Transplantation Reports最新文献

Background

Torsion is defined as rotation of allograft around its renal pedicle. It is a rare complication with high rate of graft loss. The nonspecific presentation and inability to provide definitive diagnosis by imaging in cases of partial torsion may delay the diagnosis and treatment.

Methods

We present two patients who were diagnosed with kidney allograft torsion (KAT) and underwent surgical exploration with varying outcomes. We also included the review of literature on KAT, highlighting the clinical presentation, investigation modality, intervention, and outcome. We identified reports of KAT in PubMed and Cochrane from 1990 through January 2021.

Results

22 manuscripts with 30 intraperitoneal and 6 extraperitoneal cases of KAT were identified. Most common presenting symptom was oliguria/anuria (11 cases) and abdomen pain (11 cases). Acute kidney injury was reported in almost all cases. Diagnosis of KAT by imaging was diagnosed in 7 cases before exploration. Surgical exploration led to graft salvage in 25 (69.4%) of cases and immediate transplant nephrectomy was performed in 11 (30.5%) of cases. Recurrence was documented in 3 cases and none of them had recurrence after surgical intervention

Conclusion

Renal torsion presents with various non-specific symptoms that could often be misdiagnosed. Since early suspicion and diagnosis is critical to prompt therapy and better graft outcome, including KAT as a possible cause of allograft dysfunction of unclear etiology particularly in patients with intraperitoneally placed allograft and sirolimus use, will be crucial.

Autotransplantation is a relatively rare method used in cardiac surgery. It gives the surgeon excellent opportunities for precise surgical treatment of hard-to-reach pathologies located in the heart cavities, which is especially important when the aim of procedure is to remove maximal amount of malignant neoplastic cells. In this article, we describe the use of autotransplantation in a 32-year-old man finally diagnosed with Undifferentiated Pleomorphic Sarcoma (UPS). The course of the disease, the operative strategy, and the most common pathologies will be described.

Reactivation of cytomegalovirus is one of the most significant morbidities in solid organ transplant recipients. Reports describing the risk factors for cytomegalovirus reactivation in heart transplantation are scarce. We present a case in which viral reactivation 9 days after heart transplantation resulted in cytomegalovirus enterocolitis. Before transplantation, the patient received extracorporeal membrane oxygenation. Cytomegalovirus reactivation occurred under prophylactic medication with valganciclovir and progressed to cytomegalovirus enterocolitis, complicated by ischemia and a small bowel perforation. The patient died of repeated septic shock, severe gastrointestinal tract complications, and cytomegalovirus hepatitis. A review of 70 heart transplant recipients at our hospital from 2005 to 2020 revealed that cytomegalovirus reactivation occurred more frequently in those who received pretransplantation extracorporeal membrane oxygenation than in those who did not (36.4% vs. 6.8%, P = 0.018). This finding suggests that early diagnosis and prompt management of cytomegalovirus reactivation in patients receiving extracorporeal membrane oxygenation as a bridge to heart transplantation is crucial.

Background Subacute allograft rejection (SAR) results in chronic allograft nephropathy and decreased allograft survival. Protocol biopsies (PB) are performed in many top centers to identify SAR. Our study aimed to evaluate the rate of SAR detected in PB at our single center. Methods Retrospective review of 38 pediatric patients (pts) who received a kidney allograft from April 2014 through January 2018. Induction immunosuppression consisted of basiliximab (n = 25). High risk pts received antithymocyte globulin (n = 13). Tacrolimus-based triple drug maintenance immunosuppression was used. PBs were performed 3–6 months after transplant. Pathology was evaluated by trained pathologists and classified using Banff criteria. Results Thirty-eight pts were included. Five pts underwent biopsy before 3 months due to elevated creatinine or BK viremia. Thirty-three pts underwent PB 12–23 weeks after transplant. Six pts had elevated creatinine at the time of PB; only 1/6 biopsies showed acute rejection. Of the remaining 27 PBs, only 1/27 showed acute rejection. The total rejection rate at 6 months post-transplant was 5.26%, with a SAR rate of 3.7%. Conclusions These findings do not substantiate early PB at our institution. Our study suggests that perhaps later time points for PB when immunosuppressive meds are at their lowest levels or use of novel biomarkers as an initial screen for biopsy in patients at risk for SAR would be more informative.

