Transplantation proceedings最新文献

英文中文

Coinfection of HHV 6 and HTLV-I Causing Encephalitis After Autologous Hematopoietic Stem Cell Transplantation: A Case Report and a Systematic Review of the Literature

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-27 DOI: 10.1016/j.transproceed.2025.02.022

Alexandre Mestre Tejo , Jacqueline Alves Rena , Camila Malta Romano , Amanda Lopes da Silva , Maria Cássia Mendes-Correa , Tânia Regina Tozetto Mendoza , Hermes Ryoiti Higashino , Bruno Garcia Pires , Vanderson Rocha , Silvia Figueiredo Costa

Background

A 52-year-old woman with multiple myeloma and asymptomatic human T lymphotropic virus (HTLV)-I infection underwent an autologous stem cell transplantation. Eighteen days after transplantation, she developed fever, headache, ataxia, and tremors. Coinfection of human herpesvirus 6 and HTLV-I encephalitis was diagnosed.

Methods

A systematic review of the literature was made. No article about HTLV I/II encephalitis in autologous stem cell transplantation was found. A total of 268 articles were screened and 8 matched the inclusion criteria. One was included by another source. Three of the 9 articles analyzed were excluded and 6 cases of human herpesvirus 6 encephalitis after ASCT were analyzed.

Results

The median patient age was 51 years. Multiple myeloma was the most common hematologic disease found. The median time since the hematopoietic stem cells transplantation was 19.5 days. Melphalan-based conditioning therapy was present in 83% of patients. All cerebrospinal fluid presented altered cell count and proteinorachia (median, 68.5 mg/dL). Most patients were treated with ganciclovir or foscarnet. In all cases, patients experienced a complete recovery.

Conclusion

HTLV-I encephalitis is an extremely rare disease that should be considered in patients previously infected. Human herpesvirus 6 encephalitis in patients after autologous hematopoietic stem cells transplantation is an uncommon situation but should be remembered in the differential in cases of acute confusional state. Prompt treatment may ensure complete recovery of the patient.

背景：一名患有多发性骨髓瘤和无症状人类 T 淋巴细胞病毒（HTLV）-I 感染的 52 岁女性接受了自体干细胞移植。移植后 18 天，她出现发热、头痛、共济失调和震颤。确诊为人类疱疹病毒6和HTLV-I脑炎合并感染：方法：对文献进行了系统回顾。方法：对文献进行了系统回顾，未发现有关自体干细胞移植中HTLV I/II脑炎的文章。共筛选出268篇文章，其中8篇符合纳入标准。其中一篇被其他来源纳入。在分析的9篇文章中，排除了3篇，分析了6例ASCT后人类疱疹病毒6型脑炎病例：结果：患者年龄中位数为 51 岁。多发性骨髓瘤是最常见的血液病。造血干细胞移植后的中位时间为19.5天。83%的患者接受了以美法仑为基础的调理治疗。所有患者的脑脊液均出现细胞计数和蛋白尿（中位数为68.5毫克/分升）。大多数患者接受了更昔洛韦或福斯卡尼治疗。所有患者均完全康复：结论：HTLV-I脑炎是一种极为罕见的疾病，曾感染过这种病毒的患者应考虑这种疾病。自体造血干细胞移植后患者患人类疱疹病毒6型脑炎的情况并不常见，但在急性意识模糊的病例中应注意鉴别。及时治疗可确保患者完全康复。

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引用次数: 0

Successful Lung Transplantation in A Patient With Pre-Existing Chronic Myeloid Leukemia Treated With Imatinib: A Case Report

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-27 DOI: 10.1016/j.transproceed.2025.02.020

Kemarut Laothamatas , Luke Benvenuto , Mihir Raval , Flora Kim , Philippe H. Lemaitre , Joshua R. Sonett , Selim M. Arcasoy

