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Sample records for related renal transplantation

  1. Ureteric complications in live related donor renal transplantation - impact on graft and patient survival

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    A Srivastava

    2004-01-01

    Full Text Available Objective : The study was performed with an aim to determine the incidence of ureteric complications in live related donor renal transplantation, and to study the effect of ureteric complications on long term graft and patient survival. Patients And Methods: Records of 1200 consecutive live related renal transplants done from 1989-2002 were reviewed. Twenty-six ureteric complications were noted to occur and treatment modalities employed were documented. In the non complication group sufficient data for evaluation was available in 867 patients. Survival analysis were performed using Kaplan-Meier techniques. Results: The overall incidence of urological complications is 2.9%. Complications occurred at a mean interval of 31.9 days after renal transplantation. Ureteric complications occurred in 2% patients with stented and 7.7% patients with non stented anastomosis (p=0.001. Mean follow up following renal transplantation was 37.4 months. Survival analysis showed that ureteric complications did not increase the risk of graft fai lu re or patient death. Conclusions: Ureteric complications in live related donor renal transplantation occurred in 2.9 % patients and did not impair graft and patient survival.

  2. TRANSPLANTE RENAL

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    Soraia Geraldo Rozza Lopes

    2014-01-01

    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  3. Exogenous Lipid Pneumonia Related to Smoking Weed Oil Following Cadaveric Renal Transplantation

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    Dilini Vethanayagam

    2000-01-01

    Full Text Available A 30-year-old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP reaction and exogenous lipid pneumonia (ELP. The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. Physicians should be aware of the different forms of marijuana available and of their potential medical complications.

  4. Travel-related disseminated Penicillium marneffei infection in a renal transplant patient.

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    Hart, J; Dyer, J R; Clark, B M; McLellan, D G; Perera, S; Ferrari, P

    2012-08-01

    Penicillium marneffei is a thermally dimorphic fungus that causes severe human immunodeficiency virus-related opportunistic infection in endemic areas of Southeast Asia and has rarely been reported in solid organ transplant (SOT) recipients. We report here the case of an Australian renal transplant patient who presented with disseminated P. marneffei infection shortly after a 10-day holiday to Vietnam, and review all previously published cases of penicilliosis associated with renal transplantation. This is the first reported case, to our knowledge, of P. marneffei infection in an SOT recipient acquired during travel to an endemic country, and highlights the importance of an accurate travel history when opportunistic infection is suspected, as well as giving appropriate health advice to transplant patients who travel.

  5. Successful renal transplantation during pregnancy.

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    Hold, Phoebe M; Wong, Christopher F; Dhanda, Raman K; Walkinshaw, Steve A; Bakran, Ali

    2005-09-01

    Little is known about the implications of performing a renal transplant on a patient who is already pregnant. This case study reports a successful outcome of pregnancy, diagnosed coincidentally following renal transplantation at 13 weeks gestation. The recipient was a 23-year-old woman with chronic kidney disease who received a live-related renal transplant from her father. Pregnancy was discovered at routine ultrasound scanning of the renal allograft at 5 days posttransplant and estimated at 13 weeks gestation. She received ciclosporin monotherapy as immunosuppression throughout the pregnancy, and was given valacyclovir as prophylaxis against cytomegalovirus (CMV) infection. Renal function remained stable throughout the pregnancy, which progressed normally, resulting in the vaginal delivery of a healthy, liveborn male infant at 37 weeks gestation. This case study demonstrates that transplantation during pregnancy can have a successful outcome.

  6. Dyslipoproteinemia in renal transplantation.

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    Gunjotikar R

    1994-01-01

    Full Text Available Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total cholesterol (Tch, triglycerides (TG, HDL cholesterol (HDLch, LDL cholesterol (LDLch and VLDL cholesterol (VLDLch levels were estimated. Fifteen (56% patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly lower levels of Tch (p < 0.05 and LDLch (p < 0.05 and higher levels of TG (p < 0.005 and HDLch (p < 0.05. Diet and beta blockers did not influence lipoprotein levels. A significant negative correlation was noted between post-transplant duration and Tch, TG and VLDLch levels. Increased TG levels were associated with increase in weight and higher daily prednisolone dosage at the time of evaluation. The study confirms the existence of dyslipoproteinemia in renal allograft recipients.

  7. Living related donor renal transplant in human immunodeficiency virus infected patient: Case reports from tertiary care hospital in western India

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    Sonal Dalal

    2014-01-01

    Full Text Available Renal transplantation (TX in human immunodeficiency virus (HIV infected patients with end stage renal disease (ESRD is increasingly performed in developed countries in the era of antiretroviral therapy (ART. Management of HIV infected patients during and post-transplant is very complex and challenging due to drug interaction, infection risk and associated co-infections. We described our experience with living related donor renal TX in three HIV infected patients.

  8. Imaging chronic renal disease and renal transplant in children

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    Carmichael, Jim; Easty, Marina [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2010-06-15

    At Great Ormond Street Hospital we have the highest number of paediatric renal transplant patients in Europe, taking cases from across the United Kingdom and abroad. Our caseload includes many children with rare complicating medical problems and chronic renal failure related morbidity. This review aims to provide an overview of our experience of imaging children with chronic renal failure and transplants. (orig.)

  9. Fatal lactic acidosis possibly related to ganciclovir therapy in a renal transplant patient?

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    Wittebole, Xavier; Morelle, Johann; Vincent, Marie-Françoise; Hantson, Philippe

    2015-01-01

    Ganciclovir is widely prescribed in renal transplant patients for the prevention or treatment of herpes and cytomegalovirus (CMV) infections. Side-effects are usually represented by hematological disorders, and particularly leucopenia. We report a case of severe and fatal lactic acidosis developing in a 76-year-old renal transplant woman, a few days after ganciclovir has been introduced to treat CMV pneumonia. Usual etiologies of lactic acidosis were ruled out. A high lactate/pyruvate molecular ratio was suggestive of a respiratory chain dysfunction. With the analogy to nucleoside analogues-related lactic acidosis, we suggest that ganciclovir may exceptionally be responsible for respiratory chain dysfunction and subsequent lactic acidosis, and we discuss potential risk factors in our patient. PMID:25810616

  10. Retrospective analysis of 100 consecutive patients undergoing related living donor renal transplantation.

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    Diethelm, A G; Sterling, W A; Aldrete, J S; Shaw, J F; Morgan, J M

    1976-01-01

    One hundred consecutive patients receiving related donor kidneys were analyzed in regards to graft and patient survival, morbidity, mortality, histocompatibility and rehabilitation. The average followup was 3 years and 2 months with a minimum post transplant evaluation of one year. Donor morbidity was minimal and the mortality nil. Recipient mortality was 17%, all of which occurred after the first two post transplant months. The most serious life threatening complications after transplantation were due to infection. The greatest morbidity was secondary to aseptic necrosis. The overall graft survival at one year was 94%, 2 years--87%, 3 years--81% and 4 and 5 years--72%. Separation of patients according to tissue typing revealed 95% of recipients with A and B matched kidneys to be alive 5 years later compared to 55% of patients receiving C and D matched kidneys. Rehabilitation was good to excellent in 76% of the living patients and poor in only 4%. These results suggest related donor renal transplantation to be the treatment of choice for patients with chronic renal failure excluding only those individuals who are exceptionally high risks in terms of morbidity and mortality. PMID:776105

  11. Pregnancy and renal transplantation.

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    Başaran, O; Emiroğlu, R; Seçme, S; Moray, G; Haberal, M

    2004-01-01

    Ovarian dysfunction, anovulatory vaginal bleeding, amenorrhea, high prolactin levels, and loss of libido are the causes of infertility in women with chronic renal failure. After renal transplantation, endocrine function generally improves after recovery of renal function. In this study we retrospectively evaluated the prepregnancy and postdelivery renal function, outcome of gestation, as well as maternal and fetal complications for eight pregnancies in eight renal transplant recipients between November 1975 and March 2003 of 1095 among 1425. Eight planned pregnancies occurred at a mean of 3.6 years posttransplant. Spontaneous abortion occured in the first trimester in one case. One intrauterine growth retardation was observed with a full-term pregnancy; one intrauterine growth retardation and preterm delivery; one preeclampsia with preterm delivery and urinary tract infection; and one preeclampsia with preterm delivery and oligohydramnios. The mean gestation period was 35.5 +/- 3.0 weeks (31.2 to 38.0). Pregnancy had no negative impact on renal function during a 2-year follow-up. No significant proteinuria or acute rejection episodes were observed. Among the seven deliveries, no congenital anomaly was documented and no postpartum problems for the child and the mother were observed. Our study suggests that successful pregnancy is possible in renal transplant recipients. In cases with good graft function and absence of severe proteinuria or hypertension, pregnancy does not affect graft function or patient survival; however, fetal problems are encountered such as intrauterine growth retardation, low birth weight, and preeclampsia.

  12. Health related quality of life in renal transplantation: 2 years of longitudinal follow-up.

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    Costa-Requena, Gema; Cantarell, M Carmen; Moreso, Francesc; Parramon, Gemma; Seron, Daniel

    2017-08-10

    Health related quality of life (HRQoL) is recognized as an outcome measure in kidney transplantation. In this study was assessed changes on HRQoL and kidney-specific symptoms, also was evaluated the effect of socio-demographic and clinical parameters on patient's perceived HRQoL. A longitudinal study was done, at 5 time-points over 2 years after transplantation. To evaluate HRQoL the Kidney Disease Quality of Life Questionnaire Short Form was administrated, and Hospital Anxiety and Depression Scale was used to assess psychological distress. At 6-months after transplantation, patients had similar HRQoL scores compared to the general population. The improvement on effects of kidney disease domain could be considered as large (η(2)=0.29), and medium on burden of kidney disease domain (η(2)=0.12), work status domain (η(2)=0.12), and sexual function domain (η(2)=0.13). Psychological distress, depressive symptoms, haemoglobin, and serum creatinine had significant influence on patient's perceived HRQoL over 2 years after transplantation. An improvement of HRQoL was observed on general and specific-targeted symptoms over 2 years after renal transplantation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  13. Acute leukaemia following renal transplantation.

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    Subar, M; Gucalp, R; Benstein, J; Williams, G; Wiernik, P H

    1996-03-01

    Four renal transplant patients on immunosuppressive therapy who presented with acute myeloid leukaemia are described. In two cases, azathioprine may have played an important role as a cofactor in leukaemogenesis. In a third case, the alkylating agent cyclophosphamide may have contributed. All patients were treated for leukaemia with full doses of cytotoxic chemotherapy and, in each case, a functioning renal allograft was preserved throughout the treatment despite attenuation of immunosuppressive therapy. Three patients achieved complete remission. Of the three, one is surviving at 2 years and two expired during the pancytopenic phase of their treatment with no active leukaemia present, and with intact renal function. As increasing expertise in the field of organ transplantation allows patients to survive longer, such patients' exposure to immunosuppressive and potentially leukaemogenic drugs is prolonged. The risk of secondary neoplasia has been previously documented in this population. Two of the four cases reported here suffered from polycystic kidney disease as their underlying condition. While this report suggests that the leukaemias are related to renal transplantation, we cannot rule out an association with the underlying disease which led to the transplant. This report further suggests that the leukaemia that develops in such patients may respond to standard therapy, and that such treatment does not compromise the transplanted kidney.

  14. Rupture of Renal Transplant

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    Shona Baker

    2015-01-01

    Full Text Available Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L. LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.

  15. Gastrointestinal complications in renal transplantation

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    Kamal Jeet Singh

    2004-01-01

    Full Text Available Objective: Gastrointestinal complications are responsible for substantial morbidity and mortality among renal allograft recipients. We retrospectively analyzed incidence of these complications and their impact on the patient outcome. Materials & Methods: Between 1998 to Aug 2002, 558 live related renal transplants were performed at our center. The immunosuppression used consisted mainly of cyclosporine, azathioprine and prednisolone, though varied in some patients. These patients were followed for any occurrence of significant gastrointestinal problems. Results: Out of the of 538 renal transplant recipients studied, gastro esophageal ulcerations were seen in 3% patients. Acute pancreatitis was observed in twelve (2.2% patients and four patients had acute intestinal obstruction secondary to fecal impaction. Infectious complications included acute diarrheas in 18% of patients. Three patients developed abdominal tuberculosis. Acute rejection episodes were encountered in 26% of the patients. During these episodes, 58% of patients experienced prolonged ileus. Most of these complications (66% occurred within first one-year post transplant. Three patients presenting with acute intestinal obstruction required laparotomy (two- bands, one-intussusception. There were four mortalities -two patients had severe pancreatitis, one patient had massive upper GI bleed and one succumbed due to perforation peritonitis. Conclusions: Gastrointestinal complications account for significant morbidity and mortality in renal transplant recipients. Paralytic ileus secondary to acute vascular rejection is quite common and resolves spontaneously with recovery of renal function.

  16. The outcome of living related kidney transplantation with multiple renal arteries

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    Hafiz Shahzad Ashraf

    2013-01-01

    Full Text Available The aim of our study was to compare the surgical complications and short-term outcome of renal transplants with single and multiple renal artery grafts. We reviewed the records of 105 kidney transplantations performed consecutively at our institution from July 2006 to May 2010. The data of 33 (31.4% renal transplants with multiple arteries were compared with the 72 transplants with single artery (68.6%, and the incidence of surgical complications, post-transplant hypertension, acute tubular necrosis, acute graft rejection, mean creatinine level, and patient and graft survival was analyzed. We further subdivided the study recipients into three groups: group A (n = 72 with one-renal-artery allografts and one-artery anastomosis, group B (n = 6 with mul-tiple-artery allografts with single-artery anastomosis, and group C (n = 27 with multiple-artery allografts with multiple arterial anasatomosis, and compared their outcome. No significant diffe-rences were observed among the recipients of all the three groups regarding early vascular and urological complications, post-transplant hypertension, acute tubular necrosis, acute rejection, creatinine level, and graft and patient survival. The mean cold ischemia time in groups B and C was significantly higher (P <0.05. One patient in group A developed renal vein thrombosis resulting in graft nephrectomy. None of the patients with multiple renal arteries developed either vascular or urological complications. In conclusion, kidney transplantation using grafts with mul-tiple renal arteries is equally safe as using grafts with single renal artery, regarding vascular, urological complications, as well as patient and graft survival.

  17. Sporotrichosis in Renal Transplant Patients

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    Paulo Gewehr

    2013-01-01

    Full Text Available The current report describes two renal transplant recipients who presented with sporotrichosis. In addition, the authors review the general aspects of sporotrichosis in renal transplant recipients reported in the literature. Sporotrichosis is a rare fungal infection in transplant patients and has been reported primarily in renal transplant recipients not treated with antifungal prophylaxis. Extracutaneous forms of sporotrichosis without skin manifestations and no previous history of traumatic injuries have been described in such patients and are difficult to diagnose. Renal transplant recipients with sporotrichosis described in the present report were successfully treated with antifungal therapy including amphotericin B deoxycholate, lipid amphotericin B formulations, fluconazole and itraconazole.

  18. [Renal transplantation and urinary lithiasis].

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    Lechevallier, E; Saussine, C; Traxer, O

    2008-12-01

    Renal lithiasis in renal donors is rare. A renal stone in a donor, or in a renal transplant, is not a contraindication for harvesting nor transplantation. If possible, the stone must be removed at the time of the transplantation. The risk of lithiasis is increased in the renal transplant recipient, with a frequency of 2-6%. Metabolic abnormalities for lithiasis are frequent and can be induced by the immunosuppressive treatment, anticalcineurins. Lithiasis can have a poor prognosis in the renal recipient with a risk for infection or renal dysfunction. Small (renal transplant can be followed-up. Stones of 0.5-1.5cm need an extracorporeal lithotripsy with a previous safety JJ stent. Stones greater than 1.5cm can be treated by ureteroscopy or percutaneous surgery.

  19. The role of transplant-related stressors and social support in the development of anxiety among renal transplant recipients: the direct and buffering effects.

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    Pisanti, Renato; Poli, Luca; Lombardo, Caterina; Bennardi, Linda; Giordanengo, Luca; Berloco, Pasquale Bartolomeo; Violani, Cristiano

    2014-01-01

    Several studies have shown a relevant presence of anxiety feelings among renal transplant patients. This study examines the impact of transplant-related stress and social support on anxiety. Two hypotheses were examined: H1: High transplant-related stressors and low social support are related to high anxiety (additive hypothesis); H2: Social support moderates the detrimental impact of transplant-related stressors on anxiety (buffer hypothesis). One hundred and four kidney transplant recipients (54% male), with a mean age of 50.8 (SD = 12.6), volunteered to participate in a cross-sectional study that included a face-to-face interview and several self-administered scales. Hierarchical regression analyses indicated that higher transplant-related stressors are associated with higher levels of anxiety (F change (2, 92) = 17.4, p < .001, ∆R(2) = 24%), but, contrary to our prediction, social support was not directly related with anxiety. However, social support has a moderating effect on the relationship between high transplant-related stressors and anxiety (F change (1, 91) = 5.2, p < .05, ∆R(2) = 3%). The results are consistent with the hypothesis that social support has a buffering role on the patients' distress following renal transplantation and suggest that their psychological well-being could benefit from enhancing the perception of social support in post-operative care.

  20. [Challenges in renal transplantation].

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    Thuret, R; Kleinclauss, F; Terrier, N; Karam, G; Timsit, M O

    2016-11-01

    To describe kidney transplantation surgical techniques and to propose strategies in high-risk recipients. Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov/) and Embase (http://www.embase.com/) database using the following keywords, alone or in association, "renal transplantation; peripheral arterial disease; obesity; third and fourth transplantation; robotic-assisted kidney transplant; anticoagulant therapy; dual kidney transplant". Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and case-reports were selected. A total of 1949 articles were analyzed for arterial disease and anticoagulant therapy, 1083 for obesity, 663 for dual kidney transplants, 458 for third and subsequent procedures and 84 for robotic-assisted kidney transplantation. After careful selection, 304 publications were eligible for our review. Surgical assessment of future recipients is a pivotal step to anticipate technical difficulties, to interrupt clopidogrel or direct oral anticoagulants and to propose a revascularization procedure when necessary. Lack of data regarding obese recipients does not allow us to conclude about best surgical care or optimal timing but suggest that an early global management of obesity in chronic kidney disease patients is mandatory to improve access to a successful transplantation. In neurologic bladder and congenital anomalies, urodynamics and bladder function must be assessed prior to the onset of oliguria to intend an early treatment. Urinary diversion may be performed prior to or after transplantation with similar survival outcome and comparable rates of infections. Because of a rigorous selection of donors, the French dual kidney transplant program provides satisfactory outcomes, but fails in convincing surgical

  1. Gravidez e transplante renal

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    Andrade, Joana Rita Ferreira

    2014-01-01

    Enquadramento: A gravidez é rara em mulheres com Doença Renal Crónica, sobretudo em estadio avançado, em virtude de várias condicionantes como a disfunção ovárica, hemorragias vaginais anovulatórias e amenorreia. Contudo, após transplante renal é possível alimentar o sonho de constituir família, mas é preciso considerar os riscos aumentados para o enxerto e a maior susceptibilidade para complicações da gravidez. Objectivo: Avaliar os riscos e identificar as variáveis que influenciam o suce...

  2. Evaluation of factors causing delayed graft function in live related donor renal transplantation

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    Sharma A

    2010-01-01

    Full Text Available To determine the incidence and determinants of delayed graft function due to post-transplant acute tubular necrosis in live related donor renal transplantation. This is a retrospective study of 337 recipients of live related donor renal graft performed between1986 and 2006. Of these recipients, 24 (7.1% subjects developed delayed graft function with no evidence of acute rejection, cyclosporin toxicity, vascular catastrophe or obstructive cause and had evidence of acute tubular necrosis (ATN Group. These subjects were compared with recipients (n= 313, 92.9% who had no clinical or biochemical evidence of ATN. Mean age, and gender distribution of recipients was similar in the two groups (ATN group 35.7 ± 8.3, non-ATN group 34.3 ± 7.5, P= 0.43. Gender distribution of the recipients (men 279, 89.1% vs. 21, 87.5%, P= 0.80 as well as donors (women 221, 70.6% vs. 18, 75.0%, P= 0.75 was also similar. In ATN group as compared with non-ATN group the donor age was significantly greater (56.6 ± 8.3 vs. 46.6 ± 11.2 years, P< 0.0001. There was marginal difference in pre-operative systolic BP (154.5 ± 18.3 vs. 147.4 ± 20.2 mm Hg, P= 0.077 and significant difference in diastolic BP (87.8 ± 9.5 vs. 83.4 ± 11.4 mmHg, P= 0.041. Incidence of multiple renal arteries was similar (16.7% vs. 7.3%, P= 0.22. The warm ischemia time was significantly greater in ATN group (33.3 ± 6.2 min as compared to non-ATN group (30.4 ± 5.7 min, P= 0.042. Duration of hospital stay was more in ATN group (19.9 ± 6.7 vs. 16.8 ± 8.4 days, P= 0.04 but there was no difference in 1 year survival (284 subjects, 90.7% vs. 21 subjects, 87.5%, P= 0.873. This study shows that greater donor age, higher baseline diastolic BP and greater warm ischemia time are major determinants of delayed graft function due to acute tubular necrosis after related donor renal transplantation.

  3. Trasplante renal Kidney transplant

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    P. Martín

    2006-08-01

    Full Text Available El trasplante renal es la terapia de elección para la mayoría de las causas de insuficiencia renal crónica terminal porque mejora la calidad de vida y la supervivencia frente a la diálisis. El trasplante renal de donante vivo es una excelente alternativa para el paciente joven en situación de prediálisis porque ofrece mejores resultados. El tratamiento inmunosupresor debe ser individualizado buscando la sinergia inmunosupresora y el mejor perfil de seguridad, y debe adaptarse a las diferentes etapas del trasplante renal. En el seguimiento del trasplante renal hay que tener muy en cuenta los factores de riesgo cardiovascular y los tumores puesto que la muerte del paciente con injerto funcionante es la segunda causa de pérdida del injerto tras el primer año del trasplante. La función alterada del injerto es un factor de mortalidad cardiovascular independiente que requerirá seguimiento y control de todas sus complicaciones para retrasar la entrada en diálisis.The kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. A kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. Immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. In the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. The altered function of the graft is a factor of independent cardiovascular mortality that will require follow-up and the control of all its complications to postpone the entrance in dialysis.

  4. The Frequency of Familial Mediterranean Fever Related Amyloidosis in Renal Waiting List for Transplantation

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    Keles, Mustafa; Eyerci, Nilnur; Uyanik, Abdullah; Aydinli, Bulent; Sahin, Gonul Zisan; Cetinkaya, Ramazan; Pirim, Ibrahim; Polat, Kamil Yalcin

    2010-01-01

    Objective: Our goal is to investigate the distribution of MEFV mutations in patients with renal amyloidosis who are in renal transplant waiting list which is prepared for transplantation. Materials and Methods: FMF was diagnosed in 25 of the 297 patients between the years 2004 and 2008, who were involved in the study (15 male, 10 female; age 34±7.8). 5 out of 25 patients were transplanted, remaining were waiting for Tx. Biopsy results were amyloidosis and taken from renal (n:16), rectal (n:8) and duodenal (1).All of them were carrier of mutations in both pyrin alleles.The primer cause of chronic renal failure in our group was secondary AA amyloidosis. DNA was isolated from 25 whole blood samples. The NanoChip Molecular Biology Workstation (Nanogen) uses electronic microarrays for mutation detection. Exon 2,3,5 and 10 of pyrin gene genotypes were identified in the NanoChip. Results: Genetic analysis of the patients demonstrated that each subject carries either homozygote or compound heterozygote mutations of the gene. The most common mutations were M694V, V726A, E148Q and M680I. Conclusions: The clinic manifestation and complain of our patients were febrile and painful attacks such as in the abdomen, chest and joints due to inflammation of the peritoneum, pleura and synovial membrane. The major problem in FMF is the occurrence of amyloidosis that primarily affects the kidneys causing proteinuria and renal failure. Dialysis and renal transplantation can be treatment, but it is important to diagnose FMF at earliest stages. The percentage of FMF patients in our waiting list was 8.4%. Moreover, in our region FMF incidence is highly frequent, so FMF should be chased by genetically so as to prevent chronic renal failure due to amyloidosis. PMID:25610112

  5. Haemostatic aspects of renal transplantation.

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    Sørensen, P J; Schmidt, E B; Knudsen, F; Nielsen, A H; Kristensen, S D; Dyerberg, J; Kornerup, H J

    1988-01-01

    Platelet function and protein C activity and antigen level was studied in 31 renal transplant recipients and 10 healthy controls. The patients were divided into three groups: (I) cyclosporin treated, (II) azathioprine treated, and (III) azathioprine treated patients with chronic rejection. The platelet function in the renal transplant patients was normal and there was no difference between groups I and II. The specific activity of protein C was decreased in patients after renal transplantation and decreasing protein C activity and progressive renal failure was found to be positively correlated in the azathioprine treated groups.

  6. Regulatory and Pro-Inflammatory Cytokines in Brazilian Living-Related Renal Transplant Recipients According to Creatinine Plasma Levels.

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    Mota, Ana Paula Lucas; Menezes, Cristiane Alves da Silva; Alpoim, Patrícia Nessralla; Cardoso, Carolina Neris; Martins, Suellen Rodrigues; Alves, Lorraine Vieira; de Assis Martins-Filho, Olindo; Braga Gomes Borges, Karina; Dusse, Luci Maria SantAna

    2017-07-13

    The maintenance of stable graft function in renal transplanted recipients (RTR) is a challenge for healthcare staff. The ideal biomarkers must have significative predictive values to monitor the intricate renal function response triggered after renal transplantation. The main purpose in this study was to evaluate the regulatory and pro-inflammatory cytokines as biomarkers of allograft function in living-related renal transplant patients. Regulatory and pro-inflammatory cytokine plasma levels were measured by flow cytometry in 120 living-related renal transplanted patients categorized into three groups according to creatinine plasma levels: creatinine less than 1.4 mg/dL (C1), creatinine within 1.4-2.0mg/dL (C2) and more than 2.0 mg/dL (C3). Patients were also classified as "low" or "high" cytokine producers. Clinical data were obtained from patients' medical record. We have found a peak of regulatory cytokines in RTR with low creatinine levels as well as a peak of IL-6 pro-inflammatory cytokine in patients with high creatinine levels. C1 and C3 groups showed a mixed pro-inflammatory (IL-8, IL-6, IL-1β, TNF-α, IL-12 and IFN-γ) and regulatory (IL-4, IL-5 and IL-10) cytokine pattern and C2 had a predominant pro-inflammatory profile. C3 group showed a higher frequency of high pro-inflammatory cytokine producers compared to C1. Our data suggest that regulatory cytokines IL-4, IL-5 and IL-10 could be good biomarkers associated with stable renal function, while pro-inflammatory cytokines seems to be potential markers in RTR related to high creatinine plasma levels, specially IL-6 despite of its borderline values. Copyright © 2017 John Wiley & Sons, Ltd. This article is protected by copyright. All rights reserved.

  7. Study of psychosocial parameters related to the survival rate of renal transplantation in children.

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    Mongeau, J G; Clermont, M J; Robitaille, P; Plante, A; Jéquier, J C; Godbout, C; Guertin, M C; Beaulieu, M A; Sarrazin, F

    1997-10-01

    The purpose of the present study was to assess the effect of intelligence, schooling, psychomotor, emotional, and social status on renal graft survival in children. Sixty-two cadaver renal transplant recipients were evaluated retrospectively and the influence of sex, age, weight, and the use of cyclosporin A (CyA) on the success rate of the graft from 1 to 5 years later was analyzed. Psychological and social scores were devised and included as factors predictive of survival of the graft. Univariate analysis showed that the following variables predicted renal graft survival: the use of CyA (P = 0.0002), pre-transplant dialysis (P = 0.04), weight at the time of transplantation (P = 0.072), and psychological scores (P = 0.064). Association analysis demonstrated that pre-transplantation dialysis was only a chance association and therefore the parameter was discarded. Multivariate analysis showed that the predictive parameters were the use of CyA, sex, weight in kilograms, and the psychological score. An equation was then derived from variables that predict the probability that a specific patient's graft will survive more than t months. This equation is the estimated survival distribution function and is as follow: S (t) = Exp {-Exp[-(0.8882x1 - 1.827x2 + 0.037x3 - 0.1746x4) + ln t - 4.7862]} where S (t) = the survival at t months post transplantation, x1 = sex (male 1, female 2), x2 = CyA (yes 1, no 2), x3 = weight in kilograms, and x4 = psychological score. The major impact of psychological factors on renal graft survival was surprising.

