Transplantation proceedings最新文献

We present a rare case of multicentric Castleman disease (MCD) complicated by severe respiratory failure, which was successfully managed through bilateral lung transplantation. A 31-year-old male patient exhibited progressive dyspnea attributed to MCD associated with bronchiolitis obliterans. Pretransplant evaluations indicated severe hypercapnia and markedly impaired pulmonary function. Despite the administration of steroid therapy, the patient's respiratory status continued to decline. Consequently, he underwent bilateral lung transplantation, which resulted in significant alleviation of hypercapnia and considerable improvement in pulmonary function. Four years posttransplant, the patient remains alive and does not require supplemental oxygen. This case highlights the potential efficacy of bilateral lung transplantation in addressing severe respiratory complications associated with MCD.

A 67-year-old female underwent an en-bloc double lung transplantation for idiopathic pulmonary fibrosis. The post-transplant course was complicated by refractory septic shock. Despite empiric antimicrobial coverage with vancomycin, meropenem, micafungin, and posaconazole, she continued to require high-dose vasopressors and remained unable to wean from veno-venous extracorporeal membrane oxygenation (ECMO). Blood cultures were positive for Candida Kefyr (teleomorph: Kluyveromyces marxianus), the same organism that had been isolated from donor bronchoalveolar lavage cultures 5 days prior to transplant. Micafungin and posaconazole doses were increased, and intravenous (IV) liposomal amphotericin B was added. Within 2 days, her hemodynamics improved, allowing successful weaning from ECMO. However, repeat blood cultures demonstrated persistent candidemia. Chest computed tomography revealed pericardial and bilateral pleural effusions, suspicious for mediastinitis and empyema. Transesophageal echocardiography confirmed pericardial effusion but showed no vegetations. Chorioretinal lesions were noted bilaterally without vitritis. Micafungin and posaconazole were discontinued and IV voriconazole was started for eye penetration. Amphotericin B was continued for 4 weeks and voriconazole for 3 months. Repeat blood cultures showed clearance of fungemia, and ophthalmology eye exam showed no further signs of chorioretinitis. Donor-derived infections are a rare complication of solid organ transplantation, with fungal infections posing a unique challenge due to their high morbidity and mortality. To our knowledge, there are no documented cases in the literature of possible donor-derived C. kefyr leading to blood stream infection in the recipient. This case highlights the need for heightened clinical vigilance and prompt multidisciplinary management to mitigate the impact of post-transplant complications.

Mucormycosis is an aggressive fungal infection associated with high mortality, particularly among recipients of solid organ transplants. Gastrointestinal involvement is rare but can be fatal due to delayed diagnosis and limited therapeutic options. We report on a 59-year-old female who developed intra-abdominal mucormycosis that was diagnosed during orthotopic liver transplantation. She initially presented with a perforated duodenal ulcer requiring emergent surgical repair and subsequently developed acute liver failure due to an iatrogenic transection of the portal triad. She underwent urgent orthotopic liver transplantation and was found to have multiple gastric ulcers. Tissue biopsies from the stomach and abdomen revealed broad, nonseptate hyphae consistent with Mucorales, which was later identified as Mucor circinelloides. Postoperatively, she required eight reexplorations with extensive debridement and amphotericin B irrigation of the abdominal cavity. She received systemic antifungal therapy with liposomal amphotericin B and azoles guided by susceptibility testing. Immunosuppression was minimized, with tacrolimus maintained at low trough levels and a rapid corticosteroid taper. Fungal cultures cleared up 25 days posttransplant. She completed 6 months of antifungal therapy and remains free from infection with excellent graft function at 1 year. This case underscores the importance of early diagnosis of intra-abdominal mucormycosis and highlights that aggressive surgical debridement, tailored antifungal therapy, and careful immunosuppression management are essential to achieving a successful outcome.

Background: An active Coronavirus disease 2019 (COVID-19) infection is considered a contraindication for lung transplantation. However, missing a lung transplant opportunity for patients with end-stage pulmonary disease can lead to increased morbidity and mortality. This case report focuses on a successful lung transplantation performed on a patient with an active COVID-19 infection and aims to contribute valuable insights to the limited existing literature on this topic.

Methods: After obtaining institutional ethics approval and patient consent, medical records were reviewed to prepare the case report.

Results: A 45-year-old patient with chronic rejection after her first lung transplant was on mechanical ventilation while waiting for a donor. When a suitable donor became available, she tested positive for COVID-19 right before surgery. Despite the risks, the decision was made to proceed with the transplant. She received remdesivir and intravenous immunoglobulin therapy. Her recovery was uneventful, and 3 months posttransplant, she showed excellent graft function with no signs of rejection.

Conclusion: In carefully selected patients with limited donor availability, lung transplantation may be considered in active COVID-19 infected patient, accompanied by a tailored regimen of antiviral therapy and immunosuppression.

Cytokine storm is an uncommon but devastating complication following lung transplantation, characterized by systemic hyperinflammation, multiorgan dysfunction, and hemodynamic collapse. We report the case of a 36-year-old woman with systemic sclerosis-associated interstitial lung disease and pulmonary arterial hypertension who underwent bilateral lung transplantation and developed severe primary graft dysfunction requiring extracorporeal membrane oxygenation. Her course was complicated by clinical and biochemical features consistent with a cytokine storm, including elevated ferritin, IL-6, creatine phosphokinase, and transaminases, as well as persistent fever, rash, myocarditis, and vasoplegic shock. Despite aggressive immunomodulatory therapy-including corticosteroids, intravenous immunoglobulin, plasmapheresis, and anakinra-her recovery was protracted and complex. This case highlights the need for early recognition of cytokine storm in the lung transplant population and supports incorporating cytokine-targeted strategies into the management of severe posttransplant inflammation.

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.