Although active malignancy is a contraindication to lung transplantation, there is increasing uncertainty as to what constitutes “active” malignancy given the rapidly changing therapeutic armamentarium and overall survival of patients with malignancy. Chronic myeloid leukemia (CML) is an example of a previously fatal malignancy that has been transformed into a chronic disease with close-to-normal life expectancy since the advent of tyrosine kinase inhibitor (TKI) therapy. However, it remains relatively unknown if lung transplantation could successfully be performed in patients with CML. We describe the course of a 34-year-old woman with cystic fibrosis and advanced lung disease who was diagnosed with CML while undergoing lung transplant evaluation. She was initiated on imatinib with optimal treatment response; she achieved major molecular response (MMR) and deep molecular response (DMR) at 8 and 10 months of treatment, respectively. She developed progressive respiratory failure and underwent bilateral lung transplantation at close to 3 years after achieving MMR. At 6 years post-transplant, she has excellent graft function and remains in DMR on imatinib. Treated CML in DMR should be regarded as inactive malignancy and should not preclude patients from life-saving transplant consideration. Our case also demonstrates the feasibility of long-term immunosuppression on TKI therapy.

{"title":"Successful Lung Transplantation in A Patient With Pre-Existing Chronic Myeloid Leukemia Treated With Imatinib: A Case Report","authors":"Kemarut Laothamatas , Luke Benvenuto , Mihir Raval , Flora Kim , Philippe H. Lemaitre , Joshua R. Sonett , Selim M. Arcasoy","doi":"10.1016/j.transproceed.2025.02.020","DOIUrl":"10.1016/j.transproceed.2025.02.020","url":null,"abstract":"<div><div>Although active malignancy is a contraindication to lung transplantation, there is increasing uncertainty as to what constitutes “active” malignancy given the rapidly changing therapeutic armamentarium and overall survival of patients with malignancy. Chronic myeloid leukemia (CML) is an example of a previously fatal malignancy that has been transformed into a chronic disease with close-to-normal life expectancy since the advent of tyrosine kinase inhibitor (TKI) therapy. However, it remains relatively unknown if lung transplantation could successfully be performed in patients with CML. We describe the course of a 34-year-old woman with cystic fibrosis and advanced lung disease who was diagnosed with CML while undergoing lung transplant evaluation. She was initiated on imatinib with optimal treatment response; she achieved major molecular response (MMR) and deep molecular response (DMR) at 8 and 10 months of treatment, respectively. She developed progressive respiratory failure and underwent bilateral lung transplantation at close to 3 years after achieving MMR. At 6 years post-transplant, she has excellent graft function and remains in DMR on imatinib. Treated CML in DMR should be regarded as inactive malignancy and should not preclude patients from life-saving transplant consideration. Our case also demonstrates the feasibility of long-term immunosuppression on TKI therapy.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 491-494"},"PeriodicalIF":0.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is Cytomegalovirus (CMV) Associated With Development of Posttransplant Psychosis? A Case Report and Review of the Literature

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-26 DOI: 10.1016/j.transproceed.2025.02.009

Kovacic Anja , Koren Andro , Koren Luciana , Kovacic Marta , Krajina Lovro , Basic-Jukic Nikolina

Cytomegalovirus (CMV) has a negative impact on overall posttransplant rehabilitation. While infection often manifests as gastrointestinal disease, pneumonitis, nephritis and others, it may be associated with psychotic symptoms. The role of CMV in etiology of schizophrenia has already been recognized but it was never described in the posttransplant psychosis. We present a case depicting development of psychosis 10 years post kidney transplantation associated with CMV disease.

引用次数: 0

Early Diagnosis and Effective Therapy for Encapsulating Peritoneal Sclerosis After Renal Transplantation: A Case Study

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-26 DOI: 10.1016/j.transproceed.2025.02.015

Yao-Wei Tsai , Chen-Hao Li , Jui-Hsiu Tsai , Wen-Yao Yin

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of long-term peritoneal dialysis. Characterized by thickening of the peritoneal membrane, EPS leads to bowel encapsulation, ultrafiltration failure, and bowel obstruction. This study describes the case of a 61-year-old man with a history of hypertension and end stage renal disease requiring peritoneal dialysis for ten years who developed EPS after cadaveric renal transplantation. The patient experienced recurrent episodes of abdominal distension, ascites, and ileus starting 10 days after transplantation. Diagnostic imaging and histological examination confirmed EPS, as defined by a podoplanin score of 2 with diffuse accumulation of podoplanin-positive fibroblastic cells in the peritoneal membrane. Early intervention with corticosteroids and tamoxifen led to gradual improvement and stabilization of his condition. This case not only emphasizes the importance of early diagnosis of EPS but also highlights the importance of timely treatment to promote favorable outcomes for patients with this potentially devastating disease.