  8. Successful Pregnancies Post Renal Transplantation

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    Alfi Adnan

    2008-01-01

    Full Text Available To evaluate the maternal and fetal outcomes in renal transplant female recipients who became pregnant from 1989 to 2005 in our center, we retrospectively studied 20 incident pregnancies in 12 renal transplant recipients; 5 (41.7 % of them from living related, 4 (33.3% from deceased, and 3 (25% from living unrelated donors. The mean age at pregnancy was 30.5 ± 4.5 years and mean interval from transplantation to pregnancy was 21 ± 5.7 months with the interval was < 1 year in one patient. The mean serum creatinine (SCr before pregnancy vs 6 months post delivery was 110 ± 24.3, and 156 ± 190 µmol/ L, respectively, (p = 0.2. All patients were normotensive during the prenatal period except two who were hypertensive, none was markedly proteinuric, and only one acute rejection episode occurred during one pregnancy. Graft loss one year post delivery occurred in 2 patients; one with elevated prenatal SCr > 132 µmol/L, and another with short interval from transplantation to pregnancy < 1 year, while the remaining 10 patients revealed current mean SCr of 105 ± 18.2 µmol/L. Complications during pregnancy inclu-ded pre-eclampsia in (25%, UTI (25%, preterm delivery < 37 weeks (30%, however, none of the pregnancies ended by abortion. Normal vaginal delivery vs cesarean section was 70% vs 30%, respectively. Gestational age at delivery was 36.3 ± 3.9 weeks, and mean fetal birth weight was 2349 ± 574 gm. Apgar score was 9-10 in all of the 20 babies, and none revealed intrauterine growth retardation or congenital anomalies. We conclude that consecutive pregnancies demons-trate long-term maternal and fetal survival and function. The major risk factors are elevated starting serum creatinine, hypertension, and short time interval from transplantation to pregnancy.

  9. Fungal infection following renal transplantation.

    Science.gov (United States)

    Gallis, H A; Berman, R A; Cate, T R; Hamilton, J D; Gunnells, J C; Stickel, D L

    1975-09-01

    Twenty-seven deep fungal infections developed in 22 of 171 patients following renal transplantation. These infections included cryptococcosis (ten), nocardiosis (seven), candidiasis (four), aspergillosis (two), phycomycosis (two), chromomycosis (one), and subcutaneous infection with Phialophora gougeroti (one). Twelve infections occurred in living-related and ten in cadaveric recipients. Nineteen of the 22 patients were male. Infections occurred from 0 to 61 months after transplantation. Complicating non-fungal infections were present concomitantly in 15 patients. Thirteen patients died, eight probably as a result of fungal infection. Appropriate diagnostic procedures yielded a diagnosis in 20 of 27 infections, and therapy was begun in 18 patients. Serologic, culture, and biopsy procedures useful in making rapid diagnoses are advocated in the hope of increasing survival.

  10. Renal transplantation in developing countries.

    Science.gov (United States)

    Akoh, Jacob A

    2011-07-01

    Patients with established renal failure, living in developing countries, face many obstacles including lack of access to transplantation centers, quality and safety issues, and exploittation associated with transplant tourism. This review aims to determine the state and outcome of renal transplantation performed in developing countries and to recommend some solutions. The lack of suitable legislation and infrastructure has prevented growth of deceased donor programs; so, living donors have continued to be the major source of transplantable kidneys. Transplant tourism and commercial kidney transplants are associated with a high incidence of surgical complications, acute rejection and invasive infection, which cause major morbidity and mortality. Developing transplant services worldwide has many benefits - improving the results of transplantation as they would be performed legally, increasing the donor pool, making transplant tourism unnecessary and granting various governments the moral courage to fight unacceptable practices. A private-public partnership underpinned by transparency, public audit and accountability is a prerequisite for effective transplant services in the developing world. Finally, lack of dialysis facilities coupled with better outcomes in patients spending <6 months on dialysis prior to transplantation favor pre-emptive transplantation in developing countries.

  11. Renal transplantation in Mapuche people.

    Science.gov (United States)

    Ardiles, R; Beltrán, R; Jerez, V; Droguett, M A; Mezzano, S; Ardiles, L

    2008-04-01

    Previous studies have demonstrated higher concentrations of some histocompatibility antigens in Mapuche people compared with non-Mapuche Chileans in the renal transplantation program. With the aim of evaluating whether those antigenic differences might induce differences in the outcomes of renal transplantation among patients belonging to that ethnic group, we reviewed HLA studies and at least 6 months follow-up of all patients with a first kidney transplant between 1980 and 2006. The 248 patients had a mean age of 37.6 years, 40% were females, and 48% had living related donors. The mean kidney follow-up was 90 months and patient follow-up was 106 months. Thirty-nine patients (16%) were classified as Mapuche, according to their surnames, including 16 women with overall mean age of 34.5 years, and 14 had been transplanted from a living related donor. Mapuche patients received organs with better HLA matching expressed as number of identities (3.4 +/- 0.1 versus 2.8 +/- 0.1 among non-Mapuche; P or = 3 compatibilities was significantly higher (Mapuche 38% versus non-Mapuche 22%; P Mapuche; and 83% and 65%, respectively, for non-Mapuche. Patient survival rates were 97% at 5 years and 86% at 10 years in the Mapuche group versus 91% and 79%, respectively, in the non-Mapuche group; both results were not significantly different. Our results showed similar outcomes of kidney and patient survivals among Mapuche people even when they received organs with better HLA matches.

  12. Physical Activity and Renal Transplantation

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    Vincenzo Bellizzi

    2014-07-01

    Full Text Available Renal transplantation is burdened by high cardiovascular risk because of increased prevalence of traditional and disease-specific cardiovascular risk factors and, consequently, patients are affected by greater morbidity and mortality. In renal transplanted patients, healthy lifestyle and physical activity are recommended to improve overall morbidity and cardiovascular outcomes. According to METs (Metabolic Equivalent Task; i.e. the amount of energy consumed while sitting at rest, physical activities are classified as sedentary (<3.0 METs, of moderate-(3.0 to 5.9 METs or vigorous-intensity (≥6.0 METs. Guidelines suggest for patients with chronic kidney disease an amount of physical activity of at least 30 minutes of moderate-intensity activity five times per week (min 450 MET-minutes/week. Data on physical activity in renal transplanted patients, however, are limited and have been mainly obtained by mean of non-objective methods. Available data suggest that physical activity is low either at the start or during renal transplantation and this may be associated with poor patient and graft outcomes. Therefore, in renal transplanted patients more data on physical activity obtained with objective, accelerometer-based methods are needed. In the meanwhile, physical activity have to be considered as an essential part of the medical care for renal transplanted recipients.

  13. Impact of norovirus/sapovirus-related diarrhea in renal transplant recipients hospitalized for diarrhea.

    Science.gov (United States)

    Roos-Weil, Damien; Ambert-Balay, Katia; Lanternier, Fanny; Mamzer-Bruneel, Marie-France; Nochy, Dominique; Pothier, Pierre; Avettand-Fenoel, Véronique; Anglicheau, Dany; Snanoudj, Renaud; Bererhi, Lynda; Thervet, Eric; Lecuit, Marc; Legendre, Christophe; Lortholary, Olivier; Zuber, Julien

    2011-07-15

    Diarrhea of unspecified cause frequently occurs after renal transplantation and is usually ascribed to mycophenolic acid toxicity. Norovirus (NoV) and sapovirus (SaV) have been sporadically reported to cause chronic diarrhea in immunocompromised patients. We undertook a retrospective study (2008-2009) to examine the clinical and epidemiologic significance of NoV and SaV infections in adult renal transplant recipients hospitalized for acute or chronic diarrhea. Ninety-six renal transplant recipients were hospitalized for diarrhea at our institution during a 16-month period, 87 of whom were included in the study, including 46 patients with chronic diarrhea. Among 41 patients with unexplained diarrhea, 20 patients were screened for NoV/SaV, 16 of whom were positive. Fifteen of them (94%) had chronic diarrhea. When compared with bacterial and parasitic infections, NoV/SaV infections were associated with a greater weight loss at the time of admission, a 8.7-fold longer duration of symptoms and a more frequent need for mycophenolic acid dosage reduction. Eighty-one percent of patients hospitalized for NoV/SaV-associated diarrhea experienced acute renal failure. Five and one patients subsequently had biopsy-diagnosed active graft rejection and oxalate nephropathy, respectively. Ten of the 14 patients who underwent a longitudinal study of NoV/SaV stool's clearance exhibited a prolonged viral shedding period with a median time of 289 days (107-581 days). Our study indicates that NoV/SaV infection causes posttransplant chronic diarrhea potentially complicated by severe kidney graft impairment.

  14. Colovesical Fistula After Renal Transplantation: Case Report.

    Science.gov (United States)

    Imafuku, A; Tanaka, K; Marui, Y; Sawa, N; Ubara, Y; Takaichi, K; Ishii, Y; Tomikawa, S

    2015-09-01

    Colovesical fistula is a relatively rare condition that is primarily related to diverticular disease. There are few reports of colovesical fistula after renal transplantation. We report of a 53-year-old man who was diagnosed with colovesical fistula after recurrent urinary tract infection, 5 months after undergoing cadaveric renal transplantation. Laparoscopic partial resection of the sigmoid colon with the use of the Hartmann procedure was performed. Six months after that surgery, there was no evidence of recurrent urinary tract infection and the patient's renal graft function was preserved. Physicians should keep colovesical fistula in mind as a cause of recurrent urinary tract infection in renal transplant recipients, especially in those with a history of diverticular disease.

  15. Protocol biopsies for renal transplantation

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    Rush David

    2010-01-01

    Full Text Available Protocol biopsies in renal transplantation are those that are procured at predetermined times post renal transplantation, regardless of renal function. These biopsies have been useful to study the natural history of the transplanted kidney as they have detected unexpected - i.e. "subclinical" pathology. The most significant subclinical pathologies that have been detected with protocol biopsies have been acute lesions, such as cellular and antibody mediated rejection, and chronic lesions, such as interstitial fibrosis and tubular atrophy, and transplant glomerulopathy. The potential benefit of early recognition of the above lesions is that their early treatment may result in improved long-term outcomes. Conversely, the identification of normal histology on a protocol biopsy, may inform us about the safety of reduction in overall immunosuppression. Our centre, as well as others, is attempting to develop non-invasive methods of immune monitoring of renal transplant patients. However, we believe that until such methods have been developed and validated, the protocol biopsy will remain an indispensable tool for the complete care of renal transplant patients.

  16. Risk factors for chronic transplant dysfunction and cardiovascular disease are related to accumulation of advanced glycation end-products in renal transplant recipients

    NARCIS (Netherlands)

    Hartog, Jasper W. L.; de Vries, Aiko P. J.; Bakker, Stephan J. L.; Graaff, Reindert; van Son, Willem J.; van der Heide, Jaap J. Homan; Gans, Reinold O. B.; Wolffenbuttel, Bruce H. R.; de Jong, Paul E.; Smit, Andries J.

    2006-01-01

    Background. Accumulation of advanced glycation end-products (AGEs) has been implicated in the pathogenesis of chronic transplant dysfunction and cardiovascular disease in renal transplant recipients. We aimed to investigate which factors are associated with tissue AGE accumulation in renal transplan

  17. Microvascular Disease After Renal Transplantation

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    Qi Lun Ooi

    2015-11-01

    Full Text Available Background/Aims: Individuals who reach end-stage kidney disease (CKD5 have a high risk of vascular events that persists even after renal transplantation. This study compared the prevalence and severity of microvascular disease in transplant recipients and patients with CKD5. Methods: Individuals with a renal transplant or CKD5 were recruited consecutively from renal clinics, and underwent bilateral retinal photography (Canon CR5-45, Canon. Their retinal images were deidentified and reviewed for hypertensive/microvascular signs by an ophthalmologist and a trained grader (Wong and Mitchell classification, and for vessel caliber at a grading centre using a computer-assisted method and Knudtson's modification of the Parr-Hubbard formula. Results: Ninety-two transplant recipients (median duration 6.4 years, range 0.8 to 28.8 and 70 subjects with CKD5 were studied. Transplant recipients were younger (pConclusions: Hypertensive/microvascular disease occurred just as often and was generally as severe in transplant recipients and subjects with CKD5. Microvascular disease potentially contributes to increased cardiac events post- transplantation.

  18. [Multiple complications after renal transplantation].

    Science.gov (United States)

    Manrique, J; Rossich, E; Hernández Sierra, A

    2004-01-01

    This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable.

  19. Pregnancy in renal transplant recipients.

    Science.gov (United States)

    Fuchs, Karin M; Wu, Danny; Ebcioglu, Zeynep

    2007-12-01

    Women with renal disease face increasing infertility and high-risk pregnancy as they approach end-stage renal disease due to uremia. Renal transplantation has provided these patients the ability to return to a better quality of life, and for a number of women who are of child bearing age with renal disease, it has restored their fertility and provided the opportunity to have children. But, although fertility is restored, pregnancy in these women still harbors risk to the mother, graft, and fetus. Selected patients who have stable graft function can have successful pregnancies under the supervision of a multidisciplinary team involving maternal fetal medicine specialists and transplant nephrologists. Careful observation and management are required to optimize outcome for mother and fetus.

  20. Challenges in renal transplantation in Yemen.

    Science.gov (United States)

    El-Nono, Ibrahiem H; Telha, Khaled A; Al-Alimy, Gamil M; Ghilan, Abdulilah M; Abu Asba, Nagieb W; Al-Zkri, Abdo M; Al-Adimi, Abdulilah M; Al-Ba'adani, Tawfiq H

    2015-02-16

    Background Renal replacement therapy was first introduced in Yemen in 1978 in the form of hemodialysis. Twenty years later, the first renal transplantation was performed. Kidney transplantations were started in socially and financially challenging circumstances in Yemen in 1998. A structured program was established and has been functioning regularly since 2005. A pediatric transplantation program was started in 2011. Material and Methods This was a prospective study of 181 transplants performed at the Urology and Nephrology Center between May 1998 and 2012. All transplants were from living related donors. The immunosuppressive protocol consisted initially of double therapy with steroid and mycophenolate mofetil (MMF). Subsequently, triple therapy with addition of a calcineurin inhibitor was introduced. Primary graft function was achieved in 176 (97.2%) recipients. Results Cold ischemia time was 48-68 min. Episodes of acute rejection in 12 patients were treated with high-dose steroids. Anti-thymocyte globulin (ATG) was used in cases of vascular or steroid-resistant rejection in 2 patients. The post-transplant complications, either surgical or medical, were comparable to those recorded in the literature. Conclusions Renal transplantation is a good achievement in our country. The patients and graft survival rates are comparable to other reports.

  1. Lung Cancer in Renal Transplant Recipients

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    Jozicic Mirela

    2016-06-01

    Full Text Available Introduction. Although the incidence of malignancy has increased after solid organ transplantation, data on lung cancer in this group of patients is scarce. The aim of this study was to determine clinical characteristics and outcome of patients who developed lung cancer after renal transplantation. Methods. Among a cohort of 1658 patients who received a transplant at our institution and were followedup between 1973 and 2014, five patients developed lung cancer. We analyzed risk factors, transplantation characteristics, treatment options and survival. Results. Lung cancer was diagnosed in 5 patients (0.3%. Time to diagnosis after the transplant procedure ranged from 26 to 156 months (mean 115 months. All of them had a smoking history. Tumors were classified as IIB (20%, IIIA (40%, and IV (40%. Histological types included adenocarcinoma (80% and there was one case of sarcomatoid carcinoma (20%. One patient had concomitant thyroid papillary carcinoma. Radiotherapy was applied in 2 patients, 2 underwent chemotherapy (erlotinib and combination of carboplatinum and etopozide in one patient each, and 2 died within one month after the diagnosis from disseminated malignant disease. Patients with stage IIIA survived 14 and 24 months after the diagnosis. The patient with sarcomatoid cancer underwent thoracotomy with a complete resection, lost his graft function and died 7 months after the diagnosis. Conclusion. Lung cancer is relatively rare malignancy in renal transplant recipients, but associated with high mortality. Smoking is a significant risk factor, thus smoking cessation should be promoted among renal transplant recipients, as well as regular screening for lung cancer.

  2. Factors influencing weight gain after renal transplantation.

    Science.gov (United States)

    Johnson, C P; Gallagher-Lepak, S; Zhu, Y R; Porth, C; Kelber, S; Roza, A M; Adams, M B

    1993-10-01

    Weight gain following renal transplantation occurs frequently but has not been investigated quantitatively. A retrospective chart review of 115 adult renal transplant recipients was used to describe patterns of weight gain during the first 5 years after transplantation. Only 23 subjects (21%) were overweight before their transplant. Sixty-six subjects (57%) experienced a weight gain of greater than or equal to 10%, and 49 subjects (43%) were overweight according to Metropolitan relative weight criteria at 1 year after transplantation. There was an inverse correlation between advancing age and weight gain, with the youngest patients (18-29 years) having a 13.3% weight gain and the oldest patients (age greater than 50 years) having the lowest gain of 8.3% at 1 year (P = 0.047). Black recipients experienced a greater weight gain than whites during the first posttransplant year (14.6% vs. 9.0%; P = 0.043), and maintained or increased this difference over the 5-year period. Men and women experienced comparable weight gain during the first year (9.5% vs. 12.1%), but women continued to gain weight throughout the 5-year study (21.0% total weight gain). The men remained stable after the first year (10.8% total weight gain). Recipients who experienced at least a 10% weight gain also increased their serum cholesterol (mean 261 vs. 219) and triglyceride (mean 277 vs. 159) levels significantly, whereas those without weight gain did not. Weight gain did not correlate with cumulative steroid dose, donor source (living-related versus cadaver), rejection history, pre-existing obesity, the number of months on dialysis before transplantation, or posttransplant renal function. Posttransplant weight gain is related mainly to demographic factors, not to treatment factors associated with the transplant. The average weight gain during the first year after renal transplantation is approximately 10%. This increased weight, coupled with changes in lipid metabolism, may be significant in

  3. Sulfadiazine-related obstructive urinary tract lithiasis: an unusual cause of acute renal failure after kidney transplantation.

    Science.gov (United States)

    Guitard, J; Kamar, N; Mouzin, M; Borde, J S; Tran-Van, T; Durand, D; Rostaing, L

    2005-05-01

    We report on the first case of acute renal failure related to obstructive urinary tract lithiasis involving sulfadiazine crystals in a kidney transplant recipient. This patient had disseminated toxoplasmosis which was treated by sulfadiazine (4 g/day) and pyrimethamine (50 mg/day). In the fourth week of anti-toxoplasmosis therapy, he presented with obstructive acute renal failure: the plasma creatinine level increased from 220 micromol/l to 547 micromol/l. Apercutaneous pyelography was conducted showing the presence of a lithiasis located at the junction between the graft ureter and the bladder. Six days later, he underwent surgery to retrieve an orange-colored, friable stone. Its spectrophotometric analysis confirmed that the stone consisted of N-acetyl sulfadiazine crystals.

  4. Emphysematous prostatitis in renal transplant

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    Krishnaswamy Sampathkumar

    2007-01-01

    Full Text Available Urinary tract infections are common following renal transplant. The spectrum varies from asymptomatic bacteriuria to septicemia. Gas-producing infections of the urinary tract are rare but tend to have a grave prognosis when they do occur. We report a 57-year-old gentleman who underwent a renal transplant 20 months earlier. He presented to us with fever and dysuria. Clinical examination revealed a febrile and ill-looking patient with severe graft tenderness. An emergency pelvic CT scan revealed presence of emphysematous prostatitis, cystitis and pyelitis. Urine and blood cultures grew E. coli . Endoscopic abscess drainage was done and antibiotics given but he succumbed to his illness due to multiorgan failure within 48h. This is the first reported case of emphysematous prostatitis in a renal allograft recipient.

  5. 25 years of live related renal transplantation in children: The Buenos Aires experience

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    Eduardo Ruiz

    2007-01-01

    Here we report our experience with Tx for the last 25 years, specially our long experience of live related donor transplantation in children and adolescents with emphasis on technical issues in small children and pediatric patients with severe urologic malformations and bladder dysfunction. We′ll make special considerations on the improvement in short and long follow-up with the actual prevention and treatment of graft rejection, due to the new immunosuppressive agents and protocols.

  6. Recurrent atypical hemolytic uremic syndrome associated with factor I mutation in a living related renal transplant recipient.

    Science.gov (United States)

    Chan, Micah R; Thomas, Christie P; Torrealba, Jose R; Djamali, Arjang; Fernandez, Luis A; Nishimura, Carla J; Smith, Richard J H; Samaniego, Millie D

    2009-02-01

    Atypical hemolytic uremic syndrome, or the nondiarrheal form of hemolytic uremic syndrome, is a rare disorder typically classified as familial or sporadic. Recent literature has suggested that approximately 50% of patients have mutations in factor H (CFH), factor I (CFI), or membrane cofactor protein (encoded by CD46). Importantly, results of renal transplantation in patients with mutations in either CFH or CFI are dismal, with recurrent disease leading to graft loss in the majority of cases. We describe an adult renal transplant recipient who developed recurrent hemolytic uremic syndrome 1 month after transplantation. Bidirectional sequencing of CFH, CFI, and CD46 confirmed that the patient was heterozygous for a novel missense mutation, a substitution of a serine reside for a tyrosine residue at amino acid 369, in CFI. This report reemphasizes the importance of screening patients with atypical hemolytic uremic syndrome for mutations in these genes before renal transplantation and shows the challenges in the management of these patients.

  7. Calcineurin-inhibitor minimization in liver transplant patients with calcineurin-inhibitor-related renal dysfunction: a meta-analysis.

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    Yuan Kong

    Full Text Available BACKGROUND: Introduction of calcineurin-inhibitor (CNI has made transplantation a miracle in the past century. However, the side effects of long-term use of CNI turn out to be one of the major challenges in the current century. Among these, renal dysfunction attracts more and more attention. Herein, we undertook a meta-analysis to evaluate the efficacy and safety of calcineurin-inhibitor (CNI minimization protocols in liver transplant recipients with CNI-related renal dysfunction. METHODS: We included randomized trials with no year and language restriction. All data were analyzed using random effect model by Review Manager 5.0. The primary endpoints were glomerular filtration rate (GFR, serum creatinine level (sCr and creatinine clearance rate (CrCl, and the secondary endpoints were acute rejection episodes, incidence of infection and patient survival at the end of follow-up. RESULTS: GFR was significantly improved in CNI minimization group than in routine CNI regimen group (Z = 5.45, P<0.00001; I(2 = 0%. Likely, sCr level was significantly lower in the CNI minimization group (Z = 2.84, P = 0.005; I(2 = 39%. However, CrCl was not significantly higher in the CNI minimization group (Z = 1.59, P = 0.11; I(2 = 0%. Both acute rejection episodes and patient survival were comparable between two groups (rejection: Z = 0.01, P = 0.99; I(2 = 0%; survival: Z = 0.28, P = 0.78; I(2 = 0%, respectively. However, current CNI minimization protocols may be related to a higher incidence of infections (Z = 3.06, P = 0.002; I(2 = 0%. CONCLUSION: CNI minimization can preserve or even improve renal function in liver transplant patients with renal impairment, while sharing similar short term acute rejection rate and patient survival with routine CNI regimen.

  8. Transplante renal na anemia falciforme

    OpenAIRE

    Friedrisch, Joao Ricardo; Barros, Elvino José Guardão; Manfro, Roberto Ceratti; Bittar,Christina Matzenbacher; Silla, Lucia Mariano da Rocha

    2003-01-01

    Embora a anemia falciforme e as síndromes falciformes freqüentemente causem várias alterações funcionais renais, não é comum a insuficiência renal terminal. Nestes casos, o transplante renal é uma alternativa que se acompanha de resultados comparáveis aos obtidos em receptores sem hemoglobinopatias. Esta estratégia terapêutica tem sido, no entanto, pouco relatada para portadores de hemoglobinopatia SC. Este relato descreve a evolução de dois pacientes portadores de hemoglobinopatia SC que for...

  9. Paid Living-Unrelated Renal Transplantation Abroad: Too Much Unknown

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    Yalçın SOLAK

    2012-05-01

    Full Text Available OBJECTIVE: Despite the unethical characteristic and unfavorable consequences, paid livingunrelated renal transplantation is still considered as an option for end-stage renal disease patients. This study aimed to compare the medical and surgical complications along with allograft functions of PLURT patients with age and gender matched transplant recipients who received a living or deceased donor kidney at our center. MATERIAL and METHODS: End-stage renal disease patients received PLURT (group 1 in a foreign country and age, and gender matched renal transplant recipients that received renal transplantation from living-related donors (LRT patients; group 2 and deceased donors (DDRT patients; group 3 followed between 2003-2010 at our transplantation center were included in the study. RESULTS: There were no significant differences between groups (Group 1&2 and group 1&3 regarding age, sex, urea, creatinine, creatinine clearance, and proteinuria. Data about patients that received renal transplantation from living-related and deceased-donors at our center were sufficient when compared with PLURT patients. PLURT has a negative impact on patients' survival because of surgical and medical problems. CONCLUSION: In the present study, PLURT, LRT and DDRT patients had early and late complications of renal transplantation which were similarly seen in recent studies. The main problem for unfavorable results of PLURT is the commercial aspect of renal transplantation without considering the risks for ESRD patients.

  10. Opportunistic infections following renal transplantation

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    Rao K

    2002-01-01

    Full Text Available Opportunistic infection is common following renal transplantation. Prompt diagnosis and management can be life saving. Four different types of opportunistic respiratory infections diagnosed at our center during the period of January 1998 to December 2000 are discussed. Of the four cases one had Aspergillus, second had Sporothrix, third had Nocardia and fourth case Actinomyces species. Microbiologist has an important role to play by being aware of such opportunistic infections and helping the clinician to make early aetiological diagnosis.

  11. European Transplant Registry of Senior Renal Transplant Recipients on Advagraf

    Science.gov (United States)

    2016-08-11

    Graft Failure; Death; Acute Rejection of Renal Transplant; Infections; Bone Disease; Post Transplant Diabetes Mellitus; Quality of Life; HLA Antibody Production; Cardiovascular Risk Factors; Non-HLA Antibody Production

  12. Cryptococcal meningitis presenting as sinusitis in a renal transplant recipient.

    Science.gov (United States)

    Iyer, S P; Movva, K; Wiebel, M; Chandrasekar, P; Alangaden, G; Carron, M; Tranchida, P; Revankar, S G

    2013-10-01

    Cryptococcal meningitis is a relatively common invasive fungal infection in immunocompromised patients, especially in solid organ transplant recipients. Clinical presentation typically includes fever, headache, photophobia, neck stiffness, and/or altered mental status. Unusual presentations may delay diagnosis. Therapy is challenging in renal transplant patients because of the nephrotoxicity associated with amphotericin B, the recommended treatment. We present a case of cryptococcal meningitis in a renal transplant recipient presenting as acute sinusitis with successful treatment using fluconazole as primary therapy.

  13. Pulmonary complications in renal transplantation

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    Choi, Jung Bin; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Lee, Seung Rho; Hahm, Chang Kok; Joo, Kyung Bin [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2003-04-01

    To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. The complications manifesting mainly as pulmonary nodules were lung cancer (4/4), tuberculosis (1/2), and Kaposi's sarcoma (1/1). Pulmonary consolidation was a main feature in bacterial infection (4/4), fungal infection (3/4), tuberculosis (1/2), chlamydial infection (1/1), and varicellar pneumonia (1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia (4/6), and increased interstitial making was a predominant radiographic feature in CMV pneumonia (2/6). The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.

  14. Diabetes and Renal Transplantation: Saudi Experience

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    Souqiyyeh Muhammad

    2000-01-01

    Full Text Available We conducted this study to evaluate the prevalence and risk factors of diabetes mellitus (DM in our renal transplant population. We retrospectively reviewed the records of the active renal transplant patients at two large transplant centers in Riyadh and Jeddah in Saudi Arabia, transplanted between 1979 and November 1998. The recipients were grouped according to the diagnosis of diabetes; group I: diabetes developed before transplantation (BTDM, group II: diabetes developed only after transplantation (ATDM and group III: did not have diabetes (NDM. There were 1112 patients′ records included in the study. The mean age was 38.2 years and the mean duration of transplantation was 66.9 months. There were 113(10.2% patients in BTDM group, 134 (12.1% patients in the ATDM group and 865 (77.8% patients in the NDM group. There was no significant difference in the prevalence of hypertension among the study groups. In comparison to the other groups, the BTDM group had significantly more males (78.8%, more patients who were transplanted after 1990 (pre-cyclosporin era, more patients with grafts from living non-related donors (46%, higher incidence of acute rejection episodes (39%, higher mean serum creatinine and more patients treated with azathioprine (71%. The ATDM group had significantly higher mean age (46.4 years, higher mean duration of transplantation (91.5 months, higher rate of retransplantation (8.2%, higher mean serum cholesterol level (6.0mmol/L and more frequently abnormal electrocardiogram (24.6% than the other two groups. The ATDM group had comparable mean weight (70.2 kg to the BTDM group but significantly higher than the NDM group (66.1kg. The NDM group had significantly higher mean dose of cyclosporine (3.3 mg/kg/day and higher mean dose of prednisone (0.16 mg/kg/day than the other groups. The only independent risk factor for developing DM after transplantation was advancing age. The currently used low-dose steroid therapy was not

  15. Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation

    Science.gov (United States)

    Zhang, Ye; Jarl, Johan; Gerdtham, Ulf-G.

    2017-01-01

    Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73–3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77–3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible

  16. BELATACEPT IN RENAL TRANSPLANTATION

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    A. I. Sushkov

    2013-01-01

    Full Text Available Belatacept is a novel immunosuppressive agent that inhibits T-cell activation by blocking CD28 signaling pa- thway. It was developed based on abatacept (CTLA-4Ig, the first recombinant immunoglobulin fusion protein which contains extracellular part of CTLA-4 molecule and Fc domain of IgG. First clinical trials have shown the comparable patient and graft survival in group of kidney recipients with belatacept-based maintenance im- munosuppressive therapy versus Cyclosporin A-based therapy. Advantages observed with belatacept include superior glomerular filtration rate and improved cardiovascular risk profile. Belatacept is a potential option for maintenance immunosuppressive therapy without calcineurin inhibitors. Concerns associated with belatacept use are higher rates of acute cellular rejection episodes and post-transplant lymphoproliferative disorder cases. 