Background

Some complications are frequently seen in pregnancies with kidney transplantation and graft functions may be impaired. In this study, it was aimed to examine the course and results of pregnancies after transplantation, the effect of pregnancy on graft functions and the risk factors in complications in these pregnancies.

Methods

A total of 24 pregnancies conceived after kidney transplantation due to end-stage renal disease between January 2013 and December 2020 and followed up in the Obstetrics and Gynecology clinic of our hospital were included in the study.

Results

The mean age was 31.8±6.4, the mean time between transplantation and pregnancy was 54±36 months, and the mean newborn weight was 1945±529.5 grams.

Of the pregnancies, abortion occurred in one (4.2%), preterm delivery in 17 (70.3%), and intrauterine growth retardation (IUGR) in 10 (41.7%). Immunosuppressant treatment was given to all pregnant women due to transplantation, and all women used tacrolimus. No graft rejection was seen.

The median serum creatinine level did not show a significant change during pregnancy according to the prenatal value (p>0.05 for each), and it increased significantly in the 6th month (p=0.006) and 3rd year (p=0.007) measurements. Urine protein level increased significantly in the third trimester compared to pre-pregnancy (p=0.009).

Conclusion

The findings show that pregnancy does not have a significant effect on maternal and fetal survival, graft rejection and graft function in pregnancies with kidney transplantation, but that complication rates such as hypertension, preterm delivery and low birth weight are high.

Background: The hungry bone syndrome (HBS) is a well described phenomenon occurring shortly after parathyroidectomy characterized by rapid bone formation with concomitant hypocalcemia, hypophosphatemia and hypomagnesemia requiring intensive management. Recurrent HBS occurring in isolation from parathyroidectomy has not been reported.

Case presentation: We describe a case of recurrent HBS in a kidney transplant recipient (KTR) developing years after parathyroidectomy. The KTR was a 49 year-old lady who had undergone successful total parathyroidectomy without re-implantation 14 years prior and cadaveric kidney transplantation 12 years prior. She had a stable creatinine level of 220μmol/L and an estimated glomerular filtration rate (eGFR) of 20 mL/min^-1.73m². She presented to us with severe hypercalcemia, likely a result of excessive calcium and vitamin D supplementation, and acute kidney injury. Serum creatinine, calcium, phosphate, magnesium, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) levels on admission were 743μmol/L, 4.8 mmol/L, 1.8 mmol/L, 0.75 mmol/L, 48IU/L and <0.1 pmol/L, respectively. Vigorous intravenous fluids were given in addition to withdrawal of calcium carbonate and calcitriol. Clinical improvement was evident with falling serum creatinine and calcium levels. However, this was followed 2–3 days after admission by an unexplained rise in ALP from a baseline of 48IU/L to a peak level of 1150IU/L over the next week, accompanied by the development of severe hypocalcemia, hypomagnesemia and a persistent drop in phosphate levels. The patient required large doses of calcium carbonate, calcitriol and magnesium lactate to maintain blood mineral levels. The ALP progressively decreased subsequently and the serum levels of calcium, phosphate and magnesium began to stabilize in the next 2–3 weeks.

Conclusion: Recurrent HBS can occur years after parathyroidectomy in KTRs. We hypothesize that hypercalcemia and its rapid correction might have been the trigger in this particular patient. The mechanism is not well understood but might involve bone remodeling pathways that are independent of parathyroid hormone.

Introduction

: BK polyoma virus nephropathy represents one of the non-immunological causes of renal graft loss with a cumulative incidence between 5 and 10 percent, and a graft loss rate on BK virus nephropathy patients that ranges from 30 to 90 percent depending on the nephropathy status at the time of diagnosis (1).