{"title":"Early Diagnosis and Effective Therapy for Encapsulating Peritoneal Sclerosis After Renal Transplantation: A Case Study","authors":"Yao-Wei Tsai , Chen-Hao Li , Jui-Hsiu Tsai , Wen-Yao Yin","doi":"10.1016/j.transproceed.2025.02.015","DOIUrl":"10.1016/j.transproceed.2025.02.015","url":null,"abstract":"<div><div>Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of long-term peritoneal dialysis. Characterized by thickening of the peritoneal membrane, EPS leads to bowel encapsulation, ultrafiltration failure, and bowel obstruction. This study describes the case of a 61-year-old man with a history of hypertension and end stage renal disease requiring peritoneal dialysis for ten years who developed EPS after cadaveric renal transplantation. The patient experienced recurrent episodes of abdominal distension, ascites, and ileus starting 10 days after transplantation. Diagnostic imaging and histological examination confirmed EPS, as defined by a podoplanin score of 2 with diffuse accumulation of podoplanin-positive fibroblastic cells in the peritoneal membrane. Early intervention with corticosteroids and tamoxifen led to gradual improvement and stabilization of his condition. This case not only emphasizes the importance of early diagnosis of EPS but also highlights the importance of timely treatment to promote favorable outcomes for patients with this potentially devastating disease.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 450-452"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Case of ABO-Incompatible Kidney Transplantation for a False-Positive T and B-Cell Crossmatch Test Due to Anti-A Antibodies

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-26 DOI: 10.1016/j.transproceed.2025.02.013

Masahiro Ikeda , Masayuki Tasaki , Hiroki Hashiguchi , Hitomi Kanamoto , Tsutomu Anraku , Kaede Hiruma , Tatsuro Sanami , Kazuhide Saito , Yoshihiko Tomita

The recipient was a 50-year-old man with blood type O who was referred to our department for a pre-emptive ABO-incompatible kidney transplantation (KTx), with his wife as the donor whose blood was type A. However, both of the T and B cell complement-dependent crossmatch and flow cytometric crossmatch tests showed positive results. Even though donor-specific antibodies were negative by Luminex, we did not recommend transplantation and he had received dialysis therapy for 3 years. We conducted a re-evaluation of crossmatch tests. IgM and anti-B antibody were eliminated from the recipient's sera by the processing with dithiothreitol and the absorption mixing type B red blood cells. However, crossmatch tests still showed positive. Then, we eliminated anti-A antibody by the absorption mixing type A red blood cells. T- and B-cell crossmatch tests turned to negative, suggesting anti-A antibody in the recipient's sera binds to type A substance onto the donor's T and B lymphocytes. The recipient received an ABO-incompatible KTx with our standard desensitization therapy. Immediate graft function was achieved without any rejection

{"title":"A Case of ABO-Incompatible Kidney Transplantation for a False-Positive T and B-Cell Crossmatch Test Due to Anti-A Antibodies","authors":"Masahiro Ikeda , Masayuki Tasaki , Hiroki Hashiguchi , Hitomi Kanamoto , Tsutomu Anraku , Kaede Hiruma , Tatsuro Sanami , Kazuhide Saito , Yoshihiko Tomita","doi":"10.1016/j.transproceed.2025.02.013","DOIUrl":"10.1016/j.transproceed.2025.02.013","url":null,"abstract":"<div><div>The recipient was a 50-year-old man with blood type O who was referred to our department for a pre-emptive ABO-incompatible kidney transplantation (KTx), with his wife as the donor whose blood was type A. However, both of the T and B cell complement-dependent crossmatch and flow cytometric crossmatch tests showed positive results. Even though donor-specific antibodies were negative by Luminex, we did not recommend transplantation and he had received dialysis therapy for 3 years. We conducted a re-evaluation of crossmatch tests. IgM and anti-B antibody were eliminated from the recipient's sera by the processing with dithiothreitol and the absorption mixing type B red blood cells. However, crossmatch tests still showed positive. Then, we eliminated anti-A antibody by the absorption mixing type A red blood cells. T- and B-cell crossmatch tests turned to negative, suggesting anti-A antibody in the recipient's sera binds to type A substance onto the donor's T and B lymphocytes. The recipient received an ABO-incompatible KTx with our standard desensitization therapy. Immediate graft function was achieved without any rejection</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 438-441"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Case Report of an ABO-Matched Post-Hematopoietic Stem Cell Transplant-Associated Autoimmune Hemolytic Anemia: A Diagnostic and Therapeutic Challenge ABO 配型造血干细胞移植后自身免疫性溶血性贫血病例报告：诊断和治疗的挑战。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-26 DOI: 10.1016/j.transproceed.2025.02.003