  17. Pediatric renal transplantation: Results and prognostic factors

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    Po-Cheng Huang

    2013-04-01

    Conclusion: For pediatric patients, we found that renal transplantation is now a safe and effective surgical procedure for children with end-stage renal disease. Acute rejection and male gender were identified as prognostic factors for poor graft survival.

  18. Skin Findings in Renal Transplantation Patients

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    Demet Kartal

    2013-03-01

    Full Text Available Objective: It was aimed to identify skin findings those were seen in patients who undergone renal transplantation. Methods: Patients who have been followed in Erciyes University Nephrology Hospital renal transplantation outpatient clinic were included in the study. They were evaluated for dermatologic findings during routine controls. Age, gender, transplantation date, identity of organ donor, history of medications, dermatological history and dermatological findings during examination were recorded. Biopsy was performed when needed. Results: In total 94 patients, 25 female (26.6% and 69 male (73.4%, were recruited to the study. Mean age was 36±10 years. The most frequent skin finding was drug-related acne (n=20. Most common infectious disease was verruca (n=17. There were viral disease other than verruca such as herpes zoster (n=3, superficial mycosis such as onychomycosis (n=5, tinea versicolor, tinea pedis and bacterial skin disease (n=2, and paronychia (n=1 and pre-malign lesions such as actinic cheilitis and bowenoid papulosis. Besides these, stria (n=3, kserosis (n=2, cornu cutaneum, café-au-lait spots, sebaceous hyperplasia and seborrheic dermatitis, skin tag, hypertrichosis, unguis incarinatus and calcinosis were other skin findings those were seen. No malign skin lesion was observed in any of patients. Conclusion: Miscellaneous skin lesions should develop in patients those undergone renal transplantation due to long-term utilization of various immunosuppressive drugs.

  19. New options for the management of hyperparathyroidism after renal transplantation.

    Science.gov (United States)

    Douthat, Walter Guillermo; Chiurchiu, Carlos Raul; Massari, Pablo Ulises

    2012-06-24

    The persistence and severity of hyperparathyroidism (HPT) post-renal transplantation is relatively frequent and primarily associated with the timing and its magnitude in the pre-transplant period and with the presence of parathyroid adenomas. HPT after renal transplantation is clinically manifested with hypercalcemia, hypophosphatemia, bone pain, fractures, and in more serious cases with cardiovascular calcifications that affect the survival. The primary clinical objective for patients with secondary HPT after renal transplantation is to obtain a level of parathyroid hormone (PTH) adequate to the renal transplanted function and to normalize levels of calcium, phosphorus and vitamin D. In many cases during this period, the development of hypercalcemia and/or hypophosphatemia makes it necessary to take different therapeutic measures. The use of vitamin D or its analogues has been extrapolated from the management of pre-transplant HPT obtaining variable outcomes, although its use is limited by its capacity to produce hypercalcemia. Calcimimetics are drugs that have proven be effective in reducing PTH levels in patients with HPT on dialysis and has been effective in reducing up to 50% PTH levels in moderate to severe HPT in post-renal transplantation.When HPT persists after renal transplantation and does not respond to medical treatment, invasive management by percutaneous ethanol injection therapy of parathyroid glands or parathyroidectomy should be considered. The emergence of new methods for the management of HPT expands the availability of therapeutic tools for transplant patients.

  20. Intestinal Parasitic Infections in Renal Transplant Recipients

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    EB Kia

    2007-07-01

    Full Text Available Background: Organ transplant recipients can experience serious diseases from infections due to emerging and reemerging parasitic infections. This study was carried out to evaluate the prevalence of intestinal parasites among renal transplant re-cipients of Iran. "nMethods: This cross-sectional study was conducted from June 2003 to August 2004 on renal transplant recipients in Iran. A total of 706 fecal samples obtained from randomly selected population originated from all over Iran. Patient's information was recorded in a questionnaire before sampling. A sample of stool was taken from each person. Direct wet smear exami-nation, formalin-ether concentration, Ziehl-neelsen staining, and agar plate culture were done for each sample. "nResults: Totally 32 patients (4.5% were positive for parasitic infections. In searching for emerging parasitic infections, the most prevalent parasites were found to be Blastocystis hominis, Giardia lamblia and Entamoeba coli, respectively. The merely ova which were seen were related to Hymenolepis nana. With investigation of healthy control, no significant differ-ence was found between transplanted and normal population. "nConclusion: The population showed controlled rate of intestinal infections probably due to regular awareness concerning risks of opportunistic infections; albeit regular surveillance through routine examination of stool samples for parasites seems considerably advantages the transplant recipient patients.

  1. Hyperthyroidism in a renal transplant recipient.

    Science.gov (United States)

    Peces, R; Navascués, R A; Baltar, J; Laurés, A S; Ortega, F; Alvarez-Grande, J

    1998-01-01

    We report a case of toxic multinodular goiter with severe symptomatic hyperthyroidism in a female diagnosed 5 months after successful renal transplantation. To our knowledge, this is the first well-documented case of hyperthyroidism in a renal transplant recipient that responded well to methimazole. Special attention should be made to the use of methimazole and the possible interaction with immunosuppressive drugs.

  2. False iliac artery aneurysm following renal transplantation

    DEFF Research Database (Denmark)

    Levi, N; Sønksen, Jens Otto Reimers; Schroeder, T V;

    1999-01-01

    We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously...

  3. Obesity and urologic complications after renal transplantation

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    Ashkan Heshmatzadeh Behzadi

    2014-01-01

    Full Text Available Although obesity has been associated with improved survival on dialysis, its short-and long-term effects on renal transplantation outcomes remain unclear. Herein, we evaluate the short-term and intermediate long-term effects of obesity on first-time renal transplant patients. A retrospective analysis was performed on 180 consecutive renal transplant recipients from living unrelated donors during 2006-2008 in a major transplantation center in Tehran, Iran. Among these, 34 (18% patients were found to be obese (body mass index ≥30 kg/m 2 . Obese patients were more likely to develop post-transplant renal artery stenosis (RAS (17.6% vs. 2.8%, P <0.001, hematoma (47.9% vs. 17.6, P = 0.009, surgical wound complications (64.7% vs. 9.6%, P <0.001 and renal vein thrombosis (2% vs. 0%, P <0.001. However, the incidence of delayed graft function, lymphocele, urologic complications of ureterovesical junction stenosis or urinary leakage, surgical complications of excessive bleeding or renal artery thrombosis and duration of hospitalization were similar between the two groups. The two-year patient and graft survival were also statistically not different. Renal transplantation in obese recipients is associated with a higher incidence of post-transplant RAS, hematoma, surgical wound complications and renal vein thrombosis, but similar two-year patient and graft survival.

  4. CUTANEOUS MANIFESTATIONS OF CHRONIC RENAL FAILURE AND RENAL TRANSPLANTATION

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    R. Suganya Gnanadeepam

    2017-07-01

    Full Text Available BACKGROUND The kidney and the skin are the two large networks of the body with abundant blood supply associated with various cutaneous manifestations. This study aims to detect the various cutaneous manifestations and its incidence in patients with chronic renal failure and renal transplantation. MATERIALS AND METHODS This study was done for a period of 1 year from January 2016 to December 2016 at Nephrology OPD ward and Medicine wards, Government KAPV Medical College Hospital, Trichy. During this period, 100 patients who had the presence of skin manifestations were selected and studied (80 renal failure patients and 20 renal transplantation patients. RESULTS Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus and xerosis were the most common manifestations noted in chronic renal failure while infections was commonly noted in renal transplantation patients. CONCLUSION Pruritus and xerosis were the most common among the specific cutaneous manifestations in chronic renal failure followed by nail abnormalities and pigmentary changes. Cutaneous manifestations of renal transplantation were mostly due to infections of which fungal infection is the most common followed by viral infection.

  5. Demodicosis in Renal Transplant Recipients.

    Science.gov (United States)

    Chovatiya, R J; Colegio, O R

    2016-02-01

    Solid organ transplant recipients have an increased incidence of skin infections resulting from immunosuppression. Common pathogens include herpes simplex virus, varicella zoster virus, Gram-positive bacteria and dermatophytes; however, the contribution of multicellular parasitic organisms to dermatologic disease in this population remains less studied. Demodex folliculorum and brevis are commensal mites that reside on human skin. Proliferation of Demodex mites, or demodicosis, is associated with rosacea and rosacea-like disorders, particularly in immunocompromised populations, although their ability to cause disease is still the subject of debate. We present a case series of four renal transplant recipients with the singular chief complaint of acne rosacea who we diagnosed with demodicosis. Although one of the four patients showed complete resolution following initial antiparasitic therapy, the other three required subsequent antibacterial treatment to fully resolve their lesions. We suggest that demodicosis may be more prevalent than once thought in solid organ transplant recipients and showed that Demodex-associated acne rosacea can be effectively treated in this population.

  6. Renal function after solid organ transplantation

    NARCIS (Netherlands)

    Broekroelofs, Jan

    2000-01-01

    The studies described in this thesis focus on the problem of renal chronic function loss following solid organ transplantation form a nephrologist point of view. Nephrologists have been and are still confionted with renal function loss in native kidney diseases. The last 3 decades chronic renal func

  7. [Pediatric renal transplantation in France. Introduction].

    Science.gov (United States)

    Deschênes, Georges; Fila, Marc

    2011-12-01

    Pediatric nephrology is a relatively recent medical speciality. The first French center opened in January 1969 at the Hospital des Enfants-Malades. In 2008, according to the Réseau Épidémiologie et Information en Néphrologie (REIN), the annual incidence of end stage renal disease (ESRD) was of 7,8 children/million children below the age of 20, which equals a prevalence of 49 pediatric ESRD patients/million inhabitants. The frequency of causative factors of ESRD varies according to the geographic and ethnic origin of the patients. Many challenges still lay ahead of ESRD management. The children's physical, psychological and social development has to be well taken care of until adulthood and the transition from pediatric to adult unit has to be handled with special care. The set up of pediatric nephrology departments helped to the access of patients to renal replacement therapy, in particular the pediatric priority for kidney donors below 30 years of age. In the 2000s period, the annual rate of pediatric renal transplantation was 70 to 75 grafts per year in France, half of which performed in the Paris area. This article presents the historical background of pediatric nephrology and pediatric renal transplantation in France.

  8. Human papillomavirus-related verrucous carcinoma in a renal transplant patient after long-term immunosuppression: a case report.

    Science.gov (United States)

    Imko-Walczuk, B; Cegielska, A; Placek, W; Kaszewski, Sebastian; Fiedor, P

    2014-10-01

    Verrucous carcinoma is a slow-growing tumor with 3 main localizations: Oral cavity, ano-urogenital region, and plantar surface of the foot. On the sole it may rise adjacent to viral warts and very often is mistaken for the common verruca plantaris. Although both conditions-viral warts and cutaneous squamous cell carcinoma-are often diagnosed in immunosuppressed patients, in literature we have found only 3 case reports of verrucous carcinoma in organ transplant recipients. We present a case of 26-year-old man after deceased donor renal transplantation with plantar verrucous carcinoma successfully treated with excision and 5% imiquimod.

  9. The renal scan in pregnant renal transplant patients

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, H.A.; Ziessman, H.A.; Fahey, F.H.; Collea, J.V.; Alijani, M.R.; Helfrich, G.B.

    1985-05-01

    With the greater frequency of renal transplant surgery, more female pts are becoming pregnant and carrying to term. In the renal allograft blood vessels and ureter may be compressed resulting in impaired renal function and/or, hypertension. Toxemia of pregnancy is seen more frequently than normal. Radionuclide renal scan monitoring may be of significant value in this high risk obstetrical pt. After being maintained during the pregnancy, renal function may also deteriorate in the post partum period. 5 pregnant renal transplant pts who delivered live babies had renal studies with Tc-99m DTPA to assess allograft perfusion and function. No transplanted kidney was lost during or after pregnancy as a result of pregnancy. No congenital anomalies were associated with transplant management. 7 studies were performed on these 5 pts. The 7 scans all showed the uterus/placenta. The bladder was always distorted. The transplanted kidney was rotated to a more vertical position in 3 pts. The radiation dose to the fetus is calculated at 0.024 rad/mCi administered. This study demonstrates the anatomic and physiologic alterations expected in the transplanted kidney during pregnancy when evaluated by renal scan and that the radiation burden may be acceptable in management of these pts.

  10. Intestinal parasitic infections in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Mehdi Azami

    2010-02-01

    Full Text Available The impact of intestinal parasitic infection in renal transplant recipients requires careful consideration in the developing world. However, there have been very few studies addressing this issue in Iran. This study was conducted to determine the prevalence of intestinal parasitic infections in renal transplant recipients in Iran. Stool specimens from renal transplant recipients and control groups were obtained between June 2006 and January 2007. The samples screened for intestinal parasitic infections using direct smear, formalin-ether sedimentation, Sheather's flotation and modified Ziehl-Neelsen staining methods. Out of 150 renal transplant recipients, 33.3% (50, and out of 225 control group, 20% (45 were infected with one or more type of intestinal parasites. The parasites detected among patients included Entamoeba coli (10.6%, Endolimax nana (8.7%, Giardia lamblia (7.4%, Blastocystis spp. (4.7%, Iodamoeba butschlii (0.7%, Chilomastix mesnili (0.7% and Ascaris lumbricoides (0.7%. Multiple infections were more common among renal transplant recipients group (p < 0.05. This study highlights the importance of testing for intestinal parasites among Iranian renal transplant recipients. Routine examinations of stool samples for parasites would significantly benefit the renal transplant recipients by contributing to reduce severe infections.

  11. Intestinal parasitic infections in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Mehdi Azami

    Full Text Available The impact of intestinal parasitic infection in renal transplant recipients requires careful consideration in the developing world. However, there have been very few studies addressing this issue in Iran. This study was conducted to determine the prevalence of intestinal parasitic infections in renal transplant recipients in Iran. Stool specimens from renal transplant recipients and control groups were obtained between June 2006 and January 2007. The samples screened for intestinal parasitic infections using direct smear, formalin-ether sedimentation, Sheather's flotation and modified Ziehl-Neelsen staining methods. Out of 150 renal transplant recipients, 33.3% (50, and out of 225 control group, 20% (45 were infected with one or more type of intestinal parasites. The parasites detected among patients included Entamoeba coli (10.6%, Endolimax nana (8.7%, Giardia lamblia (7.4%, Blastocystis spp. (4.7%, Iodamoeba butschlii (0.7%, Chilomastix mesnili (0.7% and Ascaris lumbricoides (0.7%. Multiple infections were more common among renal transplant recipients group (p < 0.05. This study highlights the importance of testing for intestinal parasites among Iranian renal transplant recipients. Routine examinations of stool samples for parasites would significantly benefit the renal transplant recipients by contributing to reduce severe infections.

  12. Study of the risk factors related to acquisition of urinary tract infections in patients submitted to renal transplant

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    Mayra Gonçalves Menegueti

    2015-06-01

    Full Text Available INTRODUCTION: Urinary tract infections (UTI among transplant recipients are usually caused by gram-negative microorganisms and can provoke a high incidence of morbidity and mortality. The aim of this study was to evaluate the risk factors associated with the acquisition of UTIs during the first year after renal transplantation. METHODS: Here, we report a single-center retrospective cohort study of 99 renal transplant patients followed for the first year after surgery. The definition of a UTI episode was a urine culture showing bacterial growth and leucocyturia when patients presented with urinary symptoms. The absence of infection (asymptomatic bacteriuria was defined as an absence of symptoms with negative urine culture or bacterial growth with any number of colonies. RESULTS: Ninety-nine patients were included in the study. During the study, 1,847 urine cultures were collected, and 320 (17.3% tested positive for bacterial growth. Twenty-six (26.2% patients developed a UTI. The most frequent microorganisms isolated from patients with UTIs were Klebsiella pneumoniae (36%, with 33% of the strains resistant to carbapenems, followed by Escherichia coli (20%. There were no deaths or graft losses associated with UTI episodes. CONCLUSIONS: Among the UTI risk factors studied, the only one that was associated with a higher incidence of infection was female sex. Moreover, the identification of drug-resistant strains is worrisome, as these infections have become widespread globally and represent a challenge in the control and management of infections, especially in solid organ transplantation.

  13. Morphological characteristics of spermatozoa before and after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    Long-Gen Xu; Shi-Fang Shi; Xiao-Ping Qi; Xiao-Feng Huang; Hui-Ming Xu; Qi-Zhe Song; Xing-Hong Wang; Zong-Fu Shao; Jun-Rong Zhang

    2005-01-01

    Aim: To investigate the changes of the spermatozoa ultrastructures before and after renal transplantation in uremic patients. Methods: The sperm of five uremic patients before and after transplantation and four healthy volunteers were collected and examined by scanning electron microscopy. Results: Abnormal spermatozoa were found in patients pre-transplantation; abnormalities included deletion of the acrosome, absence of the postacrosomal and postnuclear ring, dumbbell-like changes of the head, tail curling, and absence of the mitochondrial sheath in the midsegment. After renal transplantation, most of the spermatozoa became normal. Conclusion: There are many abnormalities with regard to the appearance and structure of the head, acrosome, mitochondria and tail of the spermatozoa in uremic patients. The majority of the spermatozoa returned to normal after renal transplantation, but a few still presented some abnormalities possibly relating to the administration of immunosuppressants.

  14. Longitudinal Serum Creatinine Levels in Relation to Graft Loss Following Renal Transplantation: Robust Joint Modeling of Longitudinal Measurements and Survival Time Data

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    Younespour

    2016-08-01

    Full Text Available Background Chronic kidney disease (CKD is a major public health problem that may lead to end-stage renal disease (ESRD. Renal transplantation has become the treatment modality of choice for the majority of patients with ESRD. It is therefore necessary to monitor the disease progression of patients who have undergone renal transplantation. In order to monitor the disease progression, the continuous assessment of kidney function over time is considered. Objectives This study aimed to investigate the etiological role of recipient characteristics in serum creatinine changes within the follow-up period and in relation to the graft failure risk, as well as to evaluate whether or not the serum creatinine level represents an indicator of graft failure following renal transplantation. Methods This retrospective cohort study was conducted at the department of nephrology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, between April 2005 and December 2008. The study involved 413 renal transplantation patients. The primary outcomes were the determination of the serum creatinine levels at each attendance and the time to graft failure. Robust joint modeling of the longitudinal measurements (serum creatinine level and time-to-event data (time to graft failure were used for the analysis in the presence of outliers in the serum creatinine levels. The data analysis was implemented in WinBUGS 1.4.3. Results There was a positive association between the serum creatinine level and graft failure (HR = 5.13, P < 0.001. A one unit increase in the serum creatinine level suggests an increased risk of graft failure of up to 5.13 times. The serum creatinine level significantly decreased over time (95% CI: (-1.58, -1.08. The recipient’s age was negatively associated with the serum creatinine level (95% CI: (-0.02, -0.001. Conclusions Graft failure is more likely to occur in patients with higher serum creatinine levels.

  15. Percutaneous coronary interventions and antiplatelet therapy in renal transplant recipients.

    Science.gov (United States)

    Summaria, Francesco; Giannico, Maria Benedetta; Talarico, Giovanni Paolo; Patrizi, Roberto

    2016-04-01

    Cardiovascular disease is the leading cause of mortality and morbidity following renal transplantation (RT), accounting for 40-50% of all deaths. After renal transplantation, an adverse cardiovascular event occurs in nearly 40% of patients; given the dialysis vintage and the average wait time, the likelihood of receiving coronary revascularization is very high. There is a significant gap in the literature in terms of the outcomes of prophylactic coronary revascularization in renal transplantation candidates. Current guidelines on myocardial revascularization stipulate that renal transplant patients with significant coronary artery disease (CAD) should not be excluded from the potential benefit of revascularization. Compared with percutaneous coronary intervention (PCI), however, coronary artery bypass grafting is associated with higher early and 30-day mortality. About one-third of renal transplant patients with CAD have to be treated invasively and so PCI is currently the most popular mode of revascularization in these fragile and compromised patients. A newer generation drug-eluting stent (DES) should be preferred over a bare metal stent (BMS) because of its lower risk of restenosis and improved safety concerns (stent thrombosis) compared with first generation DES and BMS. Among DES, despite no significant differences being reported in terms of efficacy, the newer everolimus and zotarolimus eluting stents should be preferred given the possibility of discontinuing, if necessary, dual antiplatelet therapy before 12 months. Since there is a lack of randomized controlled trials, the current guidelines are inadequate to provide a specifically tailored antiplatelet therapeutic approach for renal transplant patients. At present, clopidogrel is the most used agent, confirming its central role in the therapeutic management of renal transplant patients undergoing PCI. While progress in malignancy-related mortality seems a more distant target, a slow but steady reduction in

  16. Association of CYP3A4*18B and CYP3A5*3 polymorphism with cyclosporine-related liver injury in Chinese renal transplant recipients.

    Science.gov (United States)

    Xin, Hua-wen; Liu, Hui-ming; Li, Yuan-qi; Huang, Hui; Zhang, Li; Yu, Ai-rong; Wu, Xiao-chun

    2014-06-01

    The purpose of this study was to investigate the associations between CYP3A4*18B and CYP3A5*3 polymorphism and cyclosporine-related liver injuries in Chinese renal transplant recipients. We genotyped 339 renal transplant recipients treated with a triple immunosuppressive regimen including cyclosporine for CYP3A4*18B and CYP3A5*3 polymorphism using the polymerase chain reaction restriction fragment length polymorphism assay. The incidence of liver injury in the study population was 36.9% (125/339). At 1 month after transplantation, the trough concentration of cyclosporine (C0) in the group with CYP3A4*1/*1(GG alleles) was significantly higher than in the group with CYP3A4*18B/*1 8B(AA alleles) (p transplantation, the C0 in the group with CYP3A4*1/*1 and group with CYP3A4*1/*18B was markedly higher than in the group with CYP3A4*18B/*18B (p cyclosporine-related liver injury than those with the AA and GA genotypes. When adjusted for sex, the risk of the CYP3A4*18B genotypes was OR = 4.969 for GG compared to AA (p = 0.030), and OR = 2.634 for GG compared to GA (p = 0.025). However, no association was observed between CYP3A5*3 polymorphisms with cyclosporine-related liver injury. These results suggested that the wild type of CYP3A4*18B is a risk factor for the development of cyclosporine- related liver injuries in Chinese renal transplant recipients.

  17. Pediatric renal transplantation: Jordan′s experience

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    Issa Hazza

    2013-01-01

    Full Text Available To evaluate our experience with pediatric renal transplantation at King Hussein Medical Center, the medical records of 71 pediatric patients who underwent a renal transplantation procedure between the years 2004 and 2010 or started follow-up at our center within one week of transplantation done elsewhere were reviewed. Over the seven-year period, 71 children under the age of 14 years who received their first renal transplant were studied. About 56% (40 were males. The mean age was 9.44 ± 2.86 years. Dysplastic kidney was the most common cause of end-stage renal failure in our group, followed by glomerulonephritis. Mothers were the donors in 39.4% of the cases, followed by fathers. Twenty-three patients (32.4% were transplanted preemptively. The overall one-year graft survival was 96%, three-year survival was 95%, and the five-year survival was 88%. Prednisone, tacrolimus, and mycophenolate mofetil formed the main-stay of immunosuppressive agents. We have developed a successful live donor program for renal transplantation in children at King Hussein Medical Center in Amman. Although our experience is still short, the graft survival is similar to that achieved in the developed world, especially with preemptive transplant.

  18. Dyslipidaemia among renal transplant recipients: cyclosporine versus tacrolimus.

    Science.gov (United States)

    Fazal, Muhammad Asim; Idrees, Muhammad Khalid; Akhtar, Syed Fazal

    2014-05-01

    To compare new onset dyslipidaemia in live-related renal transplant recipients taking cyclosporine versus tacrolimus after 3 months of therapy. The randomised controlled trial was conducted at the Sindh Institute of Urology and Transplantation (SIUT) Karachi, from September 2010 to April 2011, and included 182 End Stage Renal Disease patients on maintenance haemodialysis with pre-transplant normal lipid profile. The patients, who had live-related renal transplant, were randomly allocated to two equal groups using lottery. Group A received cyclosporine (3 mg/kg) and group B was treated with tacrolimus (0.1 mg/kg). All patients had pre-transplant fasting lipid profile checked when they were on maintenance haemodialysis and 3 months after renal transplantation. Serum fasting lipid profile was collected by taking 5 ml blood by venipuncture after an overnight fast of 9-12 hours. SPSS 10 was used for statistical analyses. Of the 182 patients, 144 (79.1%) were males and 38 (20.9%) were females. The overall mean age was 30.18 +/- 9.57 years, and the mean weight was 54.41 +/- 11.144 kg. Significant difference was not observed between the two groups regarding age and weight of the patients. Dyslipidaemia was found in 115(63.2%) subjects; 61(67%) in group A and 54 (59.3%) in group B. There was no statistical difference (p=0.28) when comparison was done after 3 months of therapy. The occurrence of new onset hyperlipidaemia is similar in renal transplant recipients receiving either cyclosporine or tacrolimus in first 3 months post-transplant, but there is room for more research in this field as dyslipidaemia following successful renal transplantation is a frequent and persistent complication.

  19. Tuberculosis in renal transplant recipients.

    Science.gov (United States)

    Lattes, R; Radisic, M; Rial, M; Argento, J; Casadei, D

    1999-06-01

    Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement. We report the impact of TB in kidney transplantation. Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections. Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed. Patients with a history of TB or graft loss in the first month were excluded. TB was diagnosed in 14 of 384 (3.64%). Mean age at transplantation was 35 years. Twelve of these received the graft from a living donor. All had triple immunosuppression with cyclosporine. Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease. In 13 cases an invasive diagnostic procedure was performed. Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2. Annual incidence varied from 0% to 3.1%. At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus). Median time of onset was 13 months. Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft. TB was treated with 4 drugs including rifampin in 10 patients. Cyclosporine was discontinued in one, lowered in one and increased in 8. During treatment 5 patients had rejection episodes. At 1 year, graft survival was 72.7% and patient survival 90.9%. TB was more prevalent when recipient and donor were both PPD positive. In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft

  20. Allograft rejection-related gene expression in the endothelial cells of renal transplantation recipients after cytomegalovirus infection

    Institute of Scientific and Technical Information of China (English)

    Yang LI; Jun HOU; Hang YAN; Wu-jun XUE; Pu-xun TIAN; Xiao-ming DING; Xiao-ming PAN; Xin-shun FENG; Xiao-hui TIAN; He-li XIANG

    2009-01-01

    Objective: To explore the effects of cytomegalovirus (CMV) infection on rejection-related gene expression in the endothelial cells of renal transplantation recipients. Methods: Endothelial cells (ECs) were cultured and stimulated by a variety of factors: A, normal control group; B, inactivated human cytomegalovirus (HCMV) infection group; C, HCMV infection group; D, HCMV supematant infection group; and E, ganciclovir HCMV group. Expression of intercellular adhesion molecule-1 (ICAM-1) and major histocompability complex (MHC) class Ⅰ and class Ⅱ antigens was detected by flow cytometry (FCM) and immuno-histochemistry. Results: We found characteristic CMV-infected ECs in this study. There were no significant differences among groups A, B and D (P>0.05). Although the expression levels of ICAM-1 were not significantly different between groups C and E (P>0.05), the ICAM-1 expression in these two groups was significantly higher than that in group A (P0.05). Human leucocyte antigen (HLA)-ABC expression was detected in all the groups, while HLA-DR expression was only detected in groups C and E. There were no significant dif-ferences of HLA-ABC and HLA-DR expression among groups A, B and D (P>0.05). However, the HLA-ABC and HLA-DR expression levels in groups C and D were higher than those of the remaining groups previously reported (P<0.05). Meanwhile, the HLA-ABC and HLA-DR expression levels in group E were lower than those of group C (P<0.05). Conclusion: CMV could up-regulate the expression levels of ICAM-1 and MHC antigens, which was closely related to allograft rejection.

  1. Impact of mycophenolate mofetil (MMF)-related gastrointestinal complications and MMF dose alterations on transplant outcomes and healthcare costs in renal transplant recipients.

    Science.gov (United States)

    Tierce, J C; Porterfield-Baxa, J; Petrilla, A A; Kilburg, A; Ferguson, R M

    2005-12-01

    Mycophenolate mofetil (MMF), a mycophenolic acid prodrug, is a highly effective adjunct immunosuppressive agent in transplant therapy. Although MMF is generally well tolerated, optimal therapy may be limited by adverse effects, in particular gastrointestinal (GI) toxicity, which has been reported to occur in up to 45% of MMF-treated patients. MMF dose changes resulting from these adverse events may lead to sub-therapeutic dosing and impaired clinical outcomes. This retrospective study analyzed clinical records from 772 renal transplant patients from 10 US transplant centers who were initiated on MMF. The analysis revealed that 49.7% (n = 382) of patients experienced at least one GI complication within the first 6 months post-transplant, with 66.8% (n = 255) of these having multiple GI complications. Of the patients with GI complications, 39.0% experienced MMF dose adjustments or discontinuation of MMF therapy. Patients with GI complications who experienced MMF dose adjustments/discontinuation had a significantly increased incidence of acute rejections compared with patients without GI complications (30.2% vs. 19.4%; p = 0.005). Mean treatment costs were higher in patients with GI complications than in those with no GI complications, particularly in those who experienced MMF dose adjustments/discontinuation (p = 0.0001). The mean incremental cost for patients experiencing GI complications was US$3700 per patient during the 6 months post-transplant (p MMF dose adjustments/discontinuations are associated with a significant negative impact on transplant outcomes and markedly increase short-term treatment costs.

