Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100170
Nadim Cassir , Benjamin Coiffard , Linda Hadjadj , Julien Bermudez , Liliane Okdah , Lucile Ailhaud , Sophie Alexandra Baron , Martine Reynaud-Gaubert , Xavier Benoit D'Journo , Sami Hraiech , Jean-Marc Rolain
Burkholderia cepacia complex (Bcc) is an important group of opportunistic pathogens most frequently affecting patients with cystic fibrosis and responsible for life-threatening infections. Therapeutic options are limited owing to high levels of resistance of the organism, either intrinsic or acquired, to many antimicrobial agents. We describe here the successful treatment of a patient with cystic fibrosis who developed post-transplant lung abscesses and sternal osteitis caused by pan-resistant Burkholderia cenocepacia. He was treated with a combination of ceftazidime-avibactam, ciprofloxacin, meropenem, minocycline, sulfadiazine, and tobramycin. Repurposing multitarget drugs including old and new antibiotics, and their combinations with synergistic effects is a promising strategy to overcome clinical therapeutic impasses with difficult-to-treat-resistance (DTR) bacteria.
{"title":"Multi-target combination of antibiotics as salvage therapy for severe infection caused by pan-resistant Burkholderia cenocepacia following lung transplantation","authors":"Nadim Cassir , Benjamin Coiffard , Linda Hadjadj , Julien Bermudez , Liliane Okdah , Lucile Ailhaud , Sophie Alexandra Baron , Martine Reynaud-Gaubert , Xavier Benoit D'Journo , Sami Hraiech , Jean-Marc Rolain","doi":"10.1016/j.tpr.2024.100170","DOIUrl":"10.1016/j.tpr.2024.100170","url":null,"abstract":"<div><div><em>Burkholderia cepacia</em> complex (Bcc) is an important group of opportunistic pathogens most frequently affecting patients with cystic fibrosis and responsible for life-threatening infections. Therapeutic options are limited owing to high levels of resistance of the organism, either intrinsic or acquired, to many antimicrobial agents. We describe here the successful treatment of a patient with cystic fibrosis who developed post-transplant lung abscesses and sternal osteitis caused by pan-resistant <em>Burkholderia cenocepacia.</em> He was treated with a combination of ceftazidime-avibactam, ciprofloxacin, meropenem, minocycline, sulfadiazine, and tobramycin. Repurposing multitarget drugs including old and new antibiotics, and their combinations with synergistic effects is a promising strategy to overcome clinical therapeutic impasses with difficult-to-treat-resistance (DTR) bacteria.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100168
Mohammad Arammash , Barbara Hamilton , Charles Rickert
Liver transplantation has become widely available but remains a high-risk operation not suitable in the presence of severe comorbidities. Pre-operative planning to address potential challenges is key to ensuring optimal outcomes. In this report, we highlight a challenging clinical situation in which a patient with severe portal vein thrombosis and coronary artery disease developed a significant bleed post TIPS, necessitating emergent ligation of the portal structures and urgent liver transplantation. The patient successfully underwent coronary artery bypass grafting after liver transplantation. This case demonstrates an unconventional method for remediating inaccessible portal vein hemorrhage secondary to transjugular intrahepatic portosystemic shunting and the ability to perform coronary artery bypass grafting post-liver transplantation.
{"title":"Emergent management of severe post-TIPS bleed in patient with end-stage liver disease and coronary artery disease","authors":"Mohammad Arammash , Barbara Hamilton , Charles Rickert","doi":"10.1016/j.tpr.2024.100168","DOIUrl":"10.1016/j.tpr.2024.100168","url":null,"abstract":"<div><div>Liver transplantation has become widely available but remains a high-risk operation not suitable in the presence of severe comorbidities. Pre-operative planning to address potential challenges is key to ensuring optimal outcomes. In this report, we highlight a challenging clinical situation in which a patient with severe portal vein thrombosis and coronary artery disease developed a significant bleed post TIPS, necessitating emergent ligation of the portal structures and urgent liver transplantation. The patient successfully underwent coronary artery bypass grafting after liver transplantation. This case demonstrates an unconventional method for remediating inaccessible portal vein hemorrhage secondary to transjugular intrahepatic portosystemic shunting and the ability to perform coronary artery bypass grafting post-liver transplantation.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100169
R. Goodwin , K. Champlin , B. Cloud , C. Yancey , C. Hendrix , S. Parikh , M. Howell , R. Ketcham , A. Milam , B. Nave , T. Campbell , M. Cheruvu
Purpose
This retrospective case study aims to clarify the roles played by various factors in determining the actual versus expected number of organs procured from pediatric trauma patients.
