Transplantation proceedings最新文献

Background: Subcapsular hematoma (SH) is a rare but serious complication after renal transplantation, potentially leading to graft dysfunction. Through external compression and activation of the renin-angiotensin-aldosterone system a SH can lead to a serious condition known as Page kidney. Early diagnosis and timely intervention are crucial to prevent graft loss.

Case presentation: We describe a 67-year-old male who underwent kidney transplantation and developed an SH in the immediate postoperative phase. Despite being hemodynamically stable and asymptomatic, the patient exhibited persistent anuria and rising serum creatinine levels (349 μmol/L). Routine ultrasound (US) revealed a SH (2.5 cm × 4.3 cm × 7.8 cm) compressing the graft. Doppler findings showed normal renal arterial resistive indices. A subsequent non-contrast CT scan confirmed the diagnosis. Given the risk of graft ischemia, surgical decompression via longitudinal and transverse capsular incisions was performed. Postoperatively, diuresis resumed, and renal function improved, with a decline in creatinine levels. The patient was discharged on postoperative day 25 with preserved graft function.

Conclusion: SH in transplant recipients is uncommon and often linked to surgical trauma, anticoagulation, or allograft biopsy. While small hematomas may resolve conservatively, larger ones can lead to graft dysfunction. This case highlights the importance of routine postoperative US for early detection, as well as the role of timely surgical intervention in preserving renal function. Given the potential for irreversible ischemia and graft loss, proactive surgical decompression should be favored over conservative management in transplant recipients with significant SH.

We present the case of a 45-year-old male with a history of 2 renal transplants who developed right iliac fossa (RIF) pain, abscess formation, and hydronephrosis in a non-functioning transplanted kidney, a rare and serious complication. The patient underwent prompt surgical intervention, including drainage and subsequent nephrectomy of the non-functioning kidney. This case underscores the challenges of managing long-term post-transplant complications, such as infection, abscess formation, and hydronephrosis, which require timely diagnosis and multidisciplinary management.

Combined heart-liver transplantation presents significant challenges, particularly in cases requiring extended ischemic times for managing hemodynamic instability post cardiac implantation. Advances in perfusion techniques, such as the normothermic machine perfusion pump, offer advantages over traditional static cold storage by maintaining organ viability during prolonged periods. We report the first successful combined heart-liver transplant using normothermic machine perfusion for both organs from a donation after circulatory death donor. The recipient is a 45-year-old male with ischemic cardiomyopathy-induced heart failure and end-stage liver disease secondary to congestive hepatopathy. Both organs, procured from a donation after circulatory death donor were preserved on the TransMedics Organ Care System and subsequently transplanted with total post crossclamp times of 7.75 hours for the heart and 15.25 hours for the liver. At 8 months post-transplant, the patient demonstrates stable cardiac and hepatic graft function. This case highlights the critical role of normothermic machine perfusion in optimizing organ quality and mitigating ischemic injury in multi-organ transplants involving donation after circulatory death donors. Our findings support the expanded use of normothermic machine perfusion to enhance organ utilization, particularly in complex, high-risk multi-organ transplants cases.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a global reality for longer than 3 years. Serologic studies have great importance for understanding the virus's behavior in populations, as it can suggest the status of the epidemic in a community. This cross-sectional study aimed to analyze the serologic profile for COVID-19 in patients before and after pediatric heart transplantation.

Methods: Serology data on IgG and IgM antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were collected in patients of the Pediatric Cardiology and Congenital Heart Diseases unit of a Brazilian hospital between January and August 2022. A total of 174 patients were recruited, including 28 on the transplantation waiting list and 146 heart transplant recipients. Information for each patient, including demographics (age, sex, state of origin), type of heart disease (congenital or acquired), and time after transplantation, was analyzed.

Results: Overall, 72 patients had a positive serology for anti-N antibodies (48.0%), including 62 heart transplant recipients and 10 patients on the transplantation waiting list, The positivity rates in these 2 groups were 48.1% and 47.6%, respectively. Positivity rates for previously infected individuals were 62.5% and 62.1%, respectively.

Conclusions: Approximately one-half of our study sample had IgM or IgG antibodies against the SARS-CoV-2 virus. Serologic studies on the duration and level of protection provided by these antibodies are relevant public health tools for health promotion of vulnerable groups and can be useful for future studies on antibody behavior.

Background: COVID-19, caused by SARS-CoV-2, was responsible for higher morbidity and mortality in renal transplant recipients (RTx). The objective of the study was to evaluate the impact of COVID-19 infection on RTx in a single center in Brazil.

Methods: A cohort of 135 RTx was evaluated between December 2019 and June 202l, and demographics, clinical, and laboratory profiles were analyzed from deceased donors with COVID-19.

Results: Diabetic and RTx from extended criterion donors presented more frequently the severe form of the disease. Serum creatinine (sCr) after 3 months of diagnosis of COVID-19 varied according to the severity of infection. The lethality rate was higher in the group with severe symptoms (65%) compared with those with mild infection (1.5%).

Conclusion: The increase in sCr was associated with disease severity. The lethality rate for COVID-19 was 26.6%. These rates are 10-20 times higher than those reported in the general population and suggest that rigorous observation, early diagnosis, and disease prevention measures are crucial in RTx.

Background: In this paper, we present organ donation and transplantation activities in Poland from 2017 to 2022. Data came from registries maintained by the Polish Transplant Coordinating Center Poltransplant and consisted of the national waiting list, deceased donor registry, transplant registry, and the live donor registry. Poltransplant is the Competent Authority in Organs, with tasks related to preparing assessments, analyses, information, and reports in transplantation medicine and publishing and disseminating these results in the country and abroad. Poltransplant edits the Poltransplant Bulletin on its web pages and presents its activities at Polish Transplantation Society congresses, published consecutively as professional papers.