  2. Post-Renal Transplant Diabetes Mellitus in Korean Subjects: Superimposition of Transplant-Related Immunosuppressant Factors on Genetic and Type 2 Diabetic Risk Factors

    Directory of Open Access Journals (Sweden)

    Hyun Chul Lee

    2012-06-01

    Full Text Available Postrenal transplantation diabetes mellitus (PTDM, or new-onset diabetes after organ transplantation, is an important chronic transplant-associated complication. Similar to type 2 diabetes, decreased insulin secretion and increased insulin resistance are important to the pathophysiologic mechanism behind the development of PTDM. However, β-cell dysfunction rather than insulin resistance seems to be a greater contributing factor in the development of PTDM. Increased age, family history of diabetes, ethnicity, genetic variation, obesity, and hepatitis C are partially accountable for an increased underlying risk of PTDM in renal allograft recipients. In addition, the use of and kinds of immunosuppressive agents are key transplant-associated risk factors. Recently, a number of genetic variants or polymorphisms susceptible to immunosuppressants have been reported to be associated with calcineurin inhibition-induced β-cell dysfunction. The identification of high risk factors of PTDM would help prevent PTDM and improve long-term patient outcomes by allowing for personalized immunosuppressant regimens and by managing cardiovascular risk factors.

  3. Anesthesia for parturient with renal transplantation

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    Beena K Parikh

    2012-01-01

    Full Text Available Management of successful pregnancy after renal transplantation is a unique challenge to nephrologist, obstetrician, and anesthesiologist, as these patients have altered physiology and are immune-compromised. We present the anesthetic management of three postrenal transplant patients scheduled for cesarean section. While conducting such cases, cardiovascular status, hematological status, and function of transplanted kidney should be assessed thoroughly. Side effects of immunosuppressant drugs and their interaction with anesthetic agents should be taken into consideration. Main goal of anesthetic management is to maintain optimum perfusion pressure of renal allograft to preserve its function.

  4. The Oral Cavity State in Renal Transplant Recipients

    Science.gov (United States)

    Gašpar, Marija; Glavina, Ana; Grubišić, Kristina; Sabol, Ivan; Bušić, Mirela; Mravak, Marinka

    2015-01-01

    Aim Patients with a solid organ transplant can have many different complications in the mouth, as a result of immunosuppression and side effects of drugs. The aim of this study was to examine the frequency and type of oral lesions in renal transplant patients, dental status, oral hygiene, oral lesions related to drugs which patients take and the time of transplantation as well as the frequency of patient’s visits to the dentist in the post-transplant period. Material and methods The study was performed in a period of two years and included 100 subjects with a renal transplant during their regular control visits to the Department of Nephrology and Dialysis, Clinical Hospital Centre Zagreb and the Department of Oral Medicine, School of Dental Medicine, University of Zagreb and 100 randomly selected control subjects at the Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb. Results Results showed a significantly higher incidence of oral lesions in patients with renal transplant (31%) compared to control subjects. The most frequent were erythematous (inflammatory changes), keratotic lesions and gingival hyperplasia. The average DMFT index was significantly lower in patients with renal transplant than in the control group. One third of patients had a subjective feeling of dry mouth. Oral hygiene was poor overall, and only a small number of subjects used the additional sustainers for oral hygiene. Most patients did not visit the dentist after the transplantation. Conclusion Renal transplant patients need a comprehensive and regular dental care during the pre- and post-transplant period and a doctor of dental medicine should be part of a multidisciplinary team of medical specialists. PMID:27688404

  5. Transvenous Renal Transplant Biopsy via a Transfemoral Approach.

    Science.gov (United States)

    Schmid, A; Jacobi, J; Kuefner, M A; Lell, M; Wuest, W; Mayer-Kadner, I; Benz, K; Schmid, M; Amann, K; Uder, M

    2013-05-01

    Percutaneous renal biopsy (PRB) of kidney transplants might be prevented by an elevated risk of bleeding or limited access to the allograft. In the following, we describe our initial experience with 71 transvenous renal transplant biopsies in 53 consecutive patients with unexplained reduced graft function who were considered unsuitable candidates for PRB (4.2% of all renal transplant biopsies at our institution). Biopsies were performed via the ipsilateral femoral vein with a renal biopsy set designed for transjugular renal biopsy (TJRB) of native kidneys. Positioning of the biopsy system within the transplant vein was achievable in 58 of 71 (81.7%) procedures. The specimen contained a median of 10 glomeruli (range 0-38). Tissue was considered as adequate for diagnosis in 56 of 57 (98.2%) biopsies. With respect to BANFF 50.9% of the specimen were adequate (>10 glomeruli), 47.4% marginally adequate (1-9 glomeruli) and 1.8% inadequate (no glomeruli). After implementation of real-time assessment all specimen contained glomeruli. One of the fifty-eight (1.8%) procedure-related major complications occurred (hydronephrosis requiring nephrostomy due to gross hematuria). Transfemoral renal transplant biopsy (TFRTB) is feasible and appears to be safe compared to PRB. It offers a useful new alternative for histological evaluation of graft dysfunction in selected patients with contraindications to PRB.

  6. The first two cadaveric renal transplantations in Blida, Algeria.

    Science.gov (United States)

    Si-ahmed, E M

    2011-11-01

    Currently, living related donor renal transplantation is the most common source for transplantation in Algeria. To develop cadaveric organ donation, the Blida Transplantation Team (BTT) started a local education program and campaign. On March 31, 2010, we procured and transplanted 2 kidneys from a 17-year-old brain-dead donor. The BTT is conscious that the local initiative must be followed nationally, with the help of the health authorities. There is an urgent need to promote brain-dead donors and cadaveric organ retriveal throughout the country. It will also be necessary to create national waiting lists for candidates not only for renal, but also for other organ transplantations. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. [Complications of pediatric renal transplantation].

    Science.gov (United States)

    Gonçalves, Cristina; Sandes, Ana Rita; Azevedo, Sara; Stone, Rosário; Almeida, Margarida

    2013-01-01

    Introdução: A transplantação renal é a terapêutica de eleição na criança com doença renal crónica terminal, evidenciando impacto positivo na sobrevida e qualidade de vida dos doentes. Não é, no entanto, isenta de complicações, algumas com importante morbilidade. Os autores pretendem caracterizar o perfil de complicações pós transplantação renal em doentes pediátricos (até 18 anos).Material e Métodos: Análise retrospectiva dos doentes submetidos a transplantação renal e seguidos na Unidade de Nefrologia Pediátrica entre Setembro de 1995 e Agosto de 2010. Dados obtidos dos processos clínicos: características demográficas, etiologia da doença renal crónica terminal, terapêutica de substituição renal, mortalidade e perda de enxertos, complicações cirúrgicas, infecciosas e não infecciosas (rejeição aguda e crónica, recidiva da doença de base, alterações metabólicas e factores de risco cardiovascular). Análise estatística descritiva simples.Resultados: Foram incluídas 78 crianças transplantadas (48,7% sexo masculino), com idade mediana à data da transplantaçãorenal de 12 anos (2 - 18). A maioria fez previamente diálise peritoneal: 49 (62,6%). Cinco doentes (6,4%) foram transplantados sem diálise prévia. A mediana do tempo de seguimento após transplante foi 37,5 meses (1 - 169). As principais etiologias de doença renal crónica terminal foram: uronefropatias (41%) e glomerulopatias (28,2%). As complicações infecciosas ocorreram em 74,4%; infecçõesvirais em 56,4%, sendo a mais prevalente a infecção citomegalovírus (39,7%); infecções bacterianas em 53,8% (na maioria infecções urinárias em doentes urológicos). Outras complicações: 1) factores de risco para doença cardiovascular: hipertensão arterial em 85,9%; dislipidémia em 16,7% e diabetes de novo em 7,7%; 2) episódios de rejeição aguda em 32,1% e nefropatia crónica do enxerto em 17,9%; 3) complicações relacionáveis com a cirurgia em 16

  8. De novo glomerular diseases after renal transplantation.

    Science.gov (United States)

    Ponticelli, Claudio; Moroni, Gabriella; Glassock, Richard J

    2014-08-07

    Glomerular diseases developing in the kidney allograft are more often recurrences of the original disease affecting the native kidneys. However, in an undefined number of cases de novo, glomerular diseases unrelated to the original disease in the native kidneys can develop in the transplanted kidney. The clinical presentation and histologic features of de novo diseases are often similar to those features observed in patients with primary or secondary GN in the native kidneys. However, in transplanted kidneys, the glomerular, vascular, and tubulointerstitial changes are often intertwined with structural abnormalities already present at the time of transplant or caused by antibody- or cell-mediated allograft rejection, immunosuppressive drugs, or superimposed infection (most often of a viral nature). The pathophysiology of de novo glomerular diseases is quite variable. In rare cases of de novo minimal change disease, circulating factors increasing the glomerular permeability likely participate. Maladaptive hemodynamic changes and tissue fibrosis caused by calcineurin inhibitors or other factors may be involved in the pathogenesis of de novo FSGS. The exposure of cryptic podocyte antigens may favor the development of de novo membranous nephropathy. Many cases of de novo membranoproliferative GN are related to hepatitis C virus infection. Patients with Alport syndrome lacking antigenic epitopes in their glomerular basement membrane may develop antibodies against these glomerular basement membrane antigens expressed in the transplanted kidney. Infection may cause acute GN to have a heterogeneous clinical presentation and outcome. De novo pauci-immune GN in renal transplant is rare. Preexisting or acquired intolerance to glucose may, in the long term, cause diabetic nephropathy. The prognosis of de novo diseases depends on the type of GN, the severity of lesions caused by the alloimmune response, or the efficacy of immunosuppressive therapy. In most cases, the management

  9. Cutaneous Manifestations in Renal Transplant Recipients

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    Fatma Elif Demirgüneş

    2008-05-01

    Full Text Available Background and Design: This study is designed to determine the prevalence and the clinical spectrum of skin diseases in renal transplant recipients (RTRs.Material and Method: In this study RTRs who were referred to our department between 2005 and 2007 for dermatologic examination were evaluated. Dermatologic investigation included direct clinical observation and culture or histolopathological investigation when indicated. Patients were divided into three groups: group A, post-transplantation periods £1 year; group B, post-transplantation periods of 1-5 years; and group C, post-transplantation periods >5 years. Results: In this study 88 (M=50, F=38 RTRs were evaluated. The mean age was 37 ± 12 years and the median interval since transplantation was 38.5 months (range=1 month-27 years. Over a 2-year period 298 cutaneous manifestations were identified. Ninety-five immunosuppressive (IS drug-related manifestations were observed in 58 (%65.9 patients and the most common one was acneiform eruption (n=23. Forty (45.5% patients developed cutaneous viral infections, consisting of verruca vulgaris (n=29, herpes zoster (n=9, herpes simplex (n=5, molluscum (n=2 and varicella (n=1 infections. Superficial fungal infections were observed in 35(39.2% patients, most common lesions were dermatophytosis (n = 23 and pityriasis versicolor (n=17. Bacterial infections were observed in 14 (%16 patients, folliculitis was present in 12 of them. Premalignant and malignant lesions were identified in 12 (%13.6 patients, consisting of actinic keratoses (n=9, basal cell carcinoma (n=2, squamous cell carcinoma (n=1 and Kaposi's sarcoma (n=1. There were more premalignant and malignant lesions in patients receiving azathioprine (p=0.002. Cutaneous viral infections were more common in group C (p=0.023 and IS drug-related manifestations were more common in group A (p=0.003. Conclusion: Most common cutaneous manifestation among RTRs was IS drug-related and seen in early post-transplantation

  10. Routine intraoperative stenting for renal transplant recipients.

    Science.gov (United States)

    Wilson, Colin H; Bhatti, Aftab A; Rix, David A; Manas, Derek M

    2005-10-15

    Major urological complications (MUCs) after kidney transplantation contribute to patient morbidity and compromise graft function. Ureteric stents have been successfully used to treat such complications and a number of centers have adopted a policy of universal prophylactic stenting, at the time of graft implantation, to reduce the incidence of urine leaks and ureteric stenosis. In conjunction with the Cochrane Renal Group we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of articles, books and abstracts and contacted companies, authors and experts to identify randomized controlled trials examining the use of stents in renal transplantation. The primary outcome was the incidence of MUCs and data on this statistic was pooled and analyzed using a random effects model. Seven randomized controlled trials (1154 patients) of low or moderate quality were identified. The incidence of MUCs was significantly reduced (relative risk [RR] 0.24; 95% CI: 0.07 - 0.77; P=0.02; number needed to treat = 13) by prophylactic ureteric stenting. Urinary tract infections were more common in stented patients (RR 1.49), unless the patients were prescribed 480 mg cotrimoxazole once daily. With this antibiotic regime the incidence of infection was equivalent between the two groups (RR 0.97). Stents appeared generally well tolerated, although trials using longer stents (> or = 20 cm) for longer periods of time (>6 weeks) reported more problems with encrustation and migration. Universal prophylactic stenting reduces the incidence of MUCs and should be recommended on the basis of currently available randomized controlled trials.

  11. [Access to the waiting list and renal transplantation].

    Science.gov (United States)

    Hourmant, M; de Cornelissen, F; Brunet, P; Pavaday, K; Assogba, F; Couchoud, C; Jacquelinet, C

    2013-09-01

    This chapter provides a set of indicators related to Renal Transplantation access in France. It describes patient outcomes and reports on cumulative incidence rates of wait-listing and renal transplantation according to main patient of characteristics and regions. The REIN registry integrates kidney transplant and dialysis data. It provides a comprehensive view on waiting list and renal transplantation access to the patients, nephrologists, and national or regional health authorities. Access to the waiting list is evaluated on a cohort of 51,845 new patients who started dialysis between 2002 and 2011 in 25 regions. The probability of first wait-listing was of 3.7% at the start of dialysis (pre-emptive registrations), 15% at 12, 22% at 36 and 24% to 60 months. The probability of being registered was strongly related to age, diabetes and region. Patient older than 60 had a very poor access to the waiting list, whatever their diabetes status was. Probability of first wait-listing was much lower (36.5% at 60 months) in type 2 diabetic-40 to 59 years old patients. Among 13,653 patients less than 60 years old, the probability of being registered was 11% at the start of dialysis, 43% to 12 months, 62% to 36 months and 66% to 60 months (median dialysis duration: 16 months). Seventeen regions with up to 5 years follow-up show an increase of 8 to 15% in pre-emptive registrations between 2007 and 2001, without change at 1 year. Access to kidney transplant is evaluated on a cohort of 53,301 new patients who started a renal replacement therapy (dialysis or pre-emptive renal transplant) between 2002 and 2011 in 25 regions. The probability of first kidney transplant was of 7% at 12, 17% at 36 and 21% at 60 months. 8,633 patients (16,2%) had received a first renal transplant within 14.7 month median time; 1,455 (2.7%) had received a pre-emptive graft [male: 58%, median age: 48.7y]. Among the 14,770 new patients less than 60 years old, the probability of being transplanted was of

  12. [Pediatric renal transplantation in Toulouse (author's transl)].

    Science.gov (United States)

    Juskiewenski, S; Barthe, P; Vaysse, P; Bouissou, F; Guitard, J; Bacque, P; Moscovivi, J; Cao-Van, C

    1980-01-01

    The regional group of renal transplantation in Toulouse includes a medico-surgical team which participates to all the activities of this group. Dialysis and transplantation are covered in a center organized for the care of children. This branch is part of the Regional Hospital. From 15 years old on patients are moved from the pediatric branch to the medico-surgical center taking care of adults. Both teams within the regional hospital share the responsability of taking off kidneys from cadaveric donors and collaborate to France-Transplant and Euro-Transplant. Since the pediatric center in charge of renal failure has opened, 32 children underwent chronic hemodialysis. Some of these patients are presently treated in the center for adults. Fourteen children were grafted and seven are at this moment waiting to receive transplantation. The average number of transplantations per year is from 1 to 4. These fourteen children underwent renal transplantation with kidneys from cadaveric donors. Only one has been provided by Toulouse. Diuresis resumed immediately in 8 cases, later in 5. An extremely acute reject was observed in one case and transplantectomy had to be performed 10 days after transplantation. Eight children presented acute reversible reject which, for 4 of them, evoluated towards chronicle reject. Eight children presented a chronicle reject: 4 of them are again in dialysis. Altogether 8 kidneys are functioning (seven years in the longest case). Five children resumed chronic dialysis. One patient died of acute pancreatitis. He underwent a portocaval shunt for type I glycogenosis which ended in a hyperuricemic nephropathy evoluating towards renal failure forcing a transplantation. The rehabilitation of transplanted children was always satisfactory.

  13. Pulmonary Infection In Renal Transplant Recipients

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    Rassulineiad M

    2003-11-01

    Full Text Available Renal transplantation is ideal treatment of chronic renal failure. Pulmonary infection is a common and serious post transplant infection requiring hospitalization and is associated with high mortality. Increased susceptibility to infection is due to a decrease in the patients' immunological response caused by immunosuppression through drug administration, and by other influences."nMaterials and Methods: This study was case series and prospective, from July 2001 to July 2002 in Imam Khomeini hospital of Tehran."nResults: 164 renal transplant recipients were studied, 14 patients (8.5% had pulmonary infection, 11 of them (78.6% were female and 3 (21.4% were male. The mean age of them was 42.6 years. The patients were followed up for 9 to 12 months. All patients were on triple immunosuppressive regimens. The interval between transplantation and the appearance of pneumonia was 2 months to 10 years. The time of beginning infection in 3 cases (21.4% was between 1 to 6 months post transplantation, 11 cases (78.6% were occurred beyond 6 months after transplantation. In 7 cases (50%, pulmonary infection was occurred during first year after transplantation. None of the 14 patients developed pulmonary infection in first month after transplantation. BAL were used in 6 cases (42.8% of pulmonary infection, and organism were detected in 5 of them (83.3%. The most common clinical feature was fever. Six cases were due to mycobacterium tuberculosis (42.9%, this organism was the most common ethiology of pneumonia. In this study tuberculosis was seen in 3.6% of renal transplant recipients. One patient had pulmonary mucormycosis. All patients with pulmonary TB were cured, and other cases with unknown case, were cured with empirical treatment."nConclusion: Our finding indicate the invasive diagnostic procedures are required in order to earlier and reliable diagnosis and then better outcome of transplantation."n"n"n"n"n"n"n 

  14. Opportunistic infections in a renal transplant recipient

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    Vijaya V. Mysorekar

    2012-01-01

    Full Text Available With the present progress in transplantation procedures, there is an improvement in patient and allograft survival. However, the immunosuppression necessary to sustain the allograft predisposes these transplant recipients to infection, which is now a significant cause of morbidity and mortality. We describe a case of a 30-year-old renal transplant recipient with two opportunistic infections, namely, primary cutaneous aspergillosis and intestinal tuberculosis, with terminal enterococcal pleuritis and peritonitis. Control of the degree of immunosuppression, and prompt recognition and treatment of infection are vital for successful organ transplantation.

  15. Outcome of Renal Transplant in Recipients With Vasculitis.

    Science.gov (United States)

    Barbouch, Samia; Hajji, Meriam; Aoudia, Raja; Ounissi, Monther; Zammouri, Asma; Goucha, Rym; Ben Hamida, Fathi; Bacha, Mohammed Mongi; Abderrahim, Ezzedine; Ben Abdallah, Taieb

    2017-02-01

    End-stage renal disease develops in a high percentage of patients with vasculitis, in whom kidney transplant has become a therapeutic option. However, limited data are available on the prognosis and outcomes after kidney transplant in these patients. We aimed to compare the long-term graft survival and graft function in 8 renal transplant recipients with vasculitis (granulomatosis with polyangiitis, microscopic polyangiitis, Goodpasture syndrome, and Henoch-Schonlein purpura) with the other kidney recipients at a single center. We conducted a retrospective study of patients followed for chronic renal failure associated with vasculitis before renal transplant. We excluded patients with no biopsy-proven nephropathy. There was no difference in the occurrence of metabolic and cardiovascular complications in our case group compared with the other graft recipients. Infections were frequent and included cytomegalovirus and urinary tract infection. The rates of bacterial and viral infection were equivalent in our population. The incidence of allograft loss was estimated at 1.8%, less than that seen in our entire transplant population. The presence of vasculitis was not significantly related to renal failure (P = .07). Extrarenal relapse occurred in 1 patient with microscopic polyangiitis. Antineutrophil cytoplasmic antibody levels in patients with granulomatosis with polyangiitis and microscopic polyangiitis did not seem to influence the renal outcome (P = .08). Circulating antineutrophil cytoplasmic antibodies were associated with the development of vascular lesions in the graft but were not significantly correlated with graft survival (P = .07). This study supports the theory that renal transplant is an effective treatment option for patients with end-stage renal disease secondary to vasculitis. These patients fare similarly to, if not better than, other patients.

  16. Pregnancy outcome in renal transplant recipients.

    Science.gov (United States)

    Kuvacić, I; Sprem, M; Skrablin, S; Kalafatić, D; Bubić-Filipi, L; Milici D

    2000-09-01

    To correlate pregnancy outcome with complications in pregnancy and transplantation-to-pregnancy interval in renal transplant recipients in Croatia. Data on 23 pregnancies after prepregnancy stabilization of blood pressure and normalization of graft function were retrospectively analyzed. The mean interval between transplantation and conception was 3.1 years. Primary renal disease was chronic glomerulonephritis in 7, chronic pyelonephritis in 7 and agenesis of right kidney and stenosis of left renal artery in 1 patient. There were 10 term and 5 preterm deliveries, 6 induced and 2 spontaneous abortions. The mean gestational age was 38.1 weeks and the mean newborn birthweight was 3015 g. The prematurity rate was 21.7%. Patients with arterial hypertension in pregnancy, elevated serum creatinine level and bacteriuria, as well as those with conception occurring less than 2 years after transplantation, had a higher rate of therapeutic and spontaneous abortions, preterm deliveries and low birth weight infants. The interval between transplantation and conception, as well as allograft function during pregnancy, seem to be of great importance for successful obstetric outcome in renal transplant patients.

  17. Infarction of renal transplant with extrarenal excretion of Tc-99m MAG{sub 3} demonstrated by renal scintigraphy

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    Lim, Seok Tae; Kim, Min Woo; Sohn, Myung Hee [Chonbok National University Medical School, Chonju (Korea, Republic of)

    2003-06-01

    A 38-year-old woman with end stage renal disease received a living related donor-renal transplant to the right iliac fossa. She developed anuria a week later. Tc-99m MAG{sub 3} renal scintigraphy demonstrated no perfusion, uptake, or excretion of the radioactive tracer from the renal transplant. The expected area of the renal allograft appeared as a photopenic area with increased rim activity. The gallbladder and bowel activities were observed on delayed images at 24 hours. There was no blood flow within the renal artery on renal doppler examination. This case shows total absence of perfusion and function in the infarcted renal transplant with extrarenal excretion of Tc-99m MAG{sub 3} caused by acute renal artery thrombosis.

  18. Head and neck malignancies in Croatian renal transplant recipients

    National Research Council Canada - National Science Library

    Basić-Jukić, Nikolina; Bubić-Filipi, Ljubica; Prgomet, Drago; Djanić Hadzibegović, Ana; Bilić, Mario; Kovac, Lana; Kastelan, Zeljko; Pasini, Josip; Mokos, Ivica; Basić-Koretić, Martina; Kes, Petar

    2010-01-01

    Renal transplantation is associated with increased incidence of cancer. We reviewed a large series of renal transplant recipients to determine the incidence and outcome of patients with malignant changes located at the head and neck...

  19. Prostatectomy for localized prostate cancer to prepare for renal transplantation in end-stage renal disease patients.

    Science.gov (United States)

    Tillou, Xavier; Chahwan, Charles; Le Gal, Sophie; Bensadoun, Henri; Doerfler, Arnaud

    2014-11-06

    Surgical difficulties of renal transplantation related to prostate cancer (PC) treatment and the results of renal transplantation after radical prostatectomy are currently poorly known, as well as oncological follow-up before and after renal transplantation. We performed a retrospective study including all patients diagnosed with PC before renal transplantation in our department. Nineteen patients were included between August 2003 and December 2013. The mean age at diagnosis of PC was 61.7 years (range 51.4-71.1). PSA mean level at diagnosis was 8.5 ng/ml (range 4.8-20). Fourteen had a retro-pubic and 5 a laparoscopic prostatectomy. Three patients underwent radiotherapy for positive surgical margins or extra-capsular extension. Fourteen patients were transplanted. The mean time lapse between prostatectomy and kidney transplantation was 32.8 months (range 14-71). Seven recipients (50%) were transplanted less than 24 months after prostatectomy. Post-transplantation surgical complications were not significantly related to dissection difficulties (p=0.2). No recurrence of PC was observed after renal transplantation, with a mean follow-up of 38 months (range 6-77.9). Prostate cancer discovered before renal transplantation should be treated by radical prostatectomy to assess recurrence risk. If the PC is at low risk of recurrence, it seems possible to shorten the 2-year period of oncologic follow-up before transplantation called for in current recommendations.

  20. Renal transplantation in a child with thrombosed inferior vena cava

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    Surjeet Kumar

    2014-01-01

    Full Text Available The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.

  1. Race/ethnicity, poverty status, and renal transplant outcomes.

    Science.gov (United States)

    Press, Rebecca; Carrasquillo, Olveen; Nickolas, Thomas; Radhakrishnan, Jai; Shea, Steven; Barr, R Graham

    2005-10-15

    There are known racial disparities in renal graft survival. Data are lacking comparing associations of race/ethnicity and socioeconomic status with graft failure and functional status after transplantation. Our goal was to test if African-American and Hispanic race/ethnicity and poverty are associated with worse outcomes following renal transplantation. We performed a retrospective cohort study using a nationwide registry (United Network for Organ Sharing). We studied 4,471 adults who received renal transplants in 1990. Outcomes were graft failure and functional status over 10 years. Cumulative incidence of graft failure was higher among African-Americans and Hispanics than whites (77% vs. 64% vs. 60 %; Ppoverty status was not (RR 1.0, 95% CI 0.9-1.1). Days with impaired functional status were higher for African-Americans compared to whites (RR 1.6, 95% CI 1.3-1.9) but not independent of poverty. Poverty was independently associated with impaired functional status (RR 1.3, 95% CI 1.0-1.6). African-Americans and Hispanics had higher rates of graft failure compared to whites after adjustment for poverty and other covariates whereas poverty, but not race/ethnicity, was related to functional status following renal transplantation. National datasets should include individual-level measures of socioeconomic status in order to improve evaluation of social and environmental causes of disparities in renal transplant outcomes.

  2. Cervical Carcinoma in a Renal Transplant Recipient: A Case Report.

    Science.gov (United States)

    Tuncer, Hasan Aykut; Kirnap, Mahir; Dursun, Polat; Ayhan, Ali; Moray, Gokhan; Haberal, Mehmet

    2016-02-01

    A range of cancer types, at increased rates, is described in renal transplant recipients receiving immunosuppression. Aside from immunodeficiency, heightened medical surveillance for cancer, lifestyle, and other risk factors all play a role. Although the relation between cancer risk and degree of immunodeficiency might not be linear, and might be different for a wide range of cancer subtypes, human papillomavirus-related cancers in long-term transplant recipients may suggest the role of even modest immunosuppression, when present long enough. High-risk human papillomavirus types are recognized as the cause of cancer of the cervix. We report a 49-year-old female renal transplant recipient diagnosed with cervical squamous cell carcinoma, 5 years after the transplant. Based on this patient, we highlight difficulties in surgical approach and the importance of close clinical follow-up including regular gynecologic screening for cervical premalignant and malignant lesions.

  3. Epidemiology of post-transplant malignancy in Chinese renal transplant recipients: a single-center experience and literature review.

    Science.gov (United States)

    Zhang, Jian; Ma, Linlin; Xie, Zelin; Guo, Yuwen; Sun, Wen; Zhang, Lei; Lin, Jun; Xiao, Jing; Zhu, Yichen; Tian, Ye

    2014-07-01

    This study investigated the incidence and types of post-transplant malignancy in Chinese renal transplant recipients and the risk factors associated with malignancy. Data from 3,462 patients who underwent renal transplantation at Beijing Friendship Hospital were combined with data from 26 previous reports describing malignancy rates in 27,170 Chinese renal transplant recipients. Between 1974 and 2014, 179/3,462 (5.17 %) patients who underwent renal transplantation at our center developed malignancy. The most common site of malignancy was the urinary system, and the most common type was urothelial transitional cell carcinoma. Combined data from our center and previous reports showed malignancy in 671 (2.19 %) Chinese renal transplant recipients. The ten most common malignancies were urothelial transitional cell carcinoma (n = 283), hepatocellular carcinoma (n = 68), gastrointestinal cancer (n = 63), renal cell carcinoma (n = 42), lymphoma (n = 42), lung cancer (n = 28), breast cancer (n = 19), skin cancer (n = 18), Kaposi's sarcoma (n = 12), and cervical cancer (n = 10). The incidence of post-transplant malignancy in renal transplant recipients was lower in China than the reported rates in other countries, and the most common sites of malignancy were the urinary and digestive system. The relative frequency of malignancy sites differed between northern and southern China. Renal transplant recipients on long-term immunosuppressive therapy should receive careful follow-up, including annual or biannual screening for malignancy in high-risk individuals.