Significance
Trauma patients often have injuries so extensive that there is no hope of recovery. However, if they are stabilized, they may be able to save lives through organ donation. The more organs are procured, the more lives may be saved.
Strategy and Implementation
In this retrospective study, we reviewed the records of pediatric organ donors from Saint Francis Children's Hospital from 2018 to 2022 and identified seven interesting cases involving children younger than 15 years old that showed the actual and expected numbers of organs transplanted. We examined the number of organs that we expected to transplant compared with how many organs were actually transplanted and which clinical data may have affected the ability to transplant.
Outcomes
The data analysis included but was not limited to the observed-to-expected ratio, donor management goals, hospital lab and biometric values before the time of referral, cause of death, age, sex, race, body mass index, blood type, kidney donor profile index, referral timeliness, donation conversations, donation conversation outcomes, hospital attending, pre-mentions of donation to potential families, referral and donation milestone date-time stamps, donor outcomes, organs recovered, organs transplanted, organs discarded, organs submitted to research, and survey responses. Based on the seven identified cases, this study shows that an observed-to-expected ratio greater than 1 is achievable.
Implications for Practice
Identifying factors that affect increased observed organ procurement will increase the potential of transplantable organs, thus leading to a higher number of lives saved.
{"title":"Observed vs. Expected organs transplanted in pediatric donors at Saint Francis hospital","authors":"R. Goodwin , K. Champlin , B. Cloud , C. Yancey , C. Hendrix , S. Parikh , M. Howell , R. Ketcham , A. Milam , B. Nave , T. Campbell , M. Cheruvu","doi":"10.1016/j.tpr.2024.100169","DOIUrl":"10.1016/j.tpr.2024.100169","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective case study aims to clarify the roles played by various factors in determining the actual versus expected number of organs procured from pediatric trauma patients.</div></div><div><h3>Significance</h3><div>Trauma patients often have injuries so extensive that there is no hope of recovery. However, if they are stabilized, they may be able to save lives through organ donation. The more organs are procured, the more lives may be saved.</div></div><div><h3>Strategy and Implementation</h3><div>In this retrospective study, we reviewed the records of pediatric organ donors from Saint Francis Children's Hospital from 2018 to 2022 and identified seven interesting cases involving children younger than 15 years old that showed the actual and expected numbers of organs transplanted. We examined the number of organs that we expected to transplant compared with how many organs were actually transplanted and which clinical data may have affected the ability to transplant.</div></div><div><h3>Outcomes</h3><div>The data analysis included but was not limited to the observed-to-expected ratio, donor management goals, hospital lab and biometric values before the time of referral, cause of death, age, sex, race, body mass index, blood type, kidney donor profile index, referral timeliness, donation conversations, donation conversation outcomes, hospital attending, pre-mentions of donation to potential families, referral and donation milestone date-time stamps, donor outcomes, organs recovered, organs transplanted, organs discarded, organs submitted to research, and survey responses. Based on the seven identified cases, this study shows that an observed-to-expected ratio greater than 1 is achievable.</div></div><div><h3>Implications for Practice</h3><div>Identifying factors that affect increased observed organ procurement will increase the potential of transplantable organs, thus leading to a higher number of lives saved.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2025.100171
Jing Dong , Michael T. Zimmermann , Neshatul Haque , Shahram Arsang-Jang , Wael Saber , Xiaowu Gai , Raul Urrutia
Allogeneic hematopoietic stem-cell transplantation (allo-HCT), an early developed methodology for precision medicine, remains the only curative therapy for myelodysplastic syndromes (MDS). However, allo-HCT carries significant risks of morbidity and mortality due to relapse and transplant-related complications. Recurrent mutations in mitochondrial DNA (mtDNA) have been identified as significant prognostic indicators for MDS outcomes following allo-HCT. However, the biological mechanisms of mtDNA mutations remain unclear. Thus, here we performed deep variant phenotyping by integrating computational biophysics and structural genomics approaches to reveal the molecular mechanisms underlying mtDNA variant dysfunction. This emerging genomics discipline employs structural models, molecular mechanic calculations, and accelerated molecular dynamic simulations to analyze gene products, focusing on their structures and motions that determine their function. We applied this methodology on the variants in the mitochondria-encoded complex I genes that are associated with MDS pathobiology and prognosis after allo-HCT. Our results demonstrate that this approach significantly outperforms conventional analytical methods, providing enhanced and more accurate information to support the potential pathogenicity of these variants and better infer their dysfunctional mechanisms. We conclude that the adoption and further expansion of computational structural genomics approaches, as applied to the mitochondrial genome, have the potential to significantly increase our understanding of molecular mechanisms underlying the disease. Our study lays a foundation for translating mitochondrial biology into clinical applications, which will advance the integration of precision medicine with allo-HCT.