Owen Dan Luo , Angelo Rizzolo , Patricia Pelletier , Gizelle Popradi

Autoimmune hemolytic anemia (AIHA) is a rare complication of ABO-matched hematopoietic stem cell transplantation (HSCT). Post-HSCT AIHA is diagnosed by a positive hemolysis laboratory work-up and positive direct antiglobulin testing with usually a pan-reactive antibody in indirect antiglobulin testing. In this case report, we describe the diagnosis of post-HSCT AIHA in a 62-year-old male patient and its management with combined immunosuppressive therapy with steroids, rituximab, and intravenous immunoglobulin to achieve transfusion independence and disease remission. Post-HSCT AIHA is generally refractory to treatment but this case highlights the role of combination immunosuppressive therapies to maximize the likelihood of transfusion independence.

引用次数: 0

Delayed Chest Closure in Adult Living-donor Lobar Lung Transplantation—A Case Report

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-26 DOI: 10.1016/j.transproceed.2025.02.002

Marina Nakatsuka , Tatsuaki Watanabe , Chikara Sakai , Yuki Shundo , Yui Watanabe , Hirotsugu Notsuda , Takaya Suzuki , Takashi Hirama , Hisashi Oishi , Hiromichi Niikawa , Masafumi Noda , Yoshinori Okada

Delayed chest closure (DCC) is a useful technique in cases with oversized lung grafts, pulmonary edema, and hemodynamic instability. Anatomically oversized lung grafts are potentially problematic in pediatric living-donor lobar lung transplantation (LDLLT), but rarely in an adult LDLLT. We experienced a case of anatomically oversized grafts in the adult LDLLT requiring DCC, although the grafts provided only 57.2% of the recipient's predicted forced vital capacity. Through 3-dimensional computed tomography volumetry, the volume of the donor's right lower lobe was illustrated as 108% of that of the recipient's right hemithorax, the volume of the donor left lower lobe was 143% of that of the recipient's left hemithorax. Her chest was closed without volume reduction 5 days after transplantation. Our experience illustrates the importance of anatomical size-matching even in an adult LDLLT and the usefulness of DCC as a perioperative management modality.

{"title":"Delayed Chest Closure in Adult Living-donor Lobar Lung Transplantation—A Case Report","authors":"Marina Nakatsuka , Tatsuaki Watanabe , Chikara Sakai , Yuki Shundo , Yui Watanabe , Hirotsugu Notsuda , Takaya Suzuki , Takashi Hirama , Hisashi Oishi , Hiromichi Niikawa , Masafumi Noda , Yoshinori Okada","doi":"10.1016/j.transproceed.2025.02.002","DOIUrl":"10.1016/j.transproceed.2025.02.002","url":null,"abstract":"<div><div>Delayed chest closure (DCC) is a useful technique in cases with oversized lung grafts, pulmonary edema, and hemodynamic instability. Anatomically oversized lung grafts are potentially problematic in pediatric living-donor lobar lung transplantation (LDLLT), but rarely in an adult LDLLT. We experienced a case of anatomically oversized grafts in the adult LDLLT requiring DCC, although the grafts provided only 57.2% of the recipient's predicted forced vital capacity. Through 3-dimensional computed tomography volumetry, the volume of the donor's right lower lobe was illustrated as 108% of that of the recipient's right hemithorax, the volume of the donor left lower lobe was 143% of that of the recipient's left hemithorax. Her chest was closed without volume reduction 5 days after transplantation. Our experience illustrates the importance of anatomical size-matching even in an adult LDLLT and the usefulness of DCC as a perioperative management modality.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 487-490"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Silent Threat: Fatal Consequences of Occult Hepatitis C Viral Infection in a Kidney Transplant Recipient: A Case Report and Literature Review