  4. Renal-sparing strategies in cardiac transplantation

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Ross, Heather J

    2009-01-01

    PURPOSE OF REVIEW: Renal dysfunction due to calcineurin inhibitor (CNI) toxicity is a major clinical problem in cardiac transplantation. The aim of the article is to review the efficacy and safety of various renal sparing strategies in cardiac transplantation. RECENT FINDINGS: Small studies have...... documented that late initiation of CNI is safe in patients treated with induction therapy at the time of transplantation. Use of mycophenolate is superior when compared with azathioprine to allow for CNI reduction. More substantial reduction in CNI levels is safe and effective with the introduction...... of sirolimus or everolimus. However, studies that use very early CNI discontinuation have found an increased risk of allograft rejection, and this strategy requires further study before it can be routinely recommended. CNI discontinuation late after cardiac transplantation seems more effective than CNI...

  5. Proteinuria in Egyptian renal transplant recipients

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    Essam Khedr

    2015-01-01

    Full Text Available To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8% patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2% patients, acute rejection in 40 (32% patients, transplant glomerulopathy in eight (6.4% patients, glomerular disease in 16 (12.8% patients and other etiology in 17 (13.6% patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862. We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival.

  6. Urolithiasis in renal transplantation: Diagnosis and management

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    Elisa Cicerello

    2014-12-01

    Full Text Available Obiectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Patients and Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10% of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL. Three patients were treated by ureteroscopy (URS and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS. Conclusions: The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.

  7. Renal transplantation using external continent urinary diversion.

    Science.gov (United States)

    Lucon, A M; Sabbaga, E; Ianhez, L E; Chocair, P R; Pestana, J O; Arap, S

    1994-02-01

    A 29-year-old man born with bladder exstrophy presented with end stage renal failure many years after ileal conduit diversion. Bilateral nephrectomy and continent external urinary diversion were performed, and 1.5 months later a cadaveric kidney was grafted into the right iliac fossa. The patient was well at 18 months with a serum creatinine level of 1.2 mg./dl. and he was completely dry with 4 or 5 daily catheterizations. Although followup is still short, renal transplantation with drainage into an external continent urinary diversion permits excellent quality of life and good renal function. Therefore, this alternative is worth consideration whenever other reconstructive alternatives are not possible in candidates for renal transplantation.

  8. [De novo tumours of renal transplants].

    Science.gov (United States)

    Hétet, J F; Rigaud, J; Dorel-Le Théo, M; Láuté, F; Karam, G; Blanchet, P

    2007-12-01

    Kidney cancer occurs rarely and late in renal transplants. The lack of grafts and the increasing age of the cadaver donors are likely to result in an increasing number of such cancers. To date, the treatment of choice is the transplant removal. Nevertheless partial nephrectomy may be discussed in selected cases. Ultrasonographic screening should allow detection of low volume tumours suitable for partial nephrectomy. Alternative techniques (radiofrequency, cryoablation) are to be assessed in such patients.

  9. Cutaneous histoplasmosis in renal transplant recipients.

    Science.gov (United States)

    Sun, N Z; Augustine, J J; Gerstenblith, M R

    2014-10-01

    Cutaneous histoplasmosis is a rare entity, although it can be seen in a substantial portion of renal transplant recipients with disseminated disease. The prognosis of disseminated disease is worse than isolated cutaneous involvement, and significant delays in diagnosis are reported. We reviewed reports of cutaneous histoplasmosis with and without dissemination in the setting of renal transplantation to examine incidence, timing of diagnosis, clinical features, and prognosis. Remarkable morphologic variability and the non-specific appearance of skin findings suggest that tissue culture is required for definitive diagnosis. Cutaneous lesions represent an easily accessible source for early diagnosis.

  10. Brucellosis in a renal transplant recipient.

    Science.gov (United States)

    Ting, I W; Ho, M W; Sung, Y J; Tien, N; Chi, C Y; Ho, H C; Huang, C C

    2013-10-01

    Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.

  11. Bilateral Psoas Haematomata Complicating Renal Transplantation

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    Jacob A. Akoh

    2014-01-01

    Full Text Available Background. The challenge in managing patients undergoing renal transplantation is how to achieve optimum levels of anticoagulation to avoid both clotting and postoperative bleeding. We report a rare case of severe postoperative retroperitoneal bleeding including psoas haematomata complicating renal transplantation. Case Report. SM, a 55-year-old female, had a past history of aortic valve replacement, cerebrovascular event, and thoracic aortic aneurysm and was on long-term warfarin that was switched to enoxaparin 60 mg daily a week prior to her living donor transplantation. Postoperatively, she was started on a heparin infusion, but this was complicated by a large retroperitoneal bleed requiring surgical evacuation on the first postoperative day. Four weeks later, she developed features compatible with acute femoral neuropathy and a CT scan revealed bilateral psoas haematomata. Following conservative management, she made steady progress and was discharged home via a community hospital 94 days after transplantation. At her last visit 18 months after transplantation, she had returned to full fitness with excellent transplant function. Conclusion. Patients in established renal failure who require significant anticoagulation are at increased risk of bleeding that may involve prolonged hospitalisation and more protracted recovery and patients should be carefully counselled about this.

  12. Relationship Between ADPKD and Post-Renal Transplant Diabetes Mellitus

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    S. Seifi

    2006-08-01

    Full Text Available Background: Autosomal-dominant polycystic kidney disease (ADPKD, a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease (ESRD by the fifth decade of life. Post-transplant diabetes mellitus (PTDM, a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. Methods: In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients (27 ADPKD and 113 non ADPKD patients were enrolled during three years. Both groups were matched for age, sex, body mass index (BMI, duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. Results: PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant (P > 0.05. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels (P > 0.05. Conclusion: Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease.

  13. Dialysis and renal transplantation in HIV-infected patients

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  14. Chronic Acquired Demyelinating Polyneuropathy following Renal Transplantation

    OpenAIRE

    Younger, D. S.; Stuart Orsher

    2013-01-01

    The clinical, laboratory, and treatment findings of a patient with chronic acquired demyelinating polyneuropathy (CADP) in association with renal transplantation are described. Like the present case, many such patients have been described under the rubric of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).

  15. Emerging role of gasotransmitters in renal transplantation

    NARCIS (Netherlands)

    Snijder, P. M.; van den Berg, E.; Whiteman, M.; Bakker, S. J. L.; Leuvenink, H. G. D.; van Goor, H.

    2013-01-01

    Once patients with kidney disease progress to end-stage renal failure, transplantation is the preferred option of treatment resulting in improved quality of life and reduced mortality compared to dialysis. Although 1-year survival has improved considerably, graft and patient survival in the long ter

  16. [Serum beta 2 microglobulin (beta 2M) following renal transplantation].

    Science.gov (United States)

    Pacheco-Silva, A; Nishida, S K; Silva, M S; Ramos, O L; Azjen, H; Pereira, A B

    1994-01-01

    Although there was an important improvement in graft and patient survival the last 10 years, graft rejection continues to be a major barrier to the success of renal transplantation. Identification of a laboratory test that could help to diagnose graft rejection would facilitate the management of renal transplanted patients. PURPOSE--To evaluate the utility of monitoring serum beta 2M in recently transplanted patients. METHODS--We daily determined serum beta 2M levels in 20 receptors of renal grafts (10 from living related and 10 from cadaveric donors) and compared them to their clinical and laboratory evolution. RESULTS--Eight patients who presented immediate good renal function following grafting and did not have rejection had a mean serum beta 2M of 3.7 mg/L on the 4th day post transplant. The sensitivity of the test for the diagnosis of acute rejection was 87.5%, but the specificity was only 46%. Patients who presented acute tubular necrosis (ATN) without rejection had a progressive decrease in their serum levels of beta 2M, while their serum creatinine changed as they were dialyzed. In contrast, patients with ATN and concomitance of acute rejection or CSA nephrotoxicity presented elevated beta 2M and creatinine serum levels. CONCLUSION--Daily monitoring of serum beta 2M does not improve the ability to diagnose acute rejection in patients with good renal function. However, serum beta 2M levels seemed to be useful in diagnosing acute rejection or CSA nephrotoxicity in patients with ATN.

  17. Denovo Post Renal Transplantation Inflammatory Bowel Disease

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    Halim M

    2008-01-01

    Full Text Available Post-renal transplant de-novo inflammatory bowel disease (IBD may develop despite the presence of mycophenolate mofetil (MMF, a drug used for treatment of IBD, in the immunosuppressive regimen. A 39-year-old man received live unrelated renal transplant, and was started postoperatively on prednisolone, MMF, and tacrolimus, which was changed to sirolimus when he developed diabetes mellitus two months post-transplant. Nine months post-transplant, the patient developed recurrent attacks of bloody diarrhea and ischio-rectal abscesses complicated by anal fistulae not responding to routine surgical treatment. Colonoscopy diagnosed IBD, a Crohn′s disease-like pattern. The patient was treated with steroids and 5-aminosalicylic acid (5-ASA in addition to a two months course of ciprofloxacin and metronidazole. He became asymptomatic and rectal lesions healed within one month of treatment. The patient continued to be asymptomatic, and he maintained normal graft function on the same immunosuppressive treatment in addition to 5-ASA. We conclude that de-novo IBD disease can develop in renal transplant recipients in spite of immunosuppressive therapy including MMF.

  18. Impact of Depression on Long-Term Outcome After Renal Transplantation : A Prospective Cohort Study

    NARCIS (Netherlands)

    Zelle, D.M.; Dorland, H.F.; Rosmalen, J.G.M.; Corpeleijn, E.; Gans, R.O.B.; van der Heide, J.J.H.; van Son, W.J.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background. Renal transplantation is the treatment of choice for end stage renal disease. Although there is more depression in wait-listed versus transplant patients, depression persists after transplantation. We investigated the determinants of depression in renal transplantation recipients (RTRs)

  19. [Ischemic colitis after renal transplantation:etiology and pathogenesis].

    Science.gov (United States)

    Alperovich, G; Idiarte, L; Besasso, O; Avagnina, A

    2003-01-01

    Ischemic colitis is a well-recognized complication occurring in renal transplant recipients. It has often been associated with cytomegalovirus (CMV) vasculitis. However, the diagnosis of this pathology in the absence of CMV suggests that other etiological factors might be involved. Drugs inducing mesenteric vasoconstriction, such as non-steroidal anti-inflamatory drugs (NSAIDs) and cyclosporine could be related to this entity.

  20. Characterization of post transplantation lymphoma in feline renal transplant recipients.

    Science.gov (United States)

    Durham, A C; Mariano, A D; Holmes, E S; Aronson, L

    2014-01-01

    The development of malignant neoplasia following solid organ transplantation and immunosuppression is well recognized in man. Post-transplantation malignant tumours include non-melanoma skin cancers, non-Hodgkin's lymphoma and Kaposi's sarcoma and many of these cancers have a known or suspected viral cause. A similar increased incidence of cancer is seen in cats that have received a renal transplant and lymphoma is the predominant neoplasm in this population. This study examines a population of cats that received renal transplants at the University of Pennsylvania School of Veterinary Medicine and subsequently developed neoplasia. From 1998 to 2010, 111 cats were transplanted and 25 cats developed cancer (22.5%). Fourteen of the 25 cats were diagnosed with lymphoma (56%), making it the most common tumour in this patient population. The median interval between transplantation and diagnosis of lymphoma was 617 days and the median survival time (MST) following the diagnosis of lymphoma was 2 days. Tissues from seven of these cats were available for histopathological review as either samples collected at necropsy examination (n = 5) or biopsy submissions (n = 2). Five of these cats had multiorgan involvement with sites including the liver, spleen, peripheral and mesenteric lymph nodes, small intestine, urinary bladder, heart, mesenteric fat and body wall. Four of the cats with multiorgan disease had involvement of the renal allograft two of which also had lymphoma of the native kidney. All lymphomas were classified as mid to high grade, diffuse large B-cell lymphoma, which is also the most common lymphoma subtype in human cases of post-transplantation lymphoproliferative disorders.

  1. Patients with a Failed Renal Transplant

    Directory of Open Access Journals (Sweden)

    Tülin AKAGÜN

    2012-09-01

    Full Text Available Renal transplantation is the best method of renal replacement therapy for patients with end-stage renal disease. On the other hand in the early or late period of transplantation, majority of patients suffer from allograft failure and return to the dialysis. These patients carry the risks of adverse effects of previous immunosuppressive therapy (i.e infections and cancers. Furthermore, worse quality of life and many limitations of dialysis result in psychological problems. The controversial issues in treatment of these patients can be summarized under the headings of : 1- In which stage of allograft failure these patients should return to dialysis? 2- Which is the most appropriate renal replacement therapy after the renal allograft failure? 3- What are the main problems during dialysis practice and how should these problems be managed? 4- How should the immunosupression regimen be managed? 5- What are the indications for transplant nephrectomy? 6- What are the advantages and drawbacks of retransplantation? In this review these problems were discussed. [ Türkçe Özet ] [ PDF ] [ Benzer Makaleler

  2. Effect of nifedipine on renal transplant rejection.

    Science.gov (United States)

    Nicholson, M L; Dennis, M J; Beckingham, I J; Smith, S J

    1993-10-01

    The effect of early nifedipine therapy on acute renal allograft rejection was studied in 170 adult cadaveric transplant recipients. Acute rejection occurring in the first 3 months after transplantation was diagnosed by Tru-cut biopsy and the severity of each rejection episode assessed histologically. The incidence of acute rejection was significantly lower in patients treated with nifedipine (29 of 80; 36 per cent) than in controls (52 of 90; 58 per cent) (P nifedipine exerted a significant independent effect on the incidence of early acute rejection. Other factors identified in the multivariate model as influencing rejection were human leucocyte antigen (HLA) matching at the DR locus, blood level of cyclosporin during the first week, HLA matching at the B locus, donor age and donor sex. The 1-year graft survival rate was 88.6 per cent in patients given nifedipine and 63.8 per cent in controls (P nifedipine therapy has a useful role in human renal transplantation.

  3. Acute pancreatitis, acute hepatitis and acute renal failure favourably resolved in two renal transplant recipients.

    Science.gov (United States)

    Voiculescu, Mihai; Ionescu, Camelia; Ismail, Gener; Mandache, Eugen; Hortopan, Monica; Constantinescu, Ileana; Iliescu, Olguta

    2003-03-01

    Renal transplantation is often associated with severe complications. Except for acute rejection, infections and toxicity of immunosuppressive treatment are the most frequent problems observed after transplantation. Infections with hepatic viruses (HBV, HDV, HCV, HGV) and cytomegalic virus (CMV) are the main infectious complications after renal transplantation. Cyclosporine toxicity is not unusual for a patient with renal transplantation and is even more frequent for patients with hepatic impairment due to viral infections. The subjects of this report are two renal transplant recipients with acute pancreatitis, severe hepatitis and acute renal failure on graft, receiving immunosuppressive therapy for maintaining renal graft function

  4. AB95. Epidemiology of post-transplant malignancy in Chinese renal transplant recipients

    OpenAIRE

    Zhang, Jian; Ma, Linlin; Xie, Zelin; Guo, Yuwen; Sun, Wen; Zhang, Lei; Lin, Jun; Xiao, Jing; Zhu, Yichen; Tian, Ye

    2014-01-01

    Objective To investigate the incidence and types of post-transplant malignancy in Chinese renal transplant recipients. Methods We searched the CNKI and the Wanfang Data Knowledge Service Platform using the keywords “renal transplantation” and “malignancy” in Chinese. Data from 3,462 patients who underwent renal transplantation at Beijing Friendship Hospital were combined with data from 26 previous reports describing malignancy rates in 27,170 Chinese renal transplant recipients. Results The c...

  5. Cadaveric renal transplantation: the Chennai experience.

    Science.gov (United States)

    Prabahar, M R; Soundararajan, P

    2008-05-01

    Transplantation of human organs is undoubtedly one of the greatest medical breakthroughs of this century. However, few Indian patients are able to benefit from this medical advance. It is estimated that in India every year over 152,000 people are diagnosed to have end-stage renal failure needing renal transplantation. The Transplantation of Human Organs Act passed by the Indian parliament in 1994 was subsequently ratified by the state legislature of Tamil Nadu in May 1995. It accepted brain death as a form of death and prohibited commerce in organs. The first cadaveric kidney transplant in Sri Ramachandra medical college was performed in 1995 with 68 cadaveric kidney transplants thereafter. The mean age of the donors was 36 +/- 12.8 years. The mean cold ischemia time was 5.6 +/- 3.2 hours. As many as 14 donors displayed acute renal failure (serum creatinine more than 1.2 mg/dL). Immediate graft function was established in 34 patients (50%). Four had graft rupture, two of which were successfully repaired. Postoperatively 12 patients (17.6%) displayed delayed graft function requiring dialysis. During the first year, 18 patients (26.4%) experienced acute rejection episodes, of which 14 were cellular and four vascular rejection types. As many as eight patients were lost to follow-up within one year; the mean follow-up time was 968 +/- 86 days. Patient survival at 1 year was 88.2% and that of the graft 73.5%. The 5-year patient and graft survival rates were 61.7% and 58.8%, respectively. The mean serum creatinine of patients currently followed is 2.2 +/- 0.86 mg/dL. The rate of cadaver kidney transplantation in India is low despite initiatives by our university to promote donation. Creating a positive public attitude, early brain death identification, and certification, prompt consent for organ donation, adequate hospital infrastructure, and support logistics are prerequisites for successful organ transplantation.

  6. Renal transplantation in HIV patients: A series of four cases

    OpenAIRE

    2012-01-01

    Human immunodeficiency virus (HIV) infection in a patient with end-stage renal disease was considered a contraindication for renal transplantation till now despite the advent of highly active antiretroviral therapy with the apprehension that immunosuppression would further jeopardize the already compromised immune status of the patients. Renal transplantation in HIV patients is rare in developing countries including ours. Here we report a series of four cases of renal transplantation in HIV p...

  7. Concurrent validity of kidney transplant questionnaire in US renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Chisholm-Burns MA

    2011-10-01

    Full Text Available Marie A Chisholm-Burns1,2, Steven R Erickson3, Christina A Spivey1, Rainer WG Gruessner2, Bruce Kaplan4 1Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ; 2Department of Surgery, University of Arizona College of Medicine, Tucson, AZ; 3Department of Clinical Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI; 4Department of Medicine, The University of Arizona College of Medicine Tucson, AZ, USA Background: Valid instrumentation in the assessment of health-related quality of life (HQoL in renal transplant recipients is critical to identifying particular nuances and determinants of HQoL in this population. Therefore, the validity of disease-specific instruments to measure HQoL in renal transplant recipients, such as the Kidney Transplant Questionnaire (KTQ, needs further investigation. The objective of this study was to assess the concurrent validity of the KTQ in adult US renal transplant recipients using the well established SF-12 Health Survey version 2 (SF-12v2 as the comparison instrument. Methods: One hundred and fourteen renal transplant recipients met the following inclusion criteria for this study, ie, were at least 21 years of age, more than two years post-transplant, and receiving immunosuppressant therapy. Subjects were asked to complete a series of HQoL instruments, ie, the KTQ and the SF-12v2 (physical component summary [PCS-12] and mental component summary [MCS-12]. Descriptive statistics were calculated, and correlational analyses were conducted to examine the concurrent validity of the HQoL instruments. Results: Among 100 participants (87.7% response rate, the majority of participants were male (52%, had deceased donor transplants (63%, and received Medicare benefits (84%. PCS-12 was positively correlated with three of five KTQ subscales (P < 0.05, ie, KTQ-physical (r = 0.43, KTQ-fatigue (r = 0.42, and KTQ-uncertainty/fear (r = 0.2. MCS-12 was positively correlated

  8. Targeting complement activation in brain-dead donors improves renal function after transplantation

    NARCIS (Netherlands)

    Damman, Jeffrey; Hoeger, Simone; Boneschansker, Leo; Theruvath, Ashok; Waldherr, Ruediger; Leuvenink, Henri G.; Ploeg, Rutger J.; Yard, Benito A.; Seelen, Marc A.

    2011-01-01

    Kidneys recovered from brain-dead donors have inferior outcomes after transplantation compared to kidneys from living donors. Since complement activation plays an important role in renal transplant related injury, targeting complement activation in brain-dead donors might improve renal function afte

  9. Renal cancer in kidney transplanted patients.

    Science.gov (United States)

    Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio

    2015-12-01

    Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

  10. Lymphocele – urological complication after renal transplantation

    Directory of Open Access Journals (Sweden)

    Wojciech Krajewski

    2013-04-01

    Full Text Available Renal transplantation is the best renal replacement treatment. It provides longer survival and a better quality of life. The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complicationsis lymphocele. Most cases of lymphocele develop during a period of several weeks after the procedure of transplantation. However, there are some literature reports concerning lymphocele diagnosis in the later period, even after several years. Most cases of lymphocele are asymptomatic and are diagnosed accidentally. Nevertheless, a large lymphocele may press the kidney, ureter, urinary bladder or neighbouring blood vessels, causing deterioration of renal function, leg oedema and thrombosis of iliac vessels. Among other complications there are infections. The cause of lymphocele is collection of the lymph drained from damaged lymph vessels surrounding iliac blood vessels and/or lymph vessels of the graft. Important factors predisposing to lymphocele are immunosuppressive treatment, including mTOR inhibitors, mycophenolic acid derivatives and high doses of glucosteroids. Factors favouring occurrence of lymphocele comprise obesity, diabetes, elderly age of recipient, long time of warm ischaemia, acute rejection episodes and delayed graft function. The authors describe presently available treatment methods including aspiration and percutaneous drainage, with or without sclerotisation, drainage using the Tenckhoff catheter and laparoscopic or open fenestration. At present, laparoscopic fenestration is considered to be the most efficient and the safest method. However, there are clinical cases where open surgical treatment is necessary.

  11. Pediatric renal transplantation: a single center experience

    Directory of Open Access Journals (Sweden)

    João Nascimento

    2015-12-01

    Full Text Available Introduction: End-stage renal disease in children is associated with numerous comorbidities and with age-specific mortality rates approximately 30 times higher than in healthy children. The first kidney transplantation in children was performed successfully in 1954. Surgical advances and new immunosuppressive medications have greatly improved patient’s and graft’s survival in the last years. Aim: Report Centro Hospitalar do Porto experience in pediatric renal transplantation in the last 30 years. Methods: Epidemiological and clinical data of all patients younger than 18 years, transplanted between January 1984 and August 2013, were collected from our database. In order to analyze the transplantation outcome in our center we compare graft survival between decades (1984-89 / 1990-99 / 2000-09 / 2010-13. We also compare graft survival between two age groups of patients (0-10 years ; 11-17 years at the time of surgery. Results: One hundred thirty-nine patients (58.3% male underwent 147 renal transplants (6.8% live donors. Congenital anomalies of the kidney and urinary tract (56.5% and glomerulonephritis (18.4% were the major causes of renal disease. Uncensored graft survivals rates at 5, 10, 15 and 20 years were 84.7%, 71.1%, 60.0% and 51.0%, while patient survivals were 97.9%, 95.9%, 94.7% and 94.7% respectively. Graft survival improved over time and the difference between the decades was statistically significant (p=0.004. Despite the better survival in the group of patients older than 11 years, graft’s survival difference between the two age groups was not statistically significant (p=0.697. Conclusion: The results of our hospital are comparable to other international centers. Significant improvement in survival was observed over the time. It seems that an accurate follow-up of our patients helps to minimize the negative impact of adolescence on graft survival rates.

  12. Hypertension in Renal Transplantation: Saudi Arabian Experience

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    Souqiyyeh Muhammad

    1999-01-01

    Full Text Available To evaluate the prevalence, etiologic factors and therapy of hypertension in actively followed up transplant population in Saudi Arabia; we retrospectively reviewed the records of the active renal transplant patients at two large transplant centers in Riyadh and Jeddah in Saudi Arabia. These subjects were transplanted between January 1979 and November 1998. The patients were grouped according to the measurement of blood pressure; group 1 (considered normo-tensive: blood pressure below 140/90 mmHg, group2: blood pressure between 140-159/90-99, group 3: blood pressure 160-179/100-109 group 4: equal to or above 180/110. There were 1115 patients′ records included in the study. The mean duration of transplantation was 66.9 ± 50.1 months. According to the level of measured blood pressure, there were 641 (57.5% patients in the normotensive group (group 1, 404 (36.3% patients in the mildly hypertensive group (group 2 64 (5.7% patients in the moderately severe hypertension group (group 3 and only six (0.5% patients in the severe hypertension group (group 4. The estimated prevalence of hypertension in this study was almost 85%. We found no significant difference in the prevalence of hypertension in terms of gender, year of transplantation, duration of transplantation, type of donor, number of previous transplants, diagnosis of renal artery stenosis, etiology of kidney disease, diagnosis of diabetes after transplantation, diagnosis of cerebrovascular accidents, or mean dose of prednisolone and cyclosporine. There was a statistically significant association between increased level of blood pressure and old age (above 50 years, original disease associated with hypertension, history of hypertension on dialysis, acute rejection (once or more, presence of protienuria (more than 0.3 mg/day, abnormality of ECG, or serum creatinine above 300 µmol/L. We conclude that hypertension is highly prevalent in the renal transplant population in Saudi Arabia. Risk

  13. Challenges of valve surgeries in post-renal transplant patients.

    Science.gov (United States)

    Ahmad, Tanveer; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere; Pasarad, Ashwini Kumar

    2015-01-01

    Renal transplantation remains a mainstay of therapy for the end-stage renal disease. Cardiac disease has a high prevalence in this patient population. Cardiovascular disease remains the leading cause of death among kidney transplantation patients. The cardiac disease accounts for 43% of all-cause mortality among dialysis patients and for ≈38% of all-cause mortality after transplantation. In this article, we review the factors and outcomes associated with valve surgeries in renal transplant recipients and evaluate the strategy for open heart surgery after renal transplantation performed.

  14. Renal transplantation--the Starzl influence.

    Science.gov (United States)

    Salvatierra, O

    1988-02-01

    In summary, I have attempted to review with you some of Dr Starzl's numerous clinical and scientific contributions that have cut across the spectrum of the field of renal transplantation. It is thus not surprising that Dr Starzl was elected the first President of the American Society of Transplant Surgeons, singular recognition from his own peers for the many contributions and leadership that he has provided during the formative and developmental years of organ transplantation. In addition, Dr Starzl has been recognized with a number of other prestigious awards, among which was the David M. Hume Memorial Award, the highest honor bestowed by the National Kidney Foundation. Careful analysis of Dr Starzl's work therefore clearly indicates that many of his contributions since 1960 have been uniquely innovative, have provided many firsts, and have reflected the science and technology of transplantation as it is today, in 1987. Thus, it can be truly said that Dr Starzl, the surgeon-scientist, was not only a pioneer but also a leader and subsequently a giant in the field of clinical renal transplantation. He has left a lasting and indelible impact on the field, the Starzl influence, for which all of us, both patient and physician, are extremely grateful. Thank you very much, Dr Starzl.

  15. Renal Transplantation from Elderly Living Donors

    Directory of Open Access Journals (Sweden)

    Jacob A. Akoh

    2013-01-01

    Full Text Available Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5 mL/min/1.73 m2 at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended.

  16. Overview of Pregnancy in Renal Transplant Patients

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    Silvi Shah

    2016-01-01

    Full Text Available Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include presence of hypertension, serum creatinine greater than 1.4 mg/dL, and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine, azathioprine, and low dose prednisone; and it is considered safe. Sirolimus and mycophenolate mofetil should be stopped 6 weeks prior to conception. The optimal time to conception continues to remain an area of contention. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Breast-feeding is not contraindicated and should not be discouraged. This review will help the physicians in medical optimization and counseling of renal transplant recipients of childbearing age.

  17. Renal transplantation in HIV-infected patients: 2010 update.

    Science.gov (United States)

    Trullas, Joan C; Cofan, Federico; Tuset, Montse; Ricart, María J; Brunet, Mercedes; Cervera, Carlos; Manzardo, Christian; López-Dieguez, María; Oppenheimer, Federico; Moreno, Asuncion; Campistol, Josep M; Miro, Jose M

    2011-04-01

    The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm(3) and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft.

  18. Prevalence of Anemia in Renal Transplant Patients in Turkey

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    Alparslan MERDİN

    2014-05-01

    Full Text Available OBJECTIVE: Post-transplant anemia is a common complication in renal allograft recipients. The most common causes are impaired graft function, immunosuppressive drugs, and infections. The aim of our study was to further investigate the prevalence of anemia before and after renal transplantation in renal allograft recipients in Turkey. MATERIAL and METHODS: We assessed 464 patients who received a kidney transplant between the years 2010 and 2012. The prevalence of anemia was evaluated before transplantation and at the 3 rd and at 6th months after transplantation. Our study is a retrospective study. RESULTS: The prevalence of anemia at the 6th month after the transplant surgery was 28.8%. The percentage of the patients who did not have anemia prior to the transplant surgery, and who developed anemia after the transplantation was 24.4%. CONCLUSION: Our findings are similar to those found in the literature, and show that anemia is a very common entity after renal transplantation.