{"title":"Advancing deep variant phenotyping of mitochondrial enzyme complexes for precision medicine in allogeneic hematopoietic stem-cell transplantation","authors":"Jing Dong , Michael T. Zimmermann , Neshatul Haque , Shahram Arsang-Jang , Wael Saber , Xiaowu Gai , Raul Urrutia","doi":"10.1016/j.tpr.2025.100171","DOIUrl":"10.1016/j.tpr.2025.100171","url":null,"abstract":"<div><div>Allogeneic hematopoietic stem-cell transplantation (allo-HCT), an early developed methodology for precision medicine, remains the only curative therapy for myelodysplastic syndromes (MDS). However, allo-HCT carries significant risks of morbidity and mortality due to relapse and transplant-related complications. Recurrent mutations in mitochondrial DNA (mtDNA) have been identified as significant prognostic indicators for MDS outcomes following allo-HCT. However, the biological mechanisms of mtDNA mutations remain unclear. Thus, here we performed deep variant phenotyping by integrating computational biophysics and structural genomics approaches to reveal the molecular mechanisms underlying mtDNA variant dysfunction. This emerging genomics discipline employs structural models, molecular mechanic calculations, and accelerated molecular dynamic simulations to analyze gene products, focusing on their structures and motions that determine their function. We applied this methodology on the variants in the mitochondria-encoded complex I genes that are associated with MDS pathobiology and prognosis after allo-HCT. Our results demonstrate that this approach significantly outperforms conventional analytical methods, providing enhanced and more accurate information to support the potential pathogenicity of these variants and better infer their dysfunctional mechanisms. We conclude that the adoption and further expansion of computational structural genomics approaches, as applied to the mitochondrial genome, have the potential to significantly increase our understanding of molecular mechanisms underlying the disease. Our study lays a foundation for translating mitochondrial biology into clinical applications, which will advance the integration of precision medicine with allo-HCT.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2025.100172
K Afshar , JM Kozuch , M Don , C Gaissert , E Golts
Lymphomas arising in the setting of immune deficiency and/or dysregulation, also known as post-transplant lymphoproliferative disorder (PTLD) is frequently associated with immunosuppressive therapies and the Epstein Barr Virus after solid organ transplantation. Primary central nervous system PTLD (PCNS-PTLD) is extremely rare. Our group presents only the third reported case of PCNS-PTLD in the setting of lung transplantation.
{"title":"Primary central nervous system post-transplant lymphoproliferative Disorder in a lung transplant recipient despite reduction of immunosuppression","authors":"K Afshar , JM Kozuch , M Don , C Gaissert , E Golts","doi":"10.1016/j.tpr.2025.100172","DOIUrl":"10.1016/j.tpr.2025.100172","url":null,"abstract":"<div><div>Lymphomas arising in the setting of immune deficiency and/or dysregulation, also known as post-transplant lymphoproliferative disorder (PTLD) is frequently associated with immunosuppressive therapies and the Epstein Barr Virus after solid organ transplantation. Primary central nervous system PTLD (PCNS-PTLD) is extremely rare. Our group presents only the third reported case of PCNS-PTLD in the setting of lung transplantation.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.tpr.2024.100165
Mahdi Awwad , Nasim Afif AbuKaresh , Hamza A. Abdul-Hafez , Ma'moun Qawasmeh , Mohanad Jaber , Ahmad Thiab Albaw , Mohammad Alnees
Introduction and importance
Primary hyperoxaluria (PH) is a metabolic condition that leads to oxalate production, resulting in kidney failure and oxalate nephropathy. Posttransplant mobilization of oxalate poses a risk of recurrence. This case emphasizes the importance of measures in cases of end-stage kidney disease (ESKD) with unknown origins.