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-25 DOI: 10.1016/j.transproceed.2025.02.006

Hany M. El Hennawy , Abelaziz A. Abdelaziz , Yasser Mansour , Mohammad F. Zaitoun , Ibrahim Tawhari , Omar Safar , Rafaat M. Chakik , Mosa A. Fagih , Abdullah S. Al Faifi

We present the case of a 54-year-old female patient with a history of treated hepatitis B who underwent living-related kidney transplantation from her son. The timing of the transplantation and immediate postoperative period was uneventful, with no significant complications. However, within 3 months, she was repeatedly hospitalized because of persistent jaundice, abdominal pain, and diarrhea, and liver function tests indicated considerable liver injury. Extensive investigations have revealed an occult hepatitis C virus infection that occurred before transplantation. The patient subsequently developed acute fulminant liver failure accompanied by severe gastrointestinal bleeding. Despite aggressive medical management, her condition deteriorated rapidly, leading to death. This case underscores the importance of comprehensive viral screening in transplant recipients, particularly those with risk factors or symptoms of hepatitis C virus infection, to prevent potentially life-threatening complications following transplantation.

{"title":"Silent Threat: Fatal Consequences of Occult Hepatitis C Viral Infection in a Kidney Transplant Recipient: A Case Report and Literature Review","authors":"Hany M. El Hennawy , Abelaziz A. Abdelaziz , Yasser Mansour , Mohammad F. Zaitoun , Ibrahim Tawhari , Omar Safar , Rafaat M. Chakik , Mosa A. Fagih , Abdullah S. Al Faifi","doi":"10.1016/j.transproceed.2025.02.006","DOIUrl":"10.1016/j.transproceed.2025.02.006","url":null,"abstract":"<div><div>We present the case of a 54-year-old female patient with a history of treated hepatitis B who underwent living-related kidney transplantation from her son. The timing of the transplantation and immediate postoperative period was uneventful, with no significant complications. However, within 3 months, she was repeatedly hospitalized because of persistent jaundice, abdominal pain, and diarrhea, and liver function tests indicated considerable liver injury. Extensive investigations have revealed an occult hepatitis C virus infection that occurred before transplantation. The patient subsequently developed acute fulminant liver failure accompanied by severe gastrointestinal bleeding. Despite aggressive medical management, her condition deteriorated rapidly, leading to death. This case underscores the importance of comprehensive viral screening in transplant recipients, particularly those with risk factors or symptoms of hepatitis C virus infection, to prevent potentially life-threatening complications following transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 445-449"},"PeriodicalIF":0.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Donor-Derived Aspergillosis Following Kidney Transplantation: A Case Report

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-25 DOI: 10.1016/j.transproceed.2025.02.012

Michael A. Deal, John J. Nunnery, Stephen Patrick, Santosh Nagaraju, Joseph Scalea

Introduction

While kidney transplantation can improve both quality and quantity of life in patients with renal disease, there are well-described possible surgical and medical complications. Of these complications, donor-derived infections represent a source of morbidity and mortality. Donor-derived aspergillosis is a rare source of these infections. Given the limited number of reported cases of donor-derived aspergillosis, we present a case that resulted in multisystem organ failure, graft loss, and death.

Case Presentation

A 72-year-old male underwent renal transplantation. Two months later, the patient presented with fevers, chills, weakness, and right lower quadrant pain. His early hospital course was notable for blood and urine cultures positive for Enterococcus faecalis, which was treated with broad spectrum antibiotics. Despite appropriate treatment, the patient ultimately required ICU admission, intubation, and initiation of vasopressors. After additional diagnostic imaging revealed multifocal pyelonephritis, the patient underwent transplant nephrectomy with intraoperative cultures revealing aspergillosis. Shortly following transplant nephrectomy, we were notified by the Organ Procurement Organization (OPO) that this likely represented a donor-derived infection. Our patient was initiated on appropriate antifungal coverage, though had continued respiratory and hemodynamic compromise and was ultimately transitioned to comfort care. He expired shortly thereafter.