Objective

: To determine the outcomes regarding the kidney graft survival and kidney function of an early detection strategy for BK Polyomavirus nephropathy which is drawn upon urinary cytology in order to look for Decoy cells.

Methodology

: Descriptive, retrospective study type. Adult renal transplant recipients/patients from the Interdisciplinary Renal Transplant program of the Colombia University Clinic were included in a time period from 2012 to 2018, in whom monthly post-transplant monitoring with positive urinary cytology was performed.

Results

: 303 patients were transplanted in the program, 107 patients with positive urinary cytology were included, wherein, men predominated with 72% and 45 years old being the average age (IQR: 18–72). The cumulative incidence of polyomavirus nephropathy, under this early detection strategy, was 9.2%, thus preserving the graft survival at 24 months in a 100% of the patients with the management strategies employed.

Conclusions

: This early detection and monitoring study utilizing post-transplant urinary cytology proved to be useful for the early diagnosis of BK Polyomavirus nephropathy with a favorable impact on the graft livelihood.

Summary

New-onset diabetes after transplantation (NODAT) is increasing in frequency and creates many challenges directly impacting the patient and graft survival. Most transplant programs offer a fixed-dose prednisone taper schedule for the prevention of acute rejection following kidney transplantation. In this study, we investigated the incidence of NODAT in new kidney transplant recipients.

Methods

This was a retrospective, single-center study assessing rates of NODAT according to age, ethnicity, body weight, BMI, rejection, and prednisone dosing among kidney transplant recipients.

Results

Among non-diabetic consecutive kidney transplant recipients (n = 261) from 1/2014 to 12/2018, a total of 47 (18%) kidney transplant recipients developed NODAT. After adjusting for common NODAT risk factors, analysis of the population indicated that age, and corticosteroid dose in the Asian American population [adjusted for lower body weight, BMI] significantly increased the risk of NODAT. In multi-variance analysis, despite receiving lower standard doses of protocol corticosteroid daily, when adjusted for actual body weight (mg/kg/day) Asian American recipients had high incidence of NODAT compared to other ethnicity. Asian American received higher doses or corticosteroids (prednisone) than non-Asian Americans (0.14 mg/kg vs. 0.11 mg/kg) (p = 0.008). The overall incidence of rejection was not higher among those who developed NODAT (p = 0.55)

Conclusion

This is the first study to explore the relationship between corticosteroid dose and diabetes in Asian Americans. Asian Americans had higher rates of NODAT and received higher doses of weight-based corticosteroids. There is a possible iatrogenic, pharmacogenomic, and addressable etiology to NODAT in this population.

Background

. In Ecuador, it is estimated that more than eight hundred people are on the waiting list for organ transplants. For this reason, the aim of this study is to describe the epidemiological profile of patients on the waiting list and donor for a kidney transplant.

Methods

. A cross-sectional retrospective study was performed on 67 patients who underwent transplants between 2012 and 2019. We included recipients of organs from both deceased and living donors. Age of patients and donors, period in which they underwent dialysis until the transplant, type of donor, cause of chronic kidney failure, comorbidities, type of dialysis, cold ischemia time, blood-type of donors and patients, compatibility, complications after transplant, delayed graft function, and immunosuppression, were studied.

Results

. A total of 45 patients were male, with age 46.80 ± 11.48 years old. Twenty-two were females, with age of 40.45 ± 12.9 years old. The mean age of the donor was 40.71 ± 13.28 years old. 55.2% of the etiology to develop CKD in patients was unknown. The second most prevalent were diabetic nephropathy and lupus nephritis, both of which registered 7.5%. Furthermore, 92.4% received kidneys from deceased donors, and the mean age of those recipients was 45.2 ± 13.9 years old. Conversely, only 7.6% had kidneys from living donors.

Conclusions

. The importance of knowing the epidemiological profile is for health strategies. It can be developed for the medical care of the most vulnerable population within this list, and try to reduce morbidity and mortality.