Case presentation
A 53-year-old man with a history of hypothyroidism, recurring kidney stones, and a family background of renal disease and stomach cancer presented with high blood pressure and elevated creatinine levels (2 mg/dL). A subsequent renal biopsy confirmed PH1. Despite initiating hemodialysis, his kidney function deteriorated, necessitating a liver and kidney transplant. Following the transplant, the patient developed lymph node enlargement. Experienced humoral rejection, leading to the resumption of hemodialysis.
Clinical discussion
The case discussion highlights the treatment complexities associated with PH1, emphasizing the importance of detection and vigilant monitoring post transplantation and multidisciplinary care for managing complications effectively.
Conclusion
Early detection, thorough diagnostics, and customized posttransplant care play roles in managing hyperoxaluria. Future research should focus on enhancing methods, refining transplantation techniques, and developing strategies to prevent and manage complications effectively.
{"title":"Management challenges in primary hyperoxaluria type 1 with end-stage kidney disease: A case report","authors":"Mahdi Awwad , Nasim Afif AbuKaresh , Hamza A. Abdul-Hafez , Ma'moun Qawasmeh , Mohanad Jaber , Ahmad Thiab Albaw , Mohammad Alnees","doi":"10.1016/j.tpr.2024.100165","DOIUrl":"10.1016/j.tpr.2024.100165","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Primary hyperoxaluria (PH) is a metabolic condition that leads to oxalate production, resulting in kidney failure and oxalate nephropathy. Posttransplant mobilization of oxalate poses a risk of recurrence. This case emphasizes the importance of measures in cases of end-stage kidney disease (ESKD) with unknown origins.</div></div><div><h3>Case presentation</h3><div>A 53-year-old man with a history of hypothyroidism, recurring kidney stones, and a family background of renal disease and stomach cancer presented with high blood pressure and elevated creatinine levels (2 mg/dL). A subsequent renal biopsy confirmed PH1. Despite initiating hemodialysis, his kidney function deteriorated, necessitating a liver and kidney transplant. Following the transplant, the patient developed lymph node enlargement. Experienced humoral rejection, leading to the resumption of hemodialysis.</div></div><div><h3>Clinical discussion</h3><div>The case discussion highlights the treatment complexities associated with PH1, emphasizing the importance of detection and vigilant monitoring post transplantation and multidisciplinary care for managing complications effectively.</div></div><div><h3>Conclusion</h3><div>Early detection, thorough diagnostics, and customized posttransplant care play roles in managing hyperoxaluria. Future research should focus on enhancing methods, refining transplantation techniques, and developing strategies to prevent and manage complications effectively.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.tpr.2024.100160
Stephanie Almeida , William Snyder , Mita Shah , Jonathan Fisher , Christopher Marsh , Alana Hawkes , Diana Gorial , Sean DeWolf , Dianne B. McKay
Solid organ transplantation is lifesaving for persons with end-stage organ disease. Thanks to advancements in organ preservation, surgeons are now able to successfully transplant organs that were previously considered high risk for poor graft function. Innovations in perfusion machine types, preservation solutions and additives to preservation solutions have significantly improved the ability to utilize organs previously thought unusable.
Newer organ preservation techniques are offering a promising outlook for extending graft longevity and improving transplant outcomes. This review explores the impact of deceased donor type on graft quality and highlights emerging strategies designed to improve the function and viability of deceased donor organs.
{"title":"Revolutionizing deceased donor transplantation: How new approaches to machine perfusion broadens the horizon for organ donation","authors":"Stephanie Almeida , William Snyder , Mita Shah , Jonathan Fisher , Christopher Marsh , Alana Hawkes , Diana Gorial , Sean DeWolf , Dianne B. McKay","doi":"10.1016/j.tpr.2024.100160","DOIUrl":"10.1016/j.tpr.2024.100160","url":null,"abstract":"<div><p>Solid organ transplantation is lifesaving for persons with end-stage organ disease. Thanks to advancements in organ preservation, surgeons are now able to successfully transplant organs that were previously considered high risk for poor graft function. Innovations in perfusion machine types, preservation solutions and additives to preservation solutions have significantly improved the ability to utilize organs previously thought unusable.</p><p>Newer organ preservation techniques are offering a promising outlook for extending graft longevity and improving transplant outcomes. This review explores the impact of deceased donor type on graft quality and highlights emerging strategies designed to improve the function and viability of deceased donor organs.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 3","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959624000118/pdfft?md5=ed685e553841b4cf78318976de9115ff&pid=1-s2.0-S2451959624000118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-26DOI: 10.1016/j.tpr.2024.100159
Omaya Al Salkini , Mohammad Alsultan , Kassem Basha , Qussai Hassan
Introduction
proteinuria is associated with poor allograft and patient survival in kidney transplant recipients (KTRs). This study aims to investigate the prevalence and risk factors of proteinuria in KTRs and its impact on kidney function during the first two years after kidney transplantation (KT).