  19. Review of Thrombotic Microangiopathy (TMA, and Post- Renal Transplant TMA

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    Ardalan Mohammad

    2006-01-01

    Full Text Available Thrombotic microangiopathy (TMA is a rare but devastating disorder; it involves small vessels and is characterized by intravascular thrombi of aggregated platelets leading to thrombocytopenia and variable degrees of organ ischemia and anemia, which is due to erythrocyte fragmentation in microcirculation. Childhood cases with predominant renal involvement are referred as the hemolytic uremic syndrome (HUS, and adults with major central neurological involvement are labeled as thrombotic thrombocytopenia purpura (TTP. Endothelial damage due to toxins and/or lack of defense against complement activation have a central role. Recent discovery of the von Willebrand Factor cleaving protease (ADAMTS 13 has offered new insight into the pathogenesis of TMA. TMA is also a well-recognized serious complication of renal transplantation. Clinical features of intravascular hemolysis are not always found. It may occur as de novo or recurrent and the majority of de novo cases are related to cyclosporin therapy. Viral infections, severe renal ischemia and acute vascular rejection are less frequent causes. Recurrence is negligible in diarrhea-associated HUS in childhood, but non-diarrheal HUS recurs in majority of adults following renal transplantation. Renal transplantation is contraindicated in familial/relapsing recurrent forms of HUS.

  20. Nocardia infection in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    K K Kaswan

    2011-01-01

    Full Text Available Opportunistic infection occurs in up to 20% renal transplant patients and is associated with a high mortality. We report a 47-year-old diabetic female with 1-year-old deceased donor renal allograft on triple drug immunosuppression. She developed cytomegalovirus retinitis at ten months post-transplant followed by nocardiasis manifested by hemiparesis with comatose state due to lumbar epidural and multiple brain abscesses, in spite of immediately curtailing immunosuppression. She recovered with linezolid and cotrimoxazole and was discharged two weeks later. She is maintaining stable graft function with serum creatinine 1.4 mg/dL on cyclosporin 2.5 mg/kg/day and prednisone10 mg/day with maintenance therapy for nocardiasis.

  1. Donor Transmission of Melanoma Following Renal Transplant

    Directory of Open Access Journals (Sweden)

    Kathryn T. Chen

    2012-01-01

    Full Text Available Donor transmission of melanoma is one of the more common and lethal of recipient malignancies, often presenting with systemic disease. Although some patients may receive durable remission of melanoma following explantation of the allograft and withdrawal of immunosuppression, donor transmission of melanoma is fatal in most patients. Here we present a case of a 44-year-old male who developed metastatic melanoma following renal transplant.

  2. Donor transmission of melanoma following renal transplant.

    Science.gov (United States)

    Chen, Kathryn T; Olszanski, Anthony; Farma, Jeffrey M

    2012-01-01

    Donor transmission of melanoma is one of the more common and lethal of recipient malignancies, often presenting with systemic disease. Although some patients may receive durable remission of melanoma following explantation of the allograft and withdrawal of immunosuppression, donor transmission of melanoma is fatal in most patients. Here we present a case of a 44-year-old male who developed metastatic melanoma following renal transplant.

  3. Whooping cough in a renal transplant recipient.

    Science.gov (United States)

    Garbiras, M; Shabaka, A; Calvo, N; Martin, L; Moreno, M A; Lopez de la Manzanara, V; Sanchez-Fructuoso, A I

    2016-04-01

    Whooping cough is a respiratory infection with a severity that varies with age, immune status, and probably with other factors such as the degree of exposure and the virulence of the organism. The most frequent microorganism responsible for whooping cough is Bordetella pertussis. We present the case of a 62-year-old renal transplant recipient presenting with typical and severe manifestations of whooping cough caused by B. pertussis.

  4. [Post-renal transplant pregnancy: a project to plan carefully].

    Science.gov (United States)

    Trubian, Alessandra; Zaza, Gianluca; Rugiu, Carlo; Tomei, Paola; Lupo, Antonio

    2012-01-01

    Kidney transplant is the best treatment for end-stage renal disease (ESRD) as it improves the quality of life and reduces the mortality risk for most patients compared with maintenance dialysis. Additionally, evidence from the literature suggests that renal function, endocrine status and libido rapidly improve after kidney transplant, and one in 50 women of childbearing age become pregnant. Therefore, it seems clear that pregnancy after transplant is a great challenge for physicians involved in this field. The available information on pregnancy outcomes is largely derived from case reports and single-center series, which are unlikely to be representative. Moreover, poor results are less likely to be reported. Many of the reports on long-term outcome show the results of past medical, obstetric, and neonatal care, which may be very different from current practice. Attempts are being made to provide more up-to-date, representative data through national transplantation pregnancy registries. A great number of researchers worldwide have analyzed the biological and endocrinological machinery associated with this event. Additionally, several strategies have been introduced to avoid unplanned pregnancies and to minimize maternal and fetal complications in renal transplant recipients. It seems evident that the return to fertility soon after transplant is often associated with unplanned pregnancy, which can expose both mother and fetus to considerable risks. This underpins the necessity to recommend contraceptive counseling and start clinical follow-up in order to early identify possible pregnancy-related risk factors. In general, pregnancy should not be recommended within the first year after kidney transplant because the risk of acute rejection is greatest and immunosuppressive therapy the most aggressive. It should be planned when organ function and immunosuppressive therapy are stabilized and there is no sign of rejection, hypertension, or chronic infection. Additionally

  5. Emerging role of gasotransmitters in renal transplantation.

    Science.gov (United States)

    Snijder, P M; van den Berg, E; Whiteman, M; Bakker, S J L; Leuvenink, H G D; van Goor, H

    2013-12-01

    Once patients with kidney disease progress to end-stage renal failure, transplantation is the preferred option of treatment resulting in improved quality of life and reduced mortality compared to dialysis. Although 1-year survival has improved considerably, graft and patient survival in the long term have not been concurrent, and therefore new tools to improve long-term graft and patient survival are warranted. Over the past decades, the gasotransmitters nitric oxide (NO), carbon monoxide (CO) and hydrogen sulfide (H2S) have emerged as potent cytoprotective mediators in various diseases. All three gasotransmitters are endogenously produced messenger molecules that possess vasodilatory, anti-apoptotic, anti-inflammatory and anti-oxidant properties by influencing an array of intracellular signaling processes. Although many regulatory functions of gasotransmitters have overlapping actions, differences have also been reported. In addition, crosstalk between NO, CO and H2S results in synergistic regulatory effects. Endogenous and exogenous manipulation of gasotransmitter levels modulates several processes involved in renal transplantation. This review focuses on mechanisms of gas-mediated cytoprotection and complex interactions between gasotransmitters in renal transplantation.

  6. Cardiovascular disease in renal transplant recipients.

    Science.gov (United States)

    McQuarrie, Emily P; Fellström, Bengt C; Holdaas, Hallvard; Jardine, Alan G

    2010-05-01

    Renal transplant recipients have a markedly increased risk of premature cardiovascular disease (CVD) compared with the general population, although considerably lower than that of patients receiving maintenance haemodialysis. CVD in transplant recipients is poorly characterised and differs from the nonrenal population, with a much higher proportion of fatal to nonfatal cardiac events. In addition to traditional ischaemic heart disease risk factors such as age, gender, diabetes and smoking, there are additional factors to consider in this population such as the importance of hypertension, left ventricular hypertrophy and uraemic cardiomyopathy. There are factors specific to transplantation such immunosuppressive therapies and graft dysfunction which contribute to this altered risk profile. However, understanding and treatment is limited by the absence of large randomised intervention trials addressing risk factor modification, with the exception of the ALERT study. The approach to managing these patients should begin early and be multifactorial in nature.

  7. Renal transplantation and polycystic: surgical considerations.

    Science.gov (United States)

    Rodríguez-Faba, O; Breda, A; Villavicencio, H

    2014-01-01

    The indication and timing of nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) remain controversial, especially in patients who are candidates to renal transplantation (RT). The main surgical options such as unilateral vs. bilateral nephrectomy, nephrectomy before vs. after RT, or simultaneous nephrectomy and transplantation, are herein discussed. Evidence acquisition of the best surgical management available for ADPKD in the context of kidney transplantation. Systematic literature review in PubMed from 1978 to 2013 was conducted. Articles selected included:randomized controlled trials and cohort studies. Furthermore, well designed ADPKD reviews were considered for this study. Laparoscopic nephrectomy in ADPKD is a safe procedure with an acceptable complication rate. Unilateral nephrectomy has advantages over the bilateral one regarding the perioperative complication rate. Although the timing of nephrectomy is controversial, it seems that simultaneous nephrectomy and renal transplantation does not increase surgical morbidity neither affect graft survival. Simultaneous nephrectomy and RT appears to be an acceptable alternative to conventional two-stage procedure without any increased morbidity, in the context of ADPKD. Furthermore, laparoscopic nephrectomy performed in experienced centres is a safe alternative to conventional approach. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  8. Efficacy of ultrasonography-guided renal biopsy for the evaluation of renal dysfunction following renal transplantation

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    Kim, Young Jae; Choi, Chul Soon; Min, Seon Jeong; Lee, Gyung Kyu; Lee, Eil Seong; Kang, Ik Won; Bae, Sang Hoon [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2003-12-15

    To evaluate the usefulness and complications of renal biopsy under ultrasonography-guidance in renal dysfunction after renal transplantation. Ultrasonography-guided renal biopsy was done in 47 patients with the transplanted kidney. The subjects consisted of 30 males and 17 females, age ranged from 16 to 66 years (average age=38 years). Biopsies were done once in 27 patients, twice in 17 patients, three times in 3 patients, a total of 70 biopsies. The success rate of renal biopsy for the accurate pathologic diagnosis and the incidence and types of complications following biopsy were evaluated. The success rate of renal biopsy for the accurate pathologic diagnosis was 96%(67/70). Pathologic diagnosis included 27 cases of acute rejection (39%), 8 cases of acute tubular necrosis (11%), 4 cases of acute rejection and acute tubular necrosis (6%), 4 cases of cyclosporin toxicity (6%), 4 cases of primary disease recurrence (6%), 4 cases of infection (6%) and others. Complications after renal biopsy included 15 cases of microscopic hematuria (21%), 1 case of gross hematuria with spontaneous cessation and 1 case of life threatening hemorrhage. Ultrasonography-guided renal biopsy is a safe and effective diagnostic method for the evaluation of renal dysfunction following renal transplantation.

  9. Survival Benefit in Renal Transplantation Despite High Comorbidity

    DEFF Research Database (Denmark)

    Sørensen, Vibeke Rømming; Heaf, James; Wehberg, Sonja

    2016-01-01

    BACKGROUND: The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances...... with high comorbidity still had a survival benefit from renal transplantation.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly...... and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list. METHODS: Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from...

  10. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M

    2017-05-13

    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m(2). Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m(2); %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  11. Impaired renal allograft function is associated with increased arterial stiffness in renal transplant recipients

    DEFF Research Database (Denmark)

    Kneifel, M; Scholze, A; Burkert, A;

    2006-01-01

    It is important whether impairment of renal allograft function may deteriorate arterial stiffness in renal transplant recipients. In a cross-sectional study, arterial vascular characteristics were non-invasively determined in 48 patients with renal allograft using applanation tonometry and digital...... of large arteries S1 and small arteries S2 in renal transplant recipients (each p renal allograft (p ...-Wallis test between groups). It is concluded that impairment of renal allograft function is associated with an increased arterial stiffness in renal transplant recipients....

  12. Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis : A Case Report

    OpenAIRE

    種田, 建史; 金光, 俊行; 林, 哲也; 藤本, 宜正; 小出, 卓生

    2016-01-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0....

  13. Renal transplantation at the Johns Hopkins Comprehensive Transplant Center.

    Science.gov (United States)

    Montgomery, Robert A; Cooper, Matthew; Kraus, Edward; Rabb, Hamid; Samaniego, Milagros; Simpkins, Christopher E; Sonnenday, Christopher J; Ugarte, Richard M; Warren, Daniel S; Zachary, Andrea A

    2003-01-01

    A stagnant supply of transplantable organs in the face of a relentless burgeoning of transplant waiting lists has created a crisis. Necessity continues to be the mother of invention and as the crisis has deepened it has served as a crucible for the development of new ways to think about perennial problems. Our program has taken a 2-pronged approach to increasing the organ supply for our patients. First, through innovations like the laparoscopic donor nephrectomy, ABO-incompatible and positive-crossmatch transplantation protocols, unconventional paired kidney exchanges, and the use of altruistic donors we have more than doubled our utilization of live donor organs. At the same time, we have developed algorithms and interrogative techniques to enhance the intelligent use of kidneys from expanded criteria donors for patients who do not have an available live donor. The laparoscopic nephrectomy has proven to be a safe and effective way of removing a significant barrier to live donation. Our results from 100 ABOi, (+)XM, and PKE transplants are similar to national statistics for compatible live donor transplants, suggesting that existing paradigms of compatibility can be safely expanded. These encouraging early outcomes and the savings they transmit to the health care system have allowed us to obtain insurance coverage for the InKTP programs, setting the stage for further expansion of these opportunities to broaden the options for patients with end-stage renal disease.

  14. Acute torsion of a retroperitoneal renal transplant mimicking renal vein thrombosis.

    Science.gov (United States)

    Winter, Thomas C; Clarke, Andrea Lynn; Campsen, Jeffrey

    2013-09-01

    When imaging a renal transplant, the combination of absent flow in the main renal vein and reversed diastolic flow in the intrarenal arteries is considered highly suggestive of renal vein thrombosis. We present a case of torsion of a transplant kidney presenting with identical findings. Renal transplant torsion in general is a rare entity, previously described only in intraperitoneally placed organs; this case is the first that we are aware of with torsion occurring in a retroperitoneally placed graft.

  15. Five years renal transplantation data: Single-center experience from Iraq

    Directory of Open Access Journals (Sweden)

    Ala A Ali

    2016-01-01

    Full Text Available Renal transplantation is the treatment of choice for patients with end-stage renal disease. In Iraq, renal transplantation started in 1973 and has continued until now with live donor transplantation, since deceased donor transplant program is not approved as yet. Long-term transplant data are still scarce. The aim of our study is to present data on transplantation and medical follow-up at one year and, survival analysis at one, three and five years. A total of 250 renal transplantations were performed at the Nephrology and Renal Transplantation Center, Baghdad between January 2009 and January 2014. It is a living donor, blood group compatible donor program. All patients received triple immunosuppression (calcineurine inhibitor, mycophenolate mofetil or mycophenolic acid, and steroid. The Kaplan-Meier method was used to determine the survival rate. There were 92 live related donors, 143 unrelated donors, and 15 spouse donors. The mean age was 34.07 ± 12.2 years. The one-year graft survival for related and unrelated donor transplants was 98.9% and 91.8%, respectively. Graft survival was lower (82.9% in recipients with acute rejection episodes. The patient survival at one-year was 94%. The three-year graft and patient survival was 91% and 90%, respectively, and five-year survival for grafts and patients was 87.1% and 88%, respectively. The outcome of the renal transplantation in Iraq is improving. Long-term patient follow-up needs more meticulous attention. The development of renal transplant registry is critical for future planning. Moreover, renal transplantation practice in Iraq needs more social, religious, and governmental support.

  16. 42 CFR 414.320 - Determination of reasonable charges for physician renal transplantation services.

    Science.gov (United States)

    2010-10-01

    ... renal transplantation services. 414.320 Section 414.320 Public Health CENTERS FOR MEDICARE & MEDICAID... Determination of reasonable charges for physician renal transplantation services. (a) Comprehensive payment for... a renal transplantation, including the usual preoperative and postoperative care, and...

  17. Cerebral Post-Transplant Lymphoproliferative Disorder Occurring after Renal Transplantation: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Jang Ho; Byun, Woo Mok; Kim, Hong Chul; Hwang, Min Su [Dept. of Radiology, Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2012-04-15

    Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation and immunosuppression. A 36-year-old woman with a history of renal transplantation visited the hospital complaining of headache and on pathology was diagnosed with cerebral PTLD manifesting as multiple rim enhanced masses in both hemispheres. We report here a case of post-transplant lymphoproliferative disorder involving the cerebrum occurring after renal transplantation, and describe the MRI findings for this patient

  18. [Estimate of the needs in renal transplantation in Morocco].

    Science.gov (United States)

    Boly, Ahmadou; El Hassane Trabelsi, Mohamed; Ramdani, Benyounes; Bayahia, Rabea; Benghanem Gharbi, Mohamed; Boucher, Stéphanie; El Berri, Hicham; Nejjari, Chakib; Couchoud, Cécile

    2014-12-01

    Kidney transplantation is still underdeveloped in Morocco. In order to anticipate needs and discuss a possible reorganization of the provision of care, an estimate of the number of patients who would benefit from kidney transplant was conducted. This study was done in two steps. During the first step, based on the French renal replacement therapy registry (Rein), we develop a prediction score based on the likelihood of being treated by an autonomous dialysis (hemodialysis in self-care unit or peritoneal dialysis non-assisted by a nurse) and be registered on the national kidney transplant waiting list. During the second step, we apply this score to the data of the registry Magredial (Moroccan registry of renal replacement therapy, deployed in seven regions). Twelve parameters were related to autonomy and registration on the waiting list. Each of these parameters has been assigned a weight. Each patient was assigned a number of points, sum of different weights. By retaining a threshold of 21 points (80% specificity), 2260 subjects (57%) had a score less than or equal to this threshold in Magredial. With a number of patients on dialysis in Morocco estimated to 13,000 in late 2013, the estimated need for kidney transplant will be of 7410. This estimate should encourage professionals and health authorities of Morocco to engage more effort in the implementation of actions related to the transplant program.

  19. Dream anxiety in renal transplant recipients.

    Science.gov (United States)

    Yazla, Ece; Ozkurt, Sultan; Musmul, Ahmet

    2015-06-01

    Although low quality of sleep has been reported in kidney transplant patients with functioning allografts, there are no previous studies investigating the dreams of these patients. We aimed to investigate the differences in dream anxiety level between renal transplant patients and healthy control subjects. We also planned to compare depression and anxiety symptoms, sleep quality and sleepiness level between these two groups. Twenty-two living-donor renal transplant recipients followed at an outpatient nephrology clinic and 22 healthy controls were enrolled in this observational cross-sectional study. Sociodemographic Data Collection Form, and the Van Dream Anxiety Scale (VDAS), the Pittsburg Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), Beck Depression and Anxiety Inventories were used for the assessment of the necessary features. Hemoglobin (Hb), blood urea nitrogen (BUN), creatinine (Cr) and glucose levels were measured. There were no significant differences between the groups in terms of dream anxiety (p = 0.45), depression (p = 0.76), sleep quality (p = 0.8), insomnia severity (p = 0.08) and Hb (p = 0.11) and glucose levels (p = 0.14). Although, BUN (p = 0.00) and creatinine (p = 0.00) levels differed significantly between the two groups, both parameters were found to be within their normal range. In our study, chronic renal failure patients with a successful kidney transplant were found to be able to completely return to normal in terms of metabolic parameters, sleep quality and mood. Similar levels of dream anxiety are also consistent with these findings.

  20. Spontaneous Clearance of Hepatitis C after Liver and Renal Transplantation

    Directory of Open Access Journals (Sweden)

    CH Dale

    2009-01-01

    Full Text Available Spontaneous clearance of hepatitis C virus (HCV is rare in immunocompromised patients, such as those who have undergone organ transplantation. It has been recognized that patients receiving liver transplantation for HCV-related disease have decreased graft and patient survival compared with those transplanted for other etiologies. There is a growing trend toward treating HCV recurrence aggressively after liver transplantation. For other organ transplant recipients with concurrent HCV, treatment is not often an option, given the high rates of graft rejection and loss secondary to interferon and its immunomodulatory effects. Although spontaneous clearance of HCV has been reported in recipients of solitary liver and renal transplants, a common factor arising in these cases has been previous exposure to interferon. To date, no reports of spontaneous clearance of HCV RNA have been reported in a multiorgan transplant recipient. A case of spontaneous clearance of HCV RNA in an immunocompromised patient, within five months of simultaneous liver and kidney retransplantation is described. Importantly, this patient had no previous exposure to interferon.

  1. Uncommon side effect of MMF in renal transplant recipients.

    Science.gov (United States)

    Balal, M; Demir, E; Paydas, Saime; Sertdemir, Y; Erken, U

    2005-01-01

    Mycophenolate mofetil (MMF) is a potent immunosuppressive agent used in renal transplantation. Gastrointestinal and hematological side effects are commonly observed, but hepatotoxicity has not been reported. In this study, we assessed MMF-related hepatotoxicity in renal transplant recipients. A total of 124 renal transplantation recipients (RTRs) were evaluated for elevated liver enzymes associated with MMF, and 79 patients were enrolled to the study. Patients used MMF 2 g/day. The patients who had progressive increase in liver enzymes after renal transplantation and their AST, ALT, GGT, ALP, bilirubin levels, hepatitis, cytomegalovirus (CMV), abdominal ultrasonography, duration of hepatotoxicity, and decreased dosage or withdrawal of MMF were recorded. Also, we evaluated their liver enzymes while the patients were on the waiting list. Of the 79 patients, 11 patients (13.9%) had a progressive increase in liver enzymes. The median (min-max) age of the patients with MMF-hepatotoxicity was 29 (19-54) and 72.7% of them were male. None of the patients had hepatitis B or C, CMV infection, or other possible causes for elevated liver enzymes and their abdominal ultrasonography were normal. High liver enzyme levels regressed after the withdrawal (n=6) or reduce dosage (n=5) of MMF. The median time of the increase in liver enzymes was 28 (4-70) days and after 50% reduction or withdrawal of MMF, returned to normal values in 16 (4-210) days. The median levels of ALT in waiting list (I), before (II), and after (III) reduction dosage or withdrawal of MMF were 22.0 (3-22), 222.0 (51-508), and 33.0 (21-64) U/L, respectively (p I-II=0.004,p I-II=0.013, andp II-III=0.005). There were no differences for ALP, GGT, total bilirubin, and direct bilirubin levels. Also, the correlation between recovery time of ALT and persistence time of ALT elevation before adjustment of MMF was significant (r=0.739, p=0.009). Consequently, after renal transplantation, hepatotoxicity can occur due to a

  2. Treatment of advanced rectal cancer after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    Hai-Yi Liu; Xiao-Bo Liang; Yao-Ping Li; Yi Feng; Dong-Bo Liu; Wen-Da Wang

    2011-01-01

    Renal transplantation is a standard procedure for end-stage renal disease today. Due to immunosuppressive drugs and increasing survival time after renal trans-plantation, patients with transplanted kidneys carry an increased risk of developing malignant tumors. In this case report, 3 patients with advanced rectal can-cer after renal transplantation for renal failure were treated with anterior resection or abdominoperineal resection plus total mesorectal excision, followed by adjuvant chemotherapy. One patient eventually died of metastasized cancer 31 mo after therapy, although his organ grafts functioned well until his death. The other 2 patients were well during the 8 and 21 mo follow-up periods after rectal resection. We therefore strongly argue that patients with advanced rectal cancer should receive standard oncology treatment, including opera-tion and adjuvant treatment after renal transplantation. Colorectal cancer screening in such patients appears justified.

  3. [Renal transplantation without maintenance immunosuppression. Identical twins and kidney transplantation following a successful bone marrow graft].

    Science.gov (United States)

    Hadi, Riad Abdel; Thomé, Gustavo Gomes; Ribeiro, Adriana Reginato; Manfro, Roberto Ceratti

    2015-01-01

    Renal transplantation without maintenance immunosuppression has been sporadically reported in the literature. The cases include non-adherent patients who discontinued their immunosuppressive medications, transplantation between identical twins, kidney transplantation after a successful bone marrow graft from the same donor and simultaneous bone marrow and kidney transplantation for the treatment of multiple myeloma with associated renal failure. There are also ongoing clinical trials designed to induce donor specific transplant tolerance with infusion of hematopoietic cells from the same kidney donor. Here we describe two cases of renal transplantation without immunosuppression as examples of situations described above.

  4. Chronic Renal Transplant Rejection and Possible Anti-Proliferative Drug Targets.

    Science.gov (United States)

    Bhatti, Adnan Bashir; Usman, Muhammad

    2015-11-06

    The global prevalence of renal transplants is increasing with time, and renal transplantation is the only definite treatment for end-stage renal disease. We have limited the acute and late acute rejection of kidney allografts, but the long-term survival of renal tissues still remains a difficult and unanswered question as most of the renal transplants undergo failure within a decade of their transplantation. Among various histopathological changes that signify chronic allograft nephropathy (CAN), tubular atrophy, fibrous thickening of the arteries, fibrosis of the kidney interstitium, and glomerulosclerosis are the most important. Moreover, these structural changes are followed by a decline in the kidney function as well. The underlying mechanism that triggers the long-term rejection of renal transplants involves both humoral and cell-mediated immunity. T cells, with their related cytokines, cause tissue damage. In addition, CD 20+ B cells and their antibodies play an important role in the long-term graft rejection. Other risk factors that predispose a recipient to long-term graft rejection include HLA-mismatching, acute episodes of graft rejection, mismatch in donor-recipient age, and smoking. The purpose of this review article is the analyze current literature and find different anti-proliferative agents that can suppress the immune system and can thus contribute to the long-term survival of renal transplants. The findings of this review paper can be helpful in understanding the long-term survival of renal transplants and various ways to improve it.

  5. The Iranian model of living renal transplantation.

    Science.gov (United States)

    Mahdavi-Mazdeh, Mitra

    2012-09-01

    Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'.

  6. Gastrointestinal complications in renal transplant recipients.

    Science.gov (United States)

    Ponticelli, Claudio; Passerini, Patrizia

    2005-06-01

    Gastrointestinal complications are frequent in renal transplant recipients and can include oral lesions, esophagitis, peptic ulcer, diarrhea, colon disorders and malignancy. Oral lesions may be caused by drugs such as cyclosporine and sirolimus, by virus or fungal infections. Leukoplakia may develop in patients with Epstein-Barr virus (EBV) infection. The commonest esophageal disorder is represented by fungal esophagitis usually caused by candida. A number of patients may suffer from nausea, vomiting and gastric discomfort. These disorders are more frequent in patients treated with mycophenolate mofetil (MMF). Peptic ulcer is more rare than in the past. Patients with a history of peptic ulcer are particularly prone to this complication. Other gastroduodenal disorders are caused by cytomegalovirus (CMV) and herpes simplex infection. Diarrhea is a frequent disorder which may be caused by pathogen microorganisms or by immunosuppressive agents. The differential diagnosis may be difficult. Colon disorders mainly consist of hemorrhage, usually sustained by CMV infection, or perforation which may be caused by diverticulitis or intestinal ischemia. Colon cancer, anal carcinoma, and EBV-associated lymphoproliferative disorders are particularly frequent in transplant recipients. A particular gastric lymphoma called mucosa-associated lymphoid tissue (MALT) lymphoma may develop in renal transplant patients. It usually responds to the eradication of Helicobacter pylori.

  7. Microhematuria after renal transplantation in children.

    Science.gov (United States)

    Butani, Lavjay; Berg, Gerre; Makker, Sudesh P

    2002-12-01

    The renal transplant (Tx) recipient is at risk for developing various complications including urolithiasis, the only manifestation of which may be hematuria. However, there are no data on the prevalence of microscopic hematuria in renal Tx recipients. The objective of our study was to determine the prevalence of microhematuria in our pediatric Tx patients and to investigate the causes of microhematuria. Records of all pediatric renal Tx recipients followed at our center from September 1999 to September 2000 were retrospectively reviewed; of the 21 patients, seven (33%) had persistent microscopic hematuria that was first noted 2.9 years post-Tx. Patients with and without hematuria had similar baseline characteristics. Only one patient had pre-existing hematuria that continued post-Tx. The etiology of hematuria in the other six patients was: recurrent IgA nephropathy (one patient), CMV nephritis (one patient), and unexplained (four patients). None had renal calculi or hypercalciuria. Three of the four patients with unexplained hematuria have chronic allograft nephropathy, and the fourth (original disease dysplasia) has hypocomplementemia. At their last follow-up, 5.3 years after onset of hematuria, all patients are alive with stable allograft function. In conclusion, microscopic hematuria is not uncommon in pediatric renal Tx recipients. While causes of post-Tx hematuria are diverse, stones are not commonly seen. Whether chronic allograft nephropathy per se can be implicated as a cause of hematuria remains to be determined. Renal biopsies should be considered at the onset of hematuria if proteinuria and/or deterioration in renal function are seen concomitantly, to look for recurrent or de novo glomerulonephritis.

