stable clinical conditions or those with LT complications.

Background: Cytokines have regulatory crosstalk with CMV infection leading to manage of post-liver transplantation virus-related outcomes.

Objective: To investigate the link between IL-21, IL-23 and IL-27 mRNA and protein level with active CMV infection, which was evaluated in reactivated and non-reactivated liver transplant recipients.

Methods: Two groups of liver transplant recipients were enrolled in this study-54 without and 15 with active CMV infection. 3 EDTA-treated blood samples were taken on day 1, 4, and 7 post-liver transplantation. Plasma and buffy coats of all samples were separated. All samples were analyzed for CMV reactivation using antigenemia technique. The separated plasma of positive samples was used for viral DNA extraction and protein evaluation. For evaluating the mRNA expression level by real-time PCR, RNA extraction and cDNA synthesis were done for all samples. Also, the protein level of studied genes was estimated by ELISA.

Results: The expression level of IL-21, IL-23A and IL-27A cytokine genes was increased in CMV reactivated liver transplant recipients in comparison with CMV non-reactivated ones; IL-27A expression pattern was significant (p=0.001) at all sampling times. IL-21 significantly increased on the 2^nd and 3^rd (p=0.028 and 0.01, respectively) sampling days in CMV reactivated compared with non-reactivated patients. The expression level of IL-23A cytokine significantly increased on the 3^rd (p=0.017) sampling day in CMV reactivated compared with non-reactivated liver transplant recipients.

Conclusion: Elevation in the expression level of IL-21, IL-23A and IL-27A mRNA and protein level in CMV reactivated patients emphasized on the antiviral role of these cytokines in CMV reactivated liver transplant recipients.

Involvement of the renal artery is common in Takayasu arteritis. We, herein, present on a patient with Takayasu arteritis causing severe renal failure and a successful auto-transplantation. This case shows that early diagnosis and immediate appropriate interventions are life-saving in patients with Takayasu arteritis. Renal auto-transplantation performed in selected cases increases dialysis-free survival.

Background: 13%-43% of liver transplant (LT) recipients experience severe neurologic events with increased morbidity and mortality.

Objective: To evaluate the incidence of neurological complications after LT in pediatric patients in Namazi Hospital.

Methods: The medical records of 101 children aged between 1 and 18 years who underwent LT between May 2016 and May 2017 at Namazi Hospital were reviewed. Demographic data, the occurrence of neurological complications, and preoperative variables that may predict the complications and outcomes were evaluated. The mean±SD follow-up duration was 10.1±1.9 months.

Results: The mean±SD age of patients at the time of LT was 8.2±5.3 years; 51.5% were male. The most common cause of LT was biliary atresia (16.8%), progressive familial intrahepatic cholestasis (16.8%), and Wilson's disease (13.9%). The mean±SD PELD score was 18.2±1.1. After 1-year follow-up 74 73.3% patients were alive. 16 (15.8%) patients developed convulsion (2 had encephalopathy). 3 (3.0%) patients had signs of peripheral neuropathy, 3 (3.0%) complained from headache, and 1 developed dystonia.

Conclusion: Compared to other centers, neurological complications were less common in our center. The major neurological manifestation after LT was convulsion. There was no correlation between age, sex and the underlying disease and development of neurological complications.

Background: Particular requirements of pediatric and adolescent liver-transplant (LT) recipients necessitate the evaluation of such population from the endocrine viewpoint.

Objective: To determine the endocrine disorders among LT recipients.

Methods: 129 LT recipients younger than 18 years, and at least 6 months post-LT with no pervious history of endocrine disorders were included in the study. Demographic, anthropometric and biochemical data were collected.

Results: 36% of cases had evidence of impaired fasting glucose; the problem, however, was dramatically resolved (decreased to 2.3%) by using of prediabetic diet. Identifying only 1 case of primary hypothyroidism indicated that thyroid dysfunction seems not to be a prevalent finding in the patients. 3 cases of rickets and no case of parathyroid dysfunction were identified. 11% of the study population were hypocalcemic (2 had rickets as well). Pubertal condition in 3 patients and delayed puberty before LT in 6 remained the same; further evaluation revealed they had hypogonadotropic hypogonadism.

Conclusion: Regular monitoring for development of diabetes and hypocalcemia is indicated. Evaluation of those with delayed puberty for receiving sexual hormones is also recommended.

Background: Insertion of ureteral catheters is a common procedure in kidney transplantation. The stent is usually removed by cystoscope. Magnetic ureteral stents may be an alternative to conventional stents.

Objective: To assess the functional efficacy and feasibility of magnetic double J (DJ) stents in kidney transplant recipients.

Methods: We used 6 Fr (diameter), 22 cm (length) magnetic DJs. We examined 7 cases of exclusively AB0-identical living donations. Stent were removed 10-12 days after transplantation. Ureteral Stent Symptoms Questionnaire (USSQ) and visual analog scale (VAS) were used to determine quality of life and pain of the recipients. The total removal time was recorded and cost reduction was calculated.

Results: Removal of the magnetic DJ was successful in all cases. The mean±SD duration of the removal was 3.4±1.6 min. The mean±SD overall pain score on the VAS during the procedure was 2.6±1.1. Using this technique was associated with a cost reduction of € 130.

Conclusion: Using magnetic ureteral stents is a feasible option for living donation AB0-identical kidney transplant recipients.

Background: Perivalvular and valve involvement are prevalent in patients with end-stage renal disease (ESRD), especially in younger patients compared with normal population. Kidney transplantation improves the prognosis of these patients. Patients with cardiac valvular disease is also be improved following kidney transplantation.

Objective: To evaluate the impact of renal transplantation on the severity of mitral regurgitation (MR).

Methods: We studied 95 kidney transplantation candidates in Sina Hospital. The patients underwent echocardiography preoperatively and at the 3^rd, 6^th, and 12^th months post-operatively.

Results: Pre-operatively, the average MR fraction was 30%; MR volume 30 mL/beat; mitral valve mean gradient 1.8 mm Hg; mitral valve area 4.6 cm²; and mitral annular size 3 cm. No significant difference was observed among the measurements made at the 3^rd, 6^th, and 12^th months post-operatively.

Conclusion: There was no significant association between the variables measured pre- and post-operatively. The reason might be the fact that patients with ESRD in Iran do not have to expect long transplant waiting lists and dialysis cannot affect their heart adversely.

Anemia is a common finding after kidney transplantation (KT). Herein, we present a 34-year-old man who received a deceased-donor KT in 2017. Induction immunosuppression therapy consisted of thymoglobulin, tacrolimus (TAC) and methylprednisolone; the maintenance therapy included mycophenolate (MMF) 500 + 500 mg, TAC 4 + 4 mg and prednisolone (PD) 5 mg. One year after KT, he progressively developed dyspnea and fatigue. Laboratory exams revealed hypochromic microcytic anemia unresponsive to increasing doses of darbepoetin. Upper endoscopy and colonoscopy were normal. Bone marrow examination revealed erythroid hyperplasia with numerous proerythroblasts. Serology and viral load for human parvovirus B19 were both positive. Immunosuppression was reduced; he was treated with immunoglobulin. After one week, anemia improved. After 2 months the patient remained asymptomatic with stable hemoglobin. Although rare, PVB19 infection is a clinically significant infection that often presents as aplastic anemia in the post-transplantation period.