Materials and methods
200 KTRs were included in this retrospective cohort study from living donors, performed in two University hospitals in Syria, from January 2018 to March 2021. Demographic and immunological characteristics were analyzed depending on the 24 h urine protein (Up) excretion that was classified into three groups: Up I (150–500 mg/day), Up II between (0.5–1 g/day), and Up III (>1 g/day).
Results
Up was increased subsequently as the transplant progressed, where the greatest excretion of the Up was reported 2 years after KT. At 6 months after KT; the cold ischemic time (CIT), serum creatinine (Cr), using angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs), and GFR showed strong significant differences between Up groups (P = 0.00003, 0.0001, 0.00001, and 0.026; respectively). The CIT and Cr were higher in the Up III group compared to Up I and UP II groups. At 12 months after KT; Cr, using ACEIs/ARBs, and GFR showed strong significant differences between Up groups (P = 0.00009, <0.0001, and <0.0001; respectively). The mean Cr was higher in Up II and Up III groups (1.7 mg/dL; for each) compared to the Up I group (1.0 mg/dL). At 24 months after KT; CIT, using ACEIs/ARBs, Cr, and GFR showed strong significant differences between Up groups (P = 0.02, <0.0001, 0.00008, and <0.0001; respectively).
Conclusion
This is the first study from Syria that conducted in KT patients. The prevalence and amount of proteinuria showed subsequently increased as the transplant progressed. Serum Cr, GFR, CIT, and using ACEIs/ARBs showed differences between Up groups at 6 months, 1 year, and 2 years after KT. Our data suggest that the use of ACEIs/ARBs is not a contraindication in early posttransplant period. Due to several known cardiovascular and renal benefits of ACEIs/ARBs future studied in KT population should investigated to determine if these drugs could give beneficial effects on grafts and patients survival.
导言蛋白尿与肾移植受者（KTR）的异体移植和患者存活率低下有关。本研究旨在调查肾移植（KT）后头两年中蛋白尿在肾移植受者中的发生率、风险因素及其对肾功能的影响。材料与方法 2018年1月至2021年3月，叙利亚两所大学医院对200名活体供体肾移植受者进行了回顾性队列研究。根据 24 小时尿蛋白（Up）排泄量分析了人口统计学和免疫学特征，并将其分为三组：结果随着移植的进展，尿蛋白随之增加，KT 2 年后尿蛋白排泄量最大。KT 6 个月后，Up 组之间的冷缺血时间（CIT）、血清肌酐（Cr）、血管紧张素转换酶抑制剂（ACEIs）/血管紧张素 II 受体阻滞剂（ARBs）和肾小球滤过率显示出显著差异（P = 0.00003、0.0001、0.00001 和 0.026；分别为 0.00003、0.0001、0.00001 和 0.026）。与 Up I 组和 Up II 组相比，Up III 组的 CIT 和 Cr 更高。KT 12 个月后，Up 组之间在 Cr、使用 ACEIs/ARBs 和 GFR 方面存在显著差异（分别为 P = 0.00009、<0.0001 和 <0.0001）。与 Up I 组（1.0 mg/dL）相比，Up II 组和 Up III 组的平均 Cr 值更高（均为 1.7 mg/dL）。KT 24 个月后，使用 ACEIs/ARBs 的 CIT、Cr 和 GFR 在 Up 组之间显示出显著差异（分别为 P = 0.02、<0.0001、0.00008 和 <0.0001）。随着移植的进展，蛋白尿的发生率和数量随之增加。在 KT 术后 6 个月、1 年和 2 年，血清 Cr、GFR、CIT 和使用 ACEIs/ARBs 的情况在 Up 组之间存在差异。我们的数据表明，在移植后早期使用 ACEIs/ARBs 并非禁忌。由于已知 ACEIs/ARBs 对心血管和肾脏有多种益处，因此今后应对 KT 患者进行研究，以确定这些药物是否会对移植物和患者存活产生有益影响。
{"title":"Prevalence of proteinuria after living donor kidney transplantation and related risk factors: A retrospective cohort study from Syria","authors":"Omaya Al Salkini , Mohammad Alsultan , Kassem Basha , Qussai Hassan","doi":"10.1016/j.tpr.2024.100159","DOIUrl":"https://doi.org/10.1016/j.tpr.2024.100159","url":null,"abstract":"<div><h3>Introduction</h3><p>proteinuria is associated with poor allograft and patient survival in kidney transplant recipients (KTRs). This study aims to investigate the prevalence and risk factors of proteinuria in KTRs and its impact on kidney function during the first two years after kidney transplantation (KT).</p></div><div><h3>Materials and methods</h3><p>200 KTRs were included in this retrospective cohort study from living donors, performed in two University hospitals in Syria, from January 2018 to March 2021. Demographic and immunological characteristics were analyzed depending on the 24 h urine protein (Up) excretion that was classified into three groups: Up I (150–500 mg/day), Up II between (0.5–1 g/day), and Up III (>1 g/day).