  8. Targeting complement activation in brain-dead donors improves renal function after transplantation.

    Science.gov (United States)

    Damman, Jeffrey; Hoeger, Simone; Boneschansker, Leo; Theruvath, Ashok; Waldherr, Ruediger; Leuvenink, Henri G; Ploeg, Rutger J; Yard, Benito A; Seelen, Marc A

    2011-05-01

    Kidneys recovered from brain-dead donors have inferior outcomes after transplantation compared to kidneys from living donors. Since complement activation plays an important role in renal transplant related injury, targeting complement activation in brain-dead donors might improve renal function after transplantation. Brain death (BD) was induced in Fisher rats by inflation of an epidurally placed balloon catheter and ventilated for 6h. BD animals were treated with soluble complement receptor 1 (sCR1) 1h before or 1h after BD. Kidney transplantation was performed and 7 days after transplantation animals were sacrificed. Plasma creatinine and urea were measured at days 0, 1, 3, 5 and 7 after transplantation. Renal function was significantly better at day 1 after transplantation in recipients receiving a sCR1 pre-treated donor kidney compared to recipients of a non-treated donor graft. Also treatment with sCR1, 1h after the diagnosis of BD, resulted in a better renal function after transplantation. Gene expression of IL-6, IL-1beta and TGF-beta were significantly lower in renal allografts recovered from treated donors. This study shows that targeting complement activation, during BD in the donor, leads to an improved renal function after transplantation in the recipient.

  9. Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension.

    Science.gov (United States)

    Orlando, Giuseppe; Baiocchi, Leonardo; Cardillo, Andrea; Iaria, Giuseppe; De Liguori Carino, Nicola; De Liguori, Nicola; De Luca, Linda; Ielpo, Benedetto; Tariciotti, Laura; Angelico, Mario; Tisone, Giuseppe

    2007-01-01

    Although mycophenolate mofetil (MMF) monotherapy has been successfully used in liver transplant recipients suffering from calcineurin-inhibitor (CNI)-related chronic toxicity, still no consensus has been reached on its safety, efficacy and tolerability. We attempted the complete weaning off CNI in 42 individuals presenting chronic renal dysfunction and/or dyslipidemia and/or arterial hypertension and simultaneously introduced 1.5 gm/day MMF. CNI could be completely withdrawn in 41 cases. A total of 32 (75%) patients are currently on MMF. Mean follow-up from the introduction of MMF is 31.5 months and mean length of follow-up from the beginning of MMF monotherapy is 27.3 months. Renal function improved in 31/36 (89%) cases. Blood levels of cholesterol and triglycerides decreased in 13 of 17 (76%) and 15 of 17 (89%) patients, respectively. Arterial hypertension improved in 4 of 5 (80%) cases. A total of 8 patients showed a single episode of fluctuation of liver function tests during tapering off CNI. This feature was interpreted as an acute rejection (AR), based on the resolution of the clinical setting after escalation of MMF daily dose to 2 gm. A further patient developed a biopsy-proven AR insensitive to MMF adjustment, requiring reinstitution of the CNI dose. No deaths or major toxicity requiring MMF discontinuation occurred. In conclusion, low dose MMF monotherapy is safe, effective, and well tolerated.

  10. Acute cardiac tamponade: an unusual cause of acute renal failure in a renal transplant recipient.

    Science.gov (United States)

    Nampoory, Naryanan; Gheith, Osama; Al-Otaibi, Torki; Halim, Medhat; Nair, Prasad; Said, Tarek; Mosaad, Ahmed; Al-Sayed, Zakareya; Alsayed, Ayman; Yagan, Jude

    2015-04-01

    We report a case of slow graft function in a renal transplant recipient caused by uremic acute pericardial effusion with tamponade. Urgent pericardiocentesis was done with an improvement in blood pressure, immediate diuresis, and quick recovery of renal function back to baseline. Pericardial tamponade should be included in consideration of causes of type 1 cardiorenal syndrome in renal transplant recipients.

  11. Does daily urine output really matter in renal transplantation?

    Science.gov (United States)

    Tillou, Xavier; Lee-Bion, Adrien; Hurault de Ligny, Bruno; Orczyk, Clément; Le Gal, Sophie; Desmonts, Alexis; Bensadoun, Henri; Doerfler, Arnaud

    2013-12-27

    Our objective was to clarify the clinical outcome of renal transplantation based on residual daily urine output (RDUO). We retrospectively analyzed a prospective database of 276 patients who underwent renal transplantation (Tx) between January 2008 and December 2012. Patients had pre-transplantation daily urine output measurement of 24-h proteinuria and were clinically re-evaluated the day before transplantation. We included patients with no daily urine output and those with residual daily urine output. Real bladder capacity was not measured. We excluded patients with a history of lower urinary tract malformation, those treated by trans-ileal conduit or enterocystoplasty, and those with early graft thrombosis or graft primary non-function. Sex ratio, age at Tx, pre-Tx MHC antibodies levels, donor age, and cold ischemia duration were not significantly different between the 2 groups. Dialysis duration was longer in group I (p<0.001). The dialysis duration was correlated with the volume of residual urine output (r=0.12, p<0.0001). We found 14 (19.4%) urological complications in Group I (11 urinary leaks and 3 urethral stenosis) and 13 (6.4%) in Group II (5 urinary leaks and 8 stenosis). This difference was significant (p=0.0013 and relative risk [RR]=2.2). Absence of residual daily urine output was a risk factor of post-transplantation urinary leak (p<0.0001: RR=2.95). At 3 years, graft survival was 74.7% and 94.6%, respectively, in Group I and II (p=0.003). The absence of residual daily urine output seems to be a major risk factor for urological complications. Taking into account recipient residual daily urine output should modify surgical strategy during renal transplantation.

  12. Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation.

    Directory of Open Access Journals (Sweden)

    Chen C

    2003-01-01

    Full Text Available A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.

  13. Acute Rejection after Human Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Ana Roussoulières

    2007-01-01

    Full Text Available Genes involved in acute rejection (AR after organ transplantation remain to be further elucidated. In a previous work we have demonstrated the under-expression of VE-Cadherin by endothelial cells (EC in AR following murine and human heart transplantation. Serial sections from 15 human kidney Banff-graded transplant biopsies were examined for the presence of VE-Cadherin and CD34 staining by immunohistochemistry (no AR (n=5, AR grade IA (n=5, or AR grade IIA (n=5. Quantification of peritubular EC staining were evaluated and results were expressed by the percentage of stained cells per surface analysed. There was no difference in CD34 staining between the 3 groups. VE-Cadherin expression was significantly reduced in AR Grade IIA when compared to no AR (P=.01 and to AR grade IA (P=.02. This study demonstrates a reduced VE-Cadherin expression by EC in AR after renal transplantation. The down-regulation of VE-Cadherin may strongly participate in human AR.

  14. Infectious Alopecia in a Dog Breeder After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Cheng-Hsu Chen

    2008-09-01

    Full Text Available Tinea capitis rarely occurs in renal transplant recipients. We report this living-related renal transplant patient receiving cyclosporine-based therapy who initially presented with severe exfoliation of the scalp with yellowish-white scales and marked hair loss. The lesions extended to the frontal area and both cheeks, resulting in several skin ulcers with perifocal erythematous inflammatory changes, and palpable cervical lymph nodes. A biopsy of a skin lesion revealed fungal infection and culture yielded Microsporum canis. The patient mentioned an outbreak of ringworm in her breeding dogs during this period. After adequate treatment of the patient and her infected animals with griseofulvin and disinfection of the environment, her skin lesions resolved dramatically, with regrowth of hair.

  15. [Surgical complications in 479 renal transplantations].

    Science.gov (United States)

    Borrego, J; Burgos, F J; Galmes, I; Orofino, L; Rodríguez Luna, J M; Marcen, R; Fernández, E; Escudero, A; Ortuño, J

    1994-04-01

    Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

  16. [Pregnancy in patients with renal transplantation].

    Science.gov (United States)

    Chocair, P R; Ianhez, L E; de Paula, F J; Sabbaga, E; Arap, S

    1989-01-01

    From 1969 to 1987, 35 pregnancies occurred in 31 women with renal transplant. Four of them were still pregnant when this study was concluded. There was one ectopic pregnancy. All patients received azathioprine and prednisone. In the majority of patients the glomerular filtration rate increased in a way similar to normal pregnant women. In five cases there was a progressive loss in renal function. In four of them this was attributed to preexistent renal damage. No toxemia occurred. Anemia developed during 11 pregnancies and blood transfusion was required for five women. Four patients had urinary tract infection which was easily controlled with antibiotics. One patient had severe arterial hypertension, secondary to chronic rejection. One patient developed jaundice reverted with reduction in azathioprine doses. One woman died of septicemia secondary to fetal death, during the 6th month of pregnancy. Twenty children were born with no abnormalities, although many of them were underweighted. Two thirds of pregnancies were delivered by cesarean section. No harm to the pelvic allograft occurred in vaginal deliveries. There have been 4 abortions (2 of them were induced with no medical indication). Four pregnancies (26 to 39 gestational weeks) ended in stillborn babies: the mothers had impaired renal function associated with hypertension and proteinuria. One newborn died of pulmonary infection two days after delivery. Another was born with microcephaly and polydactilia and survived 6 years. No breast feeding was allowed.

  17. Causes of frequency and nocturia after renal transplantation.

    NARCIS (Netherlands)

    Weide, M.J.A. van der; Achterberg, T. van; Smits, J.P.J.M.; Heesakkers, J.P.F.A.; Bemelmans, B.L.H.; Hilbrands, L.B.

    2008-01-01

    OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant

  18. Causes of frequency and nocturia after renal transplantation

    NARCIS (Netherlands)

    Weide, M.J.A. van der; Achterberg, T. van; Smits, J.P.J.M.; Heesakkers, J.P.F.A.; Bemelmans, B.L.H.; Hilbrands, L.B.

    2008-01-01

    OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant

  19. Calcification Propensity and Survival among Renal Transplant Recipients

    NARCIS (Netherlands)

    Keyzer, Charlotte A.; de Borst, Martin H.; van den Berg, Else; Jahnen-Dechent, Willi; Arampatzis, Spyridon; Farese, Stefan; Bergmann, Ivo P.; Floege, Juergen; Navis, Gerjan; Bakker, Stephan J. L.; van Goor, Harry; Eisenberger, Ute; Pasch, Andreas

    2016-01-01

    Calciprotein particle maturation time (T-50) in serum is a novel measure of individual blood calcification propensity. To determine the clinical relevance of T-50 in renal transplantation, baseline serum T-50 was measured in a longitudinal cohort of 699 stable renal transplant recipients and the ass

  20. Causes of frequency and nocturia after renal transplantation.

    NARCIS (Netherlands)

    Weide, M.J.A. van der; Achterberg, T. van; Smits, J.P.J.M.; Heesakkers, J.P.F.A.; Bemelmans, B.L.H.; Hilbrands, L.B.

    2008-01-01

    OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant pat

  1. Causes of frequency and nocturia after renal transplantation

    NARCIS (Netherlands)

    Weide, M.J.A. van der; Achterberg, T. van; Smits, J.P.J.M.; Heesakkers, J.P.F.A.; Bemelmans, B.L.H.; Hilbrands, L.B.

    2008-01-01

    OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant pat

  2. Mineral metabolism in European children living with a renal transplant

    DEFF Research Database (Denmark)

    Bonthuis, Marjolein; Busutti, Marco; van Stralen, Karlijn J;

    2015-01-01

    Nephrology/European Renal Association-European Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant...

  3. Nephrogenic Systemic Fibrosis Symptoms Alleviated by Renal Transplantation

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Hansen, J. M.; Marckmann, P.

    2011-01-01

    are limited. Anecdotal reports have shown partial or complete resolution of NSF following successful renal transplantation early in the course of NSF. In this report, we describe alleviation of NSF symptoms in two women following successful renal transplantation more than 3 years after onset of NSF....

  4. Proptosis in a post-renal transplant patient with disseminated tuberculosis.

    Science.gov (United States)

    Vishnubhotla, S; Siddhartha, B; Sivramakrishna, G; Lakshmi, A Y; Kumaraswamy, R M

    2009-06-01

    A 55-year-old male patient 13 years post living-related renal transplant on immunosuppressives presented with prolonged fever and a recent protrusion of the right eyeball. Evaluation revealed disseminated tuberculosis with a tuberculoma in the right orbit.

  5. Interventional radiological treatment of renal transplant complications: A pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Lezzi, Roberto; La, Torre Michele fabio; Santoro, Marco; Dattesi, Robrta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; CItterio, Franco; Bonomo, Lorenzo [' A. Gemelli' Hospital - Catholic University, Rome (Italy)

    2015-06-15

    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.

  6. Clinical relevance of post-transplant pharmacodynamic analysis of cyclosporine in renal transplantation.

    Science.gov (United States)

    Kurata, Yoko; Kuzuya, Takafumi; Miwa, Yuko; Iwasaki, Kenta; Haneda, Masataka; Amioka, Katsuo; Yamada, Kiyofumi; Watarai, Yoshihiko; Katayama, Akio; Uchida, Kazuharu; Kobayashi, Takaaki

    2014-10-01

    Although therapeutic drug monitoring based on blood concentration has been widely implemented in transplant recipients treated with immunosuppressive agents, clinical adverse events such as rejection, infection or drug-induced toxicity caused by inappropriate dosage cannot be completely controlled. Development of an effective assay for optimized immunosuppression would be desirable, which can potentially lead to personalized medicine in renal transplantation. Cyclosporine (CSA) pharmacodynamic analysis using carboxyfluorescein diacetate succinimidyl ester (CFSE)-based T cell proliferation assay was examined in 66 kidney transplant recipients before and after transplantation. Two parameters, the 50% inhibitory concentration (IC50) and the percentage of T-cell proliferation values at the lower plateau (bottom), were compared with clinical events. A significant relation in CSA pharmacodynamic parameters was observed between pre- and post-transplantation. Analysis of the association between clinical outcomes and pharmacodynamic parameters in post-transplant samples demonstrated the following findings: (i) cytomegalovirus (CMV)/varicella zoster virus (VZV) reactivation and CSA-induced nephrotoxicity were significantly associated with high sensitivity to CSA (low bottom or low IC50), (ii) acute T cell-mediated rejection (ATMR) was significantly related to low sensitivity to CSA (high bottom), and (iii) de novo human leukocyte antigen (HLA) antibody production was associated with lower bottom and IC50 values, although the elucidation of those mechanisms is still in progress. It was suggested that CSA pharmacodynamics applied at post-transplantation would be useful for optimizing immunosuppressive therapy. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Uses and limitations of renal scintigraphy in renal transplantation monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Heaf, J.G. [Department of Nephrology, Herlev Hospital, University of Copenhagen (Denmark); Iversen, J. [Department of Clinical Physiology, Herlev Hospital, University of Copenhagen (Denmark)

    2000-07-01

    The value of thrice weekly technetium-99m mercaptoacetyltriglycine renography after renal transplantation was investigated in 213 consecutive transplants. A grading system was used: 0 = normal renogram; 1 = normal uptake, reduced excretion; 2 = normal uptake, flat excretion curve; 3 = rising curve; 4 = reduced rate of uptake, rising curve and reduced absolute uptake; 5 = minimal uptake. The initial renogram grade (RG) was primarily a marker of ischaemic damage, being poorer with cadaver donation, long cold ischaemia (>24 h), and high donor and recipient age. High primary RG predicted primary graft non-function, long time to graft function, low discharge Cr EDTA clearance and low 1- and 5-year graft survival. Discharge RG predicted late (>6 months) graft loss. RG was highly correlated (P<0.001) with creatinine and creatinine clearance, and changes in RG were correlated with changes in renal function. A change in RG of 0.5 was non-specific, while a change of 1 or more predicted clinical complications in 95% of cases. The negative predictive value was low (58%). RG change antedated clinical diagnosis in only 38% of cases, and in only 14% of acute rejections did an RG change of 1 or more antedate a rising creatinine. RG did not contribute to the differential diagnosis between acute rejection, acute tubulointerstitial nephropathy and cyclosporine toxicity. In conclusion, an initial renography after transplantation is valuable as it measures ischaemic damage and predicts duration of graft non-function and both short and long-term graft survival. A review of the literature suggests that the indication for serial scintigraphic monitoring for functioning grafts is less certain: the diagnostic specificity is insufficient for it to be the definitive investigation for common diagnostic problems and it does not give sufficient advance warning of impending problems. (orig.)

  8. Poly[ADP-ribose] polymerase-1 expression is related to cold ischemia, acute tubular necrosis, and delayed renal function in kidney transplantation.

    Directory of Open Access Journals (Sweden)

    Francisco O'Valle

    Full Text Available UNLABELLED: Cold ischemia time especially impacts on outcomes of expanded-criteria donor (ECD transplantation. Ischemia-reperfusion (IR injury produces excessive poly[ADP-Ribose] Polymerase-1 (PARP-1 activation. The present study explored the hypothesis that increased tubular expression of PARP-1 contributes to delayed renal function in suboptimal ECD kidney allografts and in non-ECD allografts that develop posttransplant acute tubular necrosis (ATN. MATERIALS AND METHODS: Nuclear PARP-1 immunohistochemical expression was studied in 326 paraffin-embedded renal allograft biopsies (193 with different degrees of ATN and 133 controls and in murine Parp-1 knockout model of IR injury. RESULTS: PARP-1 expression showed a significant relationship with cold ischemia time (r coefficient = 0.603, time to effective diuresis (r = 0.770, serum creatinine levels at biopsy (r = 0.649, and degree of ATN (r = 0.810 (p = 0.001, Pearson test. In the murine IR model, western blot showed an increase in PARP-1 that was blocked by Parp-1 inhibitor. Immunohistochemical study of PARP-1 in kidney allograft biopsies would allow early detection of possible delayed renal function, and the administration of PARP-1 inhibitors may offer a therapeutic option to reduce damage from IR in donor kidneys by preventing or minimizing ATN. In summary, these results suggest a pivotal role for PARP-1 in the ATN of renal transplantation. We propose the immunohistochemical assessment of PARP-1 in kidney allograft biopsies for early detection of a possible delayed renal function.

  9. Local graft irradiation in renal transplant rejection

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Masashi; Kataoka, Masaaki; Itoh, Hisao (Ehime Univ., Matsuyama (Japan). School of Medicine)

    1990-04-01

    From 1977 to 1988, of 142 renal transplantations, seven recipients (4.9%) received local graft irradiation following rejective reaction refractory to antirejection medical managements. Concurrent with the administration of pulsed high dose methylprednisolone and other antirejection medical managements, the graft was irradiated with a total dose of 6.0 Gy-150 cGy per fraction every other day at the midplane of the graft using two opposing portals of 4MX Linac. The fields were defined by palpation and echography. All patients had improvements in serum creatinine on the 10th day after beginning the irradiation. Four patients with peripheral lymphocytosis during the irradiation combined with pulsed high dose methylprednisolone improved in renal functions. On the other hand, out of 3 patients with lymphcytopenic changes, in two the transplanted graft was removed due to deteriorations, and the other patient is currently suffering from chronic rejection. Local graft irradiation can be useful in maintaining a rejective graft and reversing its functions in some patients whose rejective reaction failed to respond to the antirejection medical managements. (author).

  10. Uricosuric effect of losartan in patients with renal transplants

    DEFF Research Database (Denmark)

    Kamper, A L; Nielsen, A H

    2001-01-01

    BACKGROUND: The aim of the study was to evaluate the uricosuric effect of the angiotensin II receptor antagonist, losartan, in hypertensive patients with renal transplants who are treated with cyclosporin A (CsA). METHODS: Twenty-six patients with stable renal function and hypertension, 16 men......-daily administration of 50 mg of losartan in hypertensive CsA-treated patients with renal transplants caused a 17% increase in FE(uric acid) and an 8% fall in plasma uric acid....

  11. Prevalence and association of post-renal transplant anemia

    Directory of Open Access Journals (Sweden)

    Hesham Elsayed

    2012-01-01

    Full Text Available In some renal allograft recipients, anemia persists or develops following transplantation. Anemia is associated with pre-operative blood loss and allograft dysfunction, including delayed graft function, acute rejection and chronic allograft dysfunction. To study the prevalence and association of post-renal transplant anemia, we studied 200 renal transplant recipients; 131 (65.5% patients were males and 69 (34.5% patients were females, and age ranged from 17 to 67 years, with a mean of 37.7 ± 10.8 years. All patients were receiving cyclosporine, prednisolone and mycophenolate mofetil (MMF. Complete blood count was done at two times: three and six months post-renal transplant. There were 74% anemic patients three months after renal transplantation and 45% anemic patients six months after renal transplantation. High creatinine value, female gender, delayed graft function, episodes of acute rejection, perioperative blood loss and infections were the only significant independent risk factors for prevalence of anemia post-renal transplant. In our study, we did not find an association between MMF and cyclosporine nor angiotensin-converting enzyme inhibitors (ACEIs or angiotensin receptors blocker (ARBs with anemia. This study demonstrates that anemia is a common complication during the first six months after kidney transplantation, with several risk factors precipitating this complication.

  12. Quantitative scintigraphic parameters for the assessment of renal transplant patients

    Energy Technology Data Exchange (ETDEWEB)

    El Maghraby, T.A.F.; Eck-Smit, B.L.F. van; Pauwels, E.K.J. [Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden (Netherlands); Fijter, J.W. de [Department of Nephrology, Leiden University Medical Centre, Leiden (Netherlands)

    1998-10-01

    Radionuclide renal diagnostic studies play an important role in assessing renal allograft function especially in the early post transplant period. In the last two decades various quantitative parameters have been derived from the radionuclide renogram to facilitate and confirm the changes in perfusion and/or function of the kidney allograft. In this review article we discuss the quantitative parameters that have been used to assess graft condition with emphasis on the early post-operative period. These quantitative methods were divided into parameters used for assessing renal graft perfusion and parameters used for evaluating parenchymal function. The blood flow in renal transplants can be quantified by measuring (a) the rate of activity appearance in the kidney graft; (b) the ratio of the integral activity under the transplanted kidney and arterial curves e.g. Hilson's perfusion index and Kircher's kidney/aortic ratio; (c) calculating the renal vascular transit time by deconvolution analysis. The literature overview on these parameters showed us that they have some practical disadvantages of requiring high quality bolus injection and numerical variations related to changes in the site and size of regions of interest. In addition, the perfusion parameter values suffer from significant overlap when various graft pathologies coexist. Quantitative evaluation of the graft parenchymal extraction and excretion was assessed by parameters derived from {sup 123}I/{sup 131}I-OIH,{sup 99m}Tc-DTPA or {sup 99m}Tc-MAG3 renograms. We review in this article a number of parenchymal parameters which include (1) plasma clearance methods like glomerular filtration rate (GFR) and effective renal plasma flow (ERPF); (2) renal transit times such as parenchymal mean transit time, T{sub max}, T{sub 1/2}; (3) parenchymal uptake and excretion indices as the accumulation index, graft uptake capacity at 2 and 10 min, excretion index and elimination index. These indices, however, are

  13. Clinical role of the renal transplant biopsy

    Science.gov (United States)

    Williams, Winfred W.; Taheri, Diana; Tolkoff-Rubin, Nina; Colvin, Robert B.

    2013-01-01

    Percutaneous needle core biopsy is the definitive procedure by which essential diagnostic and prognostic information on acute and chronic renal allograft dysfunction is obtained. The diagnostic value of the information so obtained has endured for over three decades and has proven crucially important in shaping strategies for therapeutic intervention. This Review provides a broad outline of the utility of performing kidney graft biopsies after transplantation, highlighting the relevance of biopsy findings in the immediate and early post-transplant period (from days to weeks after implantation), the first post-transplant year, and the late period (beyond the first year). We focus on how biopsy findings change over time, and the wide variety of pathological features that characterize the major clinical diagnoses facing the clinician. This article also includes a discussion of acute cellular and humoral rejection, the toxic effects of calcineurin inhibitors, and the widely varying etiologies and characteristics of chronic lesions. Emerging technologies based on gene expression analyses and proteomics, the in situ detection of functionally relevant molecules, and new bioinformatic approaches that hold the promise of improving diagnostic precision and developing new, refined molecular pathways for therapeutic intervention are also presented. PMID:22231130

  14. Renal transplantation in patients with HIV.

    Science.gov (United States)

    Frassetto, Lynda A; Tan-Tam, Clara; Stock, Peter G

    2009-10-01

    HIV infection has been a major global health problem for almost three decades. With the introduction of highly active antiretroviral therapy in 1996, and the advent of effective prophylaxis and management of opportunistic infections, AIDS mortality has decreased markedly. In developed countries, this once fatal infection is now being treated as a chronic condition. As a result, rates of morbidity and mortality from other medical conditions leading to end-stage liver, kidney and heart disease are steadily increasing in individuals with HIV. Presence of HIV infection used to be viewed as a contraindication to transplantation for multiple reasons: concerns for exacerbation of an already immunocompromised state by administration of additional immunosuppressants; the use of a limited supply of donor organs with unknown long-term outcomes; and, the risk of viral transmission to the surgical and medical staff. This Review examines open questions on kidney transplantation in patients infected with HIV-1 and clinical strategies that have resulted in good outcomes. It also describes the clinical concerns associated with the treatment of renal transplant recipients with HIV.

  15. Economic analysis of basiliximab in renal transplantation.

    Science.gov (United States)

    Keown, P A; Balshaw, R; Krueger, H; Baladi, J F

    2001-06-15

    Basiliximab is a chimeric monoclonal directed against the alpha-chain of the interleukin-2 receptor. International studies have shown that it is highly effective in preventing acute rejection in patients receiving Neoral, and causes no measurable incremental toxicity, but its economic value remains unknown. This study employed an economic model to examine the potential economic benefit of basiliximab. Parameter estimates were derived from a randomized, prospective, double-blind study conducted in 21 renal transplant centers in seven countries in which 380 adult primary allograft recipients were randomized within center to receive basiliximab (20 mg i.v.) on days 0 and 4 or placebo in addition to dual immunosuppression with Neoral and steroids. Key clinical events included primary hospitalization, immunosuppressive drug use, patient and graft survival, graft rejection, treatment of rejection, dialysis, and repeat hospitalization. Health resources were valued via a comprehensive electronic cost dictionary, based upon a detailed economic evaluation of renal transplantation in Canada. Medication costs were calculated from hospital pharmacy acquisition costs; basiliximab was assessed a zero cost. The average estimated cost per patient for the first year after transplant was $55,393 (Canadian dollars) for placebo and $50,839 for basiliximab, rising to $141,690 and $130,592, respectively, after 5 years. A principal component of the cost in both groups was accrued during the initial transplant hospitalization ($14,663 for standard therapy and $14,099 for basiliximab). An additional $15,852 and $14,130 was attributable to continued care, graft loss, and dialysis in the two groups, whereas follow-up hospitalization consumed an additional $15,538 for placebo and $13,916 for basiliximab. The mean incremental cost of dialysis was $5,397 for placebo compared with $3,821 for basiliximab, whereas incremental costs of graft loss were $2,548 compared with $2,295 in the two treatment

  16. Renal transplantation across the donor-specific antibody barrier: Graft outcome and cancer risk after desensitization therapy

    Directory of Open Access Journals (Sweden)

    Ching-Yao Yang

    2016-06-01

    Conclusion: When compared to renal transplantation without DSA, desensitization therapy for DSA resulted in equivalent renal transplant outcome but potentially increased risk of urothelial carcinoma after transplantation.

  17. Renal insufficiency after heart transplantation: a case-control study

    NARCIS (Netherlands)

    T. van Gelder (Teun); R. Zietse (Bob); C.J. Hesse (Cees); W. Weimar (Willem); A.H.M.M. Balk (Aggie); B. Mochtar (Bas)

    1998-01-01

    textabstractBACKGROUND: In Rotterdam 304 heart transplants have been performed since 1984. End-stage renal failure, necessitating renal replacement therapy, has developed in 24 patients (8%) after an interval of 25-121 months (median 79 months). After starting renal rep

  18. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs

  19. Transplant tourism and the Iranian model of renal transplantation program: ethical considerations.

    Science.gov (United States)

    Ghods, Ahad J; Nasrollahzadeh, Dariush

    2005-12-01

    Currently, the buying and selling of kidneys through "transplant tourism" is occurring at an increasing rate, both in developed and developing countries. Since 1988, Iran has adopted a compensated and regulated living-unrelated donor renal transplant program, and by providing financial incentives to volunteer living donors, has eliminated the renal transplant waiting list. In the Iranian model of renal transplantation program, regulations have been put in place to prevent transplant tourism. Foreigners are not allowed to undergo renal transplantation from Iranian living-unrelated donors. They also are not permitted to volunteer as kidney donors for Iranian patients. A study at the transplant unit of Hashemi Nejad Kidney Hospital in Tehran, Iran, showed that of 1881 renal transplant recipients, 19 (1%) were Afghani or Iraqi refugees, 11 (0.6%) were other foreign nationals, and 18 (0.9%) were Iranian immigrants. Renal transplantations seemed ethically acceptable to all refugees and foreign nationals. However, transplantation of Iranian immigrants who had been residing abroad for years constituted true transplant tourism.