Conclusion

In reporting this rare case, we hope to increase awareness of the significant illness severity and associated complications with donor-derived aspergillosis. Additionally, we highlight the need for improved screening for rare organisms in donors and for decreased communication delays between the OPO and transplant centers.

{"title":"Donor-Derived Aspergillosis Following Kidney Transplantation: A Case Report","authors":"Michael A. Deal, John J. Nunnery, Stephen Patrick, Santosh Nagaraju, Joseph Scalea","doi":"10.1016/j.transproceed.2025.02.012","DOIUrl":"10.1016/j.transproceed.2025.02.012","url":null,"abstract":"<div><h3>Introduction</h3><div>While kidney transplantation can improve both quality and quantity of life in patients with renal disease, there are well-described possible surgical and medical complications. Of these complications, donor-derived infections represent a source of morbidity and mortality. Donor-derived aspergillosis is a rare source of these infections. Given the limited number of reported cases of donor-derived aspergillosis, we present a case that resulted in multisystem organ failure, graft loss, and death.</div></div><div><h3>Case Presentation</h3><div>A 72-year-old male underwent renal transplantation. Two months later, the patient presented with fevers, chills, weakness, and right lower quadrant pain. His early hospital course was notable for blood and urine cultures positive for <em>Enterococcus faecalis</em>, which was treated with broad spectrum antibiotics. Despite appropriate treatment, the patient ultimately required ICU admission, intubation, and initiation of vasopressors. After additional diagnostic imaging revealed multifocal pyelonephritis, the patient underwent transplant nephrectomy with intraoperative cultures revealing aspergillosis. Shortly following transplant nephrectomy, we were notified by the Organ Procurement Organization (OPO) that this likely represented a donor-derived infection. Our patient was initiated on appropriate antifungal coverage, though had continued respiratory and hemodynamic compromise and was ultimately transitioned to comfort care. He expired shortly thereafter.</div></div><div><h3>Conclusion</h3><div>In reporting this rare case, we hope to increase awareness of the significant illness severity and associated complications with donor-derived aspergillosis. Additionally, we highlight the need for improved screening for rare organisms in donors and for decreased communication delays between the OPO and transplant centers.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 460-463"},"PeriodicalIF":0.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Do We Need a Predischarge Psychosocial Evaluation? A Case Report on Peri-Allograft Abscess in a Noncompliant Elderly Kidney Transplant Patient

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-02-25 DOI: 10.1016/j.transproceed.2025.02.018

Hany El Hennawy , Ahmed Khattab , Eisa Al Atta , Amal Awadh , Omar Safar , Manea Al Qarni , Mohammad F. Zaitoun , Tayseer Ghalyoob , Mohamed F. Bazeed , Abdullah S. Al Faifi

Although postrenal transplant surgical site infections are relatively uncommon, we present the case of a 72-year-old diabetic and hypertensive male patient who developed a delayed peri-graft abscess and severe surgical site infection due to a closed drain exit site infection 1 month following a living-related kidney transplant. While the transplant itself was successful and the patient had passed the pretransplant psychosocial evaluation, their post-transplant noncompliance and unresolved social barriers—such as missed outpatient follow-up appointments—significantly contributed to these complications. This case highlights the limitations of relying solely on pretransplant evaluations and, therefore, emphasizes the critical need for a comprehensive predischarge psychosocial assessment. Such an assessment is particularly vital, especially in elderly patients, as it helps identify and address risks for noncompliance and barriers to follow-up care. To address these challenges, we propose implementing a predischarge psychosocial scoring system that evaluates psychological well-being, social support, cognitive function, understanding of the care plan, and potential obstacles. By identifying high-risk patients, this tool can, in turn, guide tailored interventions to improve adherence. Consequently, a structured predischarge assessment system becomes essential for optimizing post-transplant care, enhancing outcomes, and reducing complications.

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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