</p></div><div><h3>Results</h3><p>Up was increased subsequently as the transplant progressed, where the greatest excretion of the Up was reported 2 years after KT. At 6 months after KT; the cold ischemic time (CIT), serum creatinine (Cr), using angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs), and GFR showed strong significant differences between Up groups (<em>P</em> = 0.00003, 0.0001, 0.00001, and 0.026; respectively). The CIT and Cr were higher in the Up III group compared to Up I and UP II groups. At 12 months after KT; Cr, using ACEIs/ARBs, and GFR showed strong significant differences between Up groups (<em>P</em> = 0.00009, <0.0001, and <0.0001; respectively). The mean Cr was higher in Up II and Up III groups (1.7 mg/dL; for each) compared to the Up I group (1.0 mg/dL). At 24 months after KT; CIT, using ACEIs/ARBs, Cr, and GFR showed strong significant differences between Up groups (<em>P</em> = 0.02, <0.0001, 0.00008, and <0.0001; respectively).</p></div><div><h3>Conclusion</h3><p>This is the first study from Syria that conducted in KT patients. The prevalence and amount of proteinuria showed subsequently increased as the transplant progressed. Serum Cr, GFR, CIT, and using ACEIs/ARBs showed differences between Up groups at 6 months, 1 year, and 2 years after KT. Our data suggest that the use of ACEIs/ARBs is not a contraindication in early posttransplant period. Due to several known cardiovascular and renal benefits of ACEIs/ARBs future studied in KT population should investigated to determine if these drugs could give beneficial effects on grafts and patients survival.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 3","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959624000106/pdfft?md5=62db12851e39bc8664786b007e90254f&pid=1-s2.0-S2451959624000106-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25DOI: 10.1016/j.tpr.2024.100156
Estella Y Huang , Kamyar Afshar , Eugene Golts , Ryan C Broderick , Graham J Spurzem , Daniel Chung , Josefin Holmgren , Bryan J Sandler , Garth R Jacobsen , David C Kunkel , Santiago Horgan
Background
Early laparoscopic fundoplication (LF) has been shown to slow lung function decline in chronic lung disease (CLD) patients and lung transplant (LTx) recipients. Magnetic sphincter augmentation (MSA) has emerged as an effective minimally invasive alternative to LF for the treatment of GERD. We evaluate the safety and efficacy of MSA compared to LF for GERD in CLD and LTx.
Methods
A retrospective review identified CLD and LTx patients undergoing LF or MSA for GERD. Primary outcome was change in percent predicted FEV1. Secondary outcomes were 30d morbidity, mortality, operative time, and length of stay (LOS).
Results
77 patients met inclusion criteria, 45 (58.5 %) were LTx recipients. 35 (45.5 %) underwent Nissen, 23 (29.9 %) underwent Toupet, and 19 (24.7 %) underwent MSA. Average age was 54.2 years, 54.5 % were female, and average BMI at ARS was 24.9 kg/m2. Median FEV1 % change between pre-ARS and post-ARS was 0 % with no significant differences between groups. MSA had faster operative times at 50.5 min than Nissen (83.5 min, p = 0.002) and Toupet (72.6 min, p = 0.003) and shorter LOS at 0.8 days than Nissen (3.7 days, p = 0.002) and Toupet (2.1 days, p = 0.0008). MSA and Nissen had higher reintervention rates than Toupet, though this was not statistically significant. There were no differences in 30-day morbidities or 30-day ED visits between groups. There were no mortalities.