  20. Renal transplantation in Nepal: The first year′s experience

    Directory of Open Access Journals (Sweden)

    Chalise Pawan

    2010-01-01

    Full Text Available A successful renal transplantation service was started in Nepal at the Tribhuvan Univer-sity Teaching Hospital in August 2008, and a continuing regular service is being provided currently to needy people. We report here our experience in thirty five end stage renal disease patients who re-ceived kidneys from close relatives during a one year period. The mean age of donors was 46.7 years. Seventeen (49% donations were from parents, 13 (37% from spouses, four (11% between siblings and one (3% between mother and daughter in law. Although the left kidney was given preference, right sided donor nephrectomy was needed in five (14% cases. Six (17% donors had minor post-operative problems. The mean age of recipients was 33.2 years, four (11% of whom had pre-emptive renal transplantation. Recipients were immunosuppressed with dacluzimab, prednisolone, mycophena-late, and cyclosporine or tacrolimus. The average time taken for graft implantation was 137 minutes. The mean cold ischemia time and second warm ischemia time were 133 and 36 minutes respectively. Four (11% patients developed urinary tract infection, three (9% had significant hematuria, one (3% developed a peri-transplant abscess, and one (3% had ureteric ischemia and urine leak which required re-exploration in the early post-operative period. Four patients (11% developed acute rejection of which three were cell- mediated rejection and one was antibody-mediated. There were two (6% deaths, one due to transplant-related sepsis and the other due to subarachnoid hemorrhage following rupture of a posterior communicating artery aneurysm. No kidney has been lost otherwise.

  1. Renal transplantation between HIV-positive donors and recipients justified.

    Science.gov (United States)

    Muller, Elmi; Barday, Zunaid; Mendelson, Marc; Kahn, Delawir

    2012-03-02

    HIV infection was previously an absolute contraindication to renal transplantation. However, with the advent of highly active antiretroviral therapy (HAART), renal transplantation using HIV-negative donor kidneys has successfully been employed for HIV-infected patients with end-stage renal failure. In resource-limited countries, places on dialysis programmes are severely restricted; HIV-infected patients, like many others with co-morbidity, are often denied treatment. Kidneys (and other organs) from HIV-infected deceased donors are discarded. The transplantation of HIV-positive donor kidneys to HIV-infected recipients is now a viable alternative to chronic dialysis or transplantation of HIV-negative donor kidneys. This significantly increases the pool of donor kidneys to the advantage of HIV-positive and -negative patients. Arguments are presented that led to our initiation of renal transplantation from HIV-positive deceased donors to HIV-positive recipients at Groote Schuur Hospital, Cape Town.

  2. The Cost and Utility of Renal Transplantation in Malaysia

    OpenAIRE

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-01-01

    Background Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. Aim and Methods This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Min...

  3. The Cost and Utility of Renal Transplantation in Malaysia

    OpenAIRE

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-01-01

    Background Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. Aim and Methods This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Min...

  4. Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients.

    LENUS (Irish Health Repository)

    Dolan, Niamh

    2009-11-01

    We report two cases of non-cardiogenic pulmonary edema as a complication of basiliximab induction therapy in young pediatric renal transplant patients identified following a retrospective review of all pediatric renal transplant cases performed in the National Paediatric Transplant Centre, Childrens University Hospital, Temple Street, Dublin, Ireland. Twenty-eight renal transplantations, of which five were living-related (LRD) and 23 were from deceased donors (DD), were performed in 28 children between 2003 and 2006. In six cases, transplantations were pre-emptive. Immunosuppression was induced pre-operatively using a combination of basiliximab, tacrolimus and methylprednisolone in all patients. Basiliximab induction was initiated 2 h prior to surgery in all cases and, in 26 patients, basiliximab was re-administered on post-operative day 4. Two patients, one LRD and one DD, aged 6 and 11 years, respectively, developed acute non-cardiogenic pulmonary edema within 36 h of surgery. Renal dysplasia was identified as the primary etiological factor for renal failure in both cases. Both children required assisted ventilation for between 4 and 6 days. While both grafts had primary function, the DD transplant patient subsequently developed acute tubular necrosis and was eventually lost within 3 weeks due to thrombotic microangiopathy and severe acute antibody-mediated rejection despite adequate immunosuppression. Non-cardiogenic pulmonary edema is a potentially devastating post-operative complication of basiliximab induction therapy in young pediatric patients following renal transplantation. Early recognition and appropriate supportive therapy is vital for patient and, where possible, graft survival.

  5. [Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis: A Case Report].

    Science.gov (United States)

    Oida, Takeshi; Kanemitsu, Toshiyuki; Hayashi, Tetsuya; Fujimoto, Nobumasa; Koide, Takuo

    2016-02-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0.17-1.8%, for which PNL and TUL are frequently used. Although considered to be accompanied with risks of bleeding, bowel injury, and renal dysfunction, PNL is effective for urinary lithiasis after renal transplantation. TUL is less invasive, but access may be difficult when the ureter has an unusual course or ureteral stricture exists, as in our patient.

  6. Renal transplantation in children less than 5 years of age.

    Science.gov (United States)

    Rizzoni, G; Malekzadeh, M H; Pennisi, A J; Ettenger, R B; Uittenbogaart, C H; Fine, R N

    1980-01-01

    19 young children (less than 5 years old) have received 31 renal transplants from 4 live relatives and 27 cadaver donors. The 2-year allograft survival rate for the patients receiving their 1st allograft from the 4 live donors was 75 +/- 22% while for the patients receiving their 1st allograft from 15 cadaver donors was 26 +/- 11%. 10 children are currently surviving with functioning allographs (7 cadavers and 3 live relatives); 4 have died and 5 are undergoing dialysis after the loss of at least one allograft. Despite the poor allograft survival rate the fact that 7 children are surviving with cadaver allografts indicates that the lack of a living related donor should not prevent transplants in young children. PMID:7002060

  7. De novo malignancy is associated with renal transplant tourism.

    Science.gov (United States)

    Tsai, Meng-Kun; Yang, Ching-Yao; Lee, Chih-Yuan; Yeh, Chi-Chuan; Hu, Rey-Heng; Lee, Po-Huang

    2011-04-01

    Despite the objections to transplant tourism raised by the transplant community, many patients continue travel to other countries to receive commercial transplants. To evaluate some long-term complications, we reviewed medical records of 215 Taiwanese patients (touring group) who received commercial cadaveric renal transplants in China and compared them with those of 321 transplant recipients receiving domestic cadaveric renal transplants (domestic group) over the same 20-year period. Ten years after transplant, the graft and patient survival rates of the touring group were 55 and 81.5%, respectively, compared with 60 and 89.3%, respectively, of the domestic group. The difference between the two groups was not statistically significant. The 10-year cumulative cancer incidence of the touring group (21.5%) was significantly higher than that of the domestic group (6.8%). Univariate and multivariate stepwise regression analyses (excluding time on immunosuppression, an uncontrollable factor) indicated that transplant tourism was associated with significantly higher cancer incidence. Older age at transplantation was associated with a significantly increased cancer risk; however, the risk of de novo malignancy significantly decreased with longer graft survival. Thus, renal transplant tourism may be associated with a higher risk of post-transplant malignancy, especially in patients of older age at transplantation. © 2011 International Society of Nephrology

  8. The effect of different apheresis modalities on coagulation factor XIII level during antibody removal in ABO-blood type incompatible living related renal transplantation.

    Science.gov (United States)

    Hanafusa, Norio; Hamasaki, Yoshifumi; Kawarasaki, Hiroo; Kido, Ryo; Shibagaki, Yugo; Ishikawa, Akira; Enomoto, Yutaka; Fujita, Toshiro; Noiri, Eisei; Nangaku, Masaomi

    2013-10-01

    Apheresis therapy is used to remove pathogenic antibodies within the recipient blood during ABO-incompatible living related renal transplantation (LRRT). Factor XIII (FXIII) is a coagulating factor. Its deficiency reportedly engenders perioperative bleeding. This study compared apheresis modalities from the perspective of the FXIII level. Cases 1-3 were treated only with double-filtration plasmapheresis (DFPP) without (case 1) or with (cases 2 and 3) fresh frozen plasma (FFP) supplementation. Cases 4 and 5 were treated with simple plasma exchange (PEx) with FFP supplementation for the last session. Cases 1-3 showed a marked (case 1, 8.6%) or moderate (case 2, 26.2%; case 3, 28.4%) decrease in FXIII on the day before the procedure after the last apheresis session, although cases 4 (81.9%) and 5 (66.2%) did not. Case 1 experienced perioperative bleeding. The last session is usually performed the day before the surgical procedure. Therefore, FXIII elimination by DFPP might cause bleeding complications because of its slow recovery. The fact warrants that the last apheresis modality during the course might be PEx from the viewpoint of FXIII depletion.

  9. Spironolactone ameliorates transplant vasculopathy in renal chronic transplant dysfunction in rats

    NARCIS (Netherlands)

    Waanders, Femke; Rienstra, Heleen; Boer, Mark Walther; Zandvoort, Andre; Rozing, Jan; Navis, Gerjan; van Goor, Harry; Hillebrands, Jan-Luuk

    2009-01-01

    Waanders F, Rienstra H, Walther Boer M, Zandvoort A, Rozing J, Navis G, van Goor H, Hillebrands JL. Spironolactone ameliorates transplant vasculopathy in renal chronic transplant dysfunction in rats. Am J Physiol Renal Physiol 296: F1072-F1079, 2009. First published February 25, 2009; doi:10.1152/aj

  10. RENAL ALLOGENEIC TRANSPLANTATION IN PATIENT WITH HAEMOPHILIA B

    Directory of Open Access Journals (Sweden)

    N. V. Purlo

    2014-01-01

    Full Text Available We report the case of successful renal allogeneic transplantation and treatment in a 56-year-old patient with haemophilia B at Hematology Research Center. He has received replacement therapy by factor IX since 2010. The transplant is marked with good renal function during 13 post-transplant months without episodes of rejection or bleeding complications. The complicated surgical interventions are possible in patients with haemophilia В аnd end-stage chronic renal failure in the presence of replacement therapy of IX factor for the purpose of achievement of optimum hemostasis.

  11. Shotgun Proteomics Identifies Proteins Specific for Acute Renal Transplant Rejection

    Science.gov (United States)

    Sigdel, Tara K.; Kaushal, Amit; Gritsenko, Marina; Norbeck, Angela D.; Qian, Wei-Jun; Xiao, Wenzhong; Camp, David G.; Smith, Richard D.; Sarwal, Minnie M.

    2010-01-01

    Acute rejection (AR) remains the primary risk factor for renal transplant outcome; development of non-invasive diagnostic biomarkers for AR is an unmet need. We used shotgun proteomics applying LC-MS/MS and ELISA to analyze a set of 92urine samples, from patients with AR, stable grafts (STA), proteinuria (NS), and healthy controls (HC). A total of 1446 urinary proteins were identified along with a number of NS specific, renal transplantation specific and AR specific proteins. Relative abundance of identified urinary proteins was measured by protein-level spectral counts adopting a weighted fold-change statistic, assigning increased weight for more frequently observed proteins. We have identified alterations in a number of specific urinary proteins in AR, primarily relating to MHC antigens, the complement cascade and extra-cellular matrix proteins. A subset of proteins (UMOD, SERPINF1 and CD44), have been further cross-validated by ELISA in an independent set of urine samples, for significant differences in the abundance of these urinary proteins in AR. This label-free, semi-quantitative approach for sampling the urinary proteome in normal and disease states provides a robust and sensitive method for detection of urinary proteins for serial, non-invasive clinical monitoring for graft rejection after kidney transplantation. PMID:20543976

  12. PP146. Psychological assessment of renal transplant recipients during pregnancy.

    Science.gov (United States)

    Neto, V L L Belardi; de Oliveira, L G; Sass, N

    2012-07-01

    Although many centers have reported their experience on maternal and perinatal outcomes in renal transplant recipients. Very few information can be found about the psychological aspects that may rise for these patients during pregnancy. Considering the importance of the psychological concerns for this kind of patients, we have developed a protocol to better assist renal transplant recipients during pregnancy and here we show what we have learnt. To understand how the maternal concerns are seen from renal transplant recipients in terms of psychological aspects. Fifteen pregnant kidney transplanted women with an average age of 27.5years were included in the study. All patients have been investigated beyond the 20th week of pregnancy to delivery. The study is cross-sectional, qualitative, and participation is based on developed phenomenological method. Final data analysis will be done through thematic analysis and hermeneutics of meaning. The only exclusion criteria were the current presence of psychiatric disorders or use of drugs that could influence cognitive and emotional aspects during the psychological evaluation. During the last two years we have observed in these women that all of them are aware of the risks of pregnancy after transplantation. Qualitative aspects were: Pregnant with kidney transplantation show: in relation to pregnancy, the desire to be mothers, to give a son to her husband, to become a healthy person again; they believe that conception is God's will, they have fear of pregnancy, ambivalence of feelings (fear and happiness). In relation to the graft, they reported fear of baby malformations, fear and anguish of graft loss, still consider it worth the risk of having the baby, and some women name the graft, if it were another infant. In relation to delivery, state anxiety and anguish at the proximity of labor (fear of labor pain, anesthesia, cesarean section, vaginal delivery and the "psychic pain"). Pending the final results of this study, we

  13. FSGS Recurrence in Adults after Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Michael Rudnicki

    2016-01-01

    Full Text Available Recurrence of focal segmental glomerulosclerosis (FSGS in the allograft occurs in 30–50% of patients, and it is associated with poor renal allograft survival. Major risk factors for recurrence are younger age at diagnosis, rapid progression to end-stage renal disease, white race, and the loss of previous allografts due to recurrence. Recent data support the hypothesis that circulating permeability factors play a crucial role in podocyte injury and progression of FSGS. Due to lack of controlled trials, the management of recurrent FSGS is inconsistent and highly empirical. Prophylactic and perioperative treatment with plasmapheresis and high-dose (intravenous cyclosporine represent the main cornerstones of immunosuppressive therapy. In recent years, therapy with rituximab has shown promising results. Despite evidence of activation of the renin-angiotensin system (RAS in recurrent FSGS and its association with progression, only limited data exist on the renoprotective role of RAS blockade in this setting. Further well designed studies are needed on pathogenesis risk factors and therapeutical options in FSGS and its recurrence after transplantation.

  14. The role of diet and physical activity in post-transplant weight gain after renal transplantation

    NARCIS (Netherlands)

    Zelle, Dorien M.; Kok, Trijntje; Dontje, Manon L.; Danchell, Eva I.; Navis, Gerjan; van Son, Willem J.; Bakker, Stephan J. L.; Corpeleijn, Eva

    2013-01-01

    Background Long-term survival of renal transplant recipients (RTR) has not improved over the past 20yr. The question rises to what extent lifestyle factors play a role in post-transplant weight gain and its associated risks after transplantation. Methods Twenty-six RTR were measured for body weight,

  15. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  16. Vascular Variations and Anastomosis Techniques in Renal Transplant Donors

    Directory of Open Access Journals (Sweden)

    ilker Murat Arer

    2015-09-01

    Conclusion: Preoperative evaluation of renal vasculature of transplant donors is an important issue in means of decreasing peroperative vascular complications and decision for nephrectomy site. [Cukurova Med J 2015; 40(3.000: 542-546

  17. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  18. Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

    NARCIS (Netherlands)

    Berg, van den Else; Engberink, M.F.; Brink, E.J.; Baak, van M.A.; Joosten, M.M.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. Thi

  19. Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

    NARCIS (Netherlands)

    Berg, van den Else; Engberink, M.F.; Brink, E.J.; Baak, van M.A.; Joosten, M.M.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs.

  20. Methylene blue treatment for resistant shock following renal transplantation.

    Science.gov (United States)

    Hershman, Eli; Hadash, Amir; Attias, Ori; Ben-Ari, Josef

    2015-11-01

    We report a case of a 19-year-old female with a history of hyperoxaluria type 1 and renal failure. The patient presented for a second renal transplantation 17 years after her first combined liver and kidney transplantation. Postoperative shock was highly resistant to fluids and required massive pharmacologic hemodynamic support. Vasoplegic shock was the presumed diagnosis, and methylene blue was utilized as a rescue therapy, with a rapid hemodynamic response and no apparent side effects.

  1. The Efficacy of Mew Score in Renal Transplant Recipients Referred to Emergency Department

    Directory of Open Access Journals (Sweden)

    Egemen Kocabas

    2014-03-01

    Full Text Available Aim: The best treatment option in relation to the advantages in survival in chronic renal disease and in life quality is renal transplantation. During or after the renal transplantation some complications may occur depending on technical reasons. In long term, various infections and metabolic disorders can appear as a result of current immunosuppressive treatments. The present study was conducted in order to determine critical conditions in management of renal transplant cases in Emergency Department and to investigate the efficacy of MODIFIED EARLY WARNING (MEW score in determining the morbidity and acute renal failure (ARF in renal transplant cases. Material and Method: 172 renal transplant recipients presenting to Uludag University Medicine Faculty Emergency Department were investigated prospectively. The patients, whose MEW scores were calculated, were evaluated in terms of the diagnoses, hospitalisation reasons, and presence of (ARF attack and the relationship with MEW score was investigated. Results: 22.8% (n:26 of applications matched with sepsis and significant difference was found out in those patients in terms of ARF (p

  2. Calcineurin inhibitors and male fertility after renal transplantation - a review.

    Science.gov (United States)

    Georgiou, G K; Dounousi, E; Harissis, H V

    2016-06-01

    Renal transplantation and restoration of renal function are associated with significant favourable changes regarding the reproductive capacity of male patients with previous end-stage renal disease. However, there is evidence that some of the immunosuppressive agents may impair male fertility after all. Calcineurin inhibitors (CNIs), cyclosporine A and tacrolimus (FK506), which constitute the cornerstone of immunosuppression regimen following renal transplantation, have been implicated in causing an overall decline in the fertilisation capacity of male renal transplant recipients (RTRs). In this review, data from human clinical studies are collectively presented in an effort to estimate the potential adverse effects of CNIs on the masculine reproductive organs, the hormonal axis of males, the process of spermatogenesis and generally the male RTRs capacity to fertilise. © 2015 Blackwell Verlag GmbH.

  3. An assessment of the long-term health outcome of renal transplant recipients in Ireland.

    LENUS (Irish Health Repository)

    Al-Aradi, A

    2009-06-04

    BACKGROUND: Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others. AIMS AND METHODS: In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures. RESULTS: The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor. CONCLUSIONS: This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.

  4. Acute renal failure in liver transplant patients: Indian study.

    Science.gov (United States)

    Naik, Pradeep; Premsagar, B; Mallikarjuna, M

    2015-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

  5. Donor-Recipient Size Mismatch in Paediatric Renal Transplantation

    Directory of Open Access Journals (Sweden)

    J. Donati-Bourne

    2014-01-01

    Full Text Available Introduction. End stage renal failure in children is a rare but devastating condition, and kidney transplantation remains the only permanent treatment option. The aim of this review was to elucidate the broad surgical issues surrounding the mismatch in size of adult kidney donors to their paediatric recipients. Methods. A comprehensive literature search was undertaken on PubMed, MEDLINE, and Google Scholar for all relevant scientific articles published to date in English language. Manual search of the bibliographies was also performed to supplement the original search. Results. Size-matching kidneys for transplantation into children is not feasible due to limited organ availability from paediatric donors, resulting in prolonged waiting list times. Transplanting a comparatively large adult kidney into a child may lead to potential challenges related to the surgical incision and approach, vessel anastomoses, wound closure, postoperative cardiovascular stability, and age-correlated maturation of the graft. Conclusion. The transplantation of an adult kidney into a size mismatched paediatric recipient significantly reduces waiting times for surgery; however, it presents further challenges in terms of both the surgical procedure and the post-operative management of the patient’s physiological parameters.

  6. Urinary tract infection in renal transplantation

    OpenAIRE

    2012-01-01

    Introduction Urinary tract infection (UTI), especially recurrent UTI, is a common problem, occurring in >75% of kidney transplant (KTX) recipients. UTI degrades the health-related quality of life and can impair graft function, potentially reducing graft and patient survival. As urologists are often involved in treating UTI after KTX, previous reports were searched to elucidate underlying causes, risk factors and treatment options, as well as recommendations for prophylaxis of UTI after KTX. M...

  7. Risk and outcome of pyelonephritis among renal transplant recipients.

    Science.gov (United States)

    Graversen, Mette Elneff; Dalgaard, Lars Skov; Jensen-Fangel, Søren; Jespersen, Bente; Østergaard, Lars; Søgaard, Ole Schmeltz

    2016-06-10

    Urinary tract infection is the most common infectious disease requiring hospitalisation following renal transplantation. However, the risk and outcome of post-transplant pyelonephritis remains unclear. This population-based cohort study was conducted from 1 January 1990 to 31 December 2009. Each member of a Danish population-based, nationwide cohort of first-time renal transplant recipients was matched by age and gender with up to 19 population controls. Information on hospital discharge diagnosis, emigration, and mortality was obtained from nationwide administrative databases. Individuals were observed from the date of first renal transplantation and until graft loss, emigration, or death. Risk factors were assessed by Poisson regression. The incidence rate (IR) of first-time hospitalisation for pyelonephritis was 18.5 (95 % confidence interval [CI]: 16.4-20.9) per 1,000 person-years of follow-up (PYFU) among renal transplant recipients (N = 2,656) and 0.26 (CI: 0.21-0.31) per 1,000 PYFU among population controls (N = 49,226) yielding an incidence rate-ratio (IRR) of 72.0 (95 % CI: 57.8-89.7). Among renal transplant recipients, the risk of pyelonephritis decreased during the entire study period and was lowest in 2005-09 (IRR = 0.46, CI: 0.31-0.68). The highest risk of pyelonephritis was observed within the first six months post-transplantation (IR = 69.9 per 1,000 PYFU; CI: 56.4-86.7). Other risk factors for post-transplant pyelonephritis included female gender, high Charlson comorbidity index score, HLA-DR mismatch, cause of renal failure, and calendar period. Interestingly, we found that the combined risk of graft loss and death was 45 %, (CI: 19-77 %) higher in renal transplant recipients following post-transplant pyelonephritis compared to those who had no admission due to pyelonephritis. The risk of first-time hospitalisation for pyelonephritis among renal transplant recipients is high. Further, post-transplant pyelonephritis was

  8. [Visceral leishmaniasis and pregnancy in renal transplanted patient: case report].

    Science.gov (United States)

    Silva, Jaqueline de Almeida; Araújo, Ivan de Melo; Pavanetti, Luiz Carlos; Okamoto, Liene Shigaki; Dias, Mônica

    2015-01-01

    Visceral leishmaniasis (VL) is a severe and potentially fatal disease caused by different Leishmania species, Leishmania chagasi prevailing in Brazil. Main symptoms include fever, malaise, anorexia, weight loss and abdominal enlargement with typically occurring hepatosplenomegaly Currently, VL is considered an opportunistic infection in immunocompromised hosts, including solid organ transplanted patients. The present study reports a case of VL associated to pregnancy after renal transplantation.

  9. Constrictive pericarditis in a renal transplant recipient with tuberculosis.

    Science.gov (United States)

    Sreejith, P; Kuthe, S; Jha, V; Kohli, H S; Rathi, M; Gupta, K L; Sakhuja, V

    2010-07-01

    Tuberculosis is a common cause of pericarditis in the developing countries and constrictive pericarditis is a serious sequel. There are only three cases of constrictive pericarditis in kidney transplant recipients previously reported in literature. Here, we report a case of constrictive pericarditis developing in a renal transplant recipient while on antituberculous therapy for tuberculous pleural effusion.

  10. Endourological management of ureteral obstruction after renal transplantation

    NARCIS (Netherlands)

    Bosma, RJ; vanDriel, MF; vanSon, WJ; deRuiter, AJ; Mensink, HJA

    1996-01-01

    Purpose: We evaluated endourological treatment of ureteral obstruction after renal transplantation. Materials and Methods: Between January 1986 and December 1993, 582 kidney transplantations were performed at our center, and ureteral obstruction was suspected in 31 cases (5.3%). Results: Initial tre

  11. Plasma bilirubin and late graft failure in renal transplant recipients

    NARCIS (Netherlands)

    Deetman, Petronella E.; Zelle, Dorien M.; van der Heide, Jaap J. Homan; Navis, Gerjan J.; Gans, Reinold O. B.; Bakker, Stephan J. L.

    2012-01-01

    Exogenous bilirubin has been shown to protect against oxidative stress in ischemia-reperfusion injury. Oxidative stress has been implicated in the pathophysiology of chronic transplant dysfunction leading to late graft failure after renal transplantation. We prospectively investigated whether high e

  12. The Current Role of Endourologic Management of Renal Transplantation Complications

    Directory of Open Access Journals (Sweden)

    Brian D. Duty

    2013-01-01

    Full Text Available Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter. Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.

  13. Disseminated Mycobacterium gordonae infection in a renal transplant recipient.

    NARCIS (Netherlands)

    Broeder, A. den; Vervoort, G.M.M.; Assen, S. van; Verduyn Lunel, F.M.; Lange, W.C.M. de; Sevaux, R.G.L. de

    2003-01-01

    The use of more intensive immunosuppressive regimens and the increasing number of patients that are exposed to immunosuppressive strategies in transplantation medicine have changed the spectrum of infections that is encountered by the clinician. We describe a 62-year-old female renal transplant reci

  14. Disseminated Mycobacterium gordonae infection in a renal transplant recipient

    NARCIS (Netherlands)

    Den Broeder, Alfons A.; Vervoort, G.; Van Assen, S.; Verduyn Lunel, F.; De Lange, W.C.; De Sévaux, R.G.L.

    2003-01-01

    The use of more intensive immunosuppressive regimens and the increasing number of patients that are exposed to immunosuppressive strategies in transplantation medicine have changed the spectrum of infections that is encountered by the clinician. We describe a 62-year-old female renal transplant reci

  15. [Infected solitary renal cyst of the graft in a renal transplant recipient : a case report].

    Science.gov (United States)

    Ishida, Kenichiro; Tsuchiya, Tomohiro; Kondo, Hiromi; Nakane, Keita; Kato, Taku; Seike, Kensaku; Miwa, Kousei; Yasuda, Mitsuru; Yokoi, Sigeaki; Nakano, Masahiro; Deguchi, Takashi

    2011-09-01

    A 59-year-old woman with end-stage renal disease of diabetic nephropathy who had been on maintenance hemodialisis for 4 years, underwent a living-unrelated renal transplantation 6 years ago. She was admitted to our hospital, because of a low grade fever and edema. Ultrasonography revealed the cyst with heterogeneity structure in the upper pole of the transplanted kidney. Magnetic resonance imaging showed a high-intensity cystic mass measuring 68×53 mm. As fever and laboratory data did not improve sufficiently by the treatment with antibiotics, echo-guided puncture and drainage were performed for the abnormal structure in the upper pole of the transplanted kidney. In the culture of the purulent aspirate drained from renal cyst, Escherichia coli was isolated. To our knowledge, this is the first report of infected renal cyst of the graft in a renal transplant recipient in the world.

  16. Angioplasty and stent treatment of transplant renal artery stenosis.

    Science.gov (United States)

    Del Pozo, Maitane; Martí, Jordi; Guirado, Lluís; Facundo, Carme; Canal, Cristina; de la Torre, Pablo; Ballarín, José; Díaz, Joan M

    2012-07-17

    Transplant renal artery stenosis is a major complication that requires a therapeutic approach involving surgery or angioplasty. The aim of this study was to analyse the evolution of renal transplant patients with renal allograft artery stenosis treated by angioplasty and stent placement. Thirteen patients were diagnosed with transplant renal artery stenosis. Clinical suspicion was based on deterioration of renal function and/or poorly controlled hypertension with compatible Doppler ultrasound findings. The diagnosis was confirmed by arteriography, performing an angioplasty with stent placement during the same operation. A progressive improvement in renal function was observed during the first 3 months after the angioplasty, and renal function then remained stable over 2 years. In addition, blood pressure improved during the first 2 years, and as a consequence there was no need to increase the average number of anti-hypertensive drugs administered (2.5 drugs per patient). In conclusion, angioplasty with stent placement is a safe and effective procedure for the treatment of transplant renal artery stenosis.

  17. Late renal dysfunction in adult survivors of bone marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, C.A.; Cohen, E.P.; Barber-Derus, S.W.; Murray, K.J.; Ash, R.C.; Casper, J.T.; Moulder, J.E. (Medical College of Wisconsin Affiliated Hospitals, Milwaukee (USA))

    1991-06-01

    Until recently long-term renal toxicity has not been considered a major late complication of bone marrow transplantation (BMT). Late renal dysfunction has been described in a pediatric population status post-BMT which was attributable to the radiation in the preparatory regimen. A thorough review of adults with this type of late renal dysfunction has not previously been described. Fourteen of 103 evaluable adult patients undergoing allogeneic (96) or autologous (7) bone marrow transplantation, predominantly for leukemia and lymphomas, at the Medical College of Wisconsin (Milwaukee, WI) have had a syndrome of renal insufficiency characterized by increased serum creatinine, decreased glomerular filtration rate, anemia, and hypertension. This syndrome developed at a median of 9 months (range, 4.5 to 26 months) posttransplantation in the absence of specific identifiable causes. The cumulative probability of having this renal dysfunction is 20% at 1 year. Renal biopsies performed on seven of these cases showed the endothelium widely separated from the basement membrane, extreme thickening of the glomerular basement membrane, and microthrombi. Previous chemotherapy, antibiotics, and antifungals as well as cyclosporin may add to and possibly potentiate a primary chemoradiation marrow transplant renal injury, but this clinical syndrome is most analogous to clinical and experimental models of radiation nephritis. This late marrow transplant-associated nephritis should be recognized as a potentially limiting factor in the use of some intensive chemoradiation conditioning regimens used for BMT. Some selective attenuation of the radiation to the kidneys may decrease the incidence of this renal dysfunction.

  18. Commercial cadaveric