Conclusion
MSA is an advantageous alternative to LF in the CLD and LTx population with stabilization of percent predicted FEV1, equivalent safety profile, shorter operative times, and shorter length of hospital stay.
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Pub Date : 2024-06-25DOI: 10.1016/j.tpr.2024.100158
Maryam Rahbar , Marzieh Latifi , Elahe Pourhosein , Ebrahim Mahmoudi , Iman Seyhoun , Sanaz Dehghani
Long-term immunosuppression after transplantation can increase the risk of cancer development in recipient patients. This case report describes the treatment approach for glioblastoma in a kidney transplant recipient after transplantation. The patient, a 61-year-old woman, received a living donor kidney transplant 24 years ago due to congenital nephrotic syndrome. The patient was on various immunosuppressive medications, including cyclosporine, prednisolone, and mycophenolate mofetil.
After 16 years of follow-up, the patient presented with symptoms of brain tumor, leading to further tests. Subsequent examination revealed the presence of a tumor that had spread to frontal region within the brain.
A surgical procedure was subsequently conducted to extract the tumor cells and alleviate the resulting pressure within the brain. Based on pathology results, it was determined that the patient had glioblastoma.
Methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter was detected, indicating the potential response to chemotherapy. Chemotherapy was initiated, along with radiation therapy.
After the diagnosis and surgery, the patient's medications for the kidney transplant were modified. Rapamycin replaced the previous medications, and the dose of mycophenolate mofetil and prednisolone was decreased. After 7 years, the patient's kidney is functioning well, with a creatinine level of 1.5, and brain imaging showed no abnormalities. After kidney transplantation, there is an increased risk of various cancers.
Overall, this case report demonstrates a successful treatment approach for glioblastoma after kidney transplantation, emphasizing the need for close monitoring and individualized management in transplant recipients at risk for cancer development.
Considering the current stability of the patient's condition after a change in medication regimen, patients who have been using the drug Cyclosporine for a long time should be included in future evaluations due to its carcinogenic properties.
{"title":"Long-term graft survival in a kidney transplant recipient with glioblastoma: Case report","authors":"Maryam Rahbar , Marzieh Latifi , Elahe Pourhosein , Ebrahim Mahmoudi , Iman Seyhoun , Sanaz Dehghani","doi":"10.1016/j.tpr.2024.100158","DOIUrl":"https://doi.org/10.1016/j.tpr.2024.100158","url":null,"abstract":"<div><p>Long-term immunosuppression after transplantation can increase the risk of cancer development in recipient patients. This case report describes the treatment approach for glioblastoma in a kidney transplant recipient after transplantation. The patient, a 61-year-old woman, received a living donor kidney transplant 24 years ago due to congenital nephrotic syndrome. The patient was on various immunosuppressive medications, including cyclosporine, prednisolone, and mycophenolate mofetil.</p><p>After 16 years of follow-up, the patient presented with symptoms of brain tumor, leading to further tests. Subsequent examination revealed the presence of a tumor that had spread to frontal region within the brain.</p><p>A surgical procedure was subsequently conducted to extract the tumor cells and alleviate the resulting pressure within the brain. Based on pathology results, it was determined that the patient had glioblastoma.</p><p>Methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter was detected, indicating the potential response to chemotherapy. Chemotherapy was initiated, along with radiation therapy.</p><p>After the diagnosis and surgery, the patient's medications for the kidney transplant were modified. Rapamycin replaced the previous medications, and the dose of mycophenolate mofetil and prednisolone was decreased. After 7 years, the patient's kidney is functioning well, with a creatinine level of 1.5, and brain imaging showed no abnormalities. After kidney transplantation, there is an increased risk of various cancers.</p><p>Overall, this case report demonstrates a successful treatment approach for glioblastoma after kidney transplantation, emphasizing the need for close monitoring and individualized management in transplant recipients at risk for cancer development.</p><p>Considering the current stability of the patient's condition after a change in medication regimen, patients who have been using the drug Cyclosporine for a long time should be included in future evaluations due to its carcinogenic properties.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 3","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245195962400009X/pdfft?md5=c85d0d1fcf492b0b46327a05eb4cce26&pid=1-s2.0-S245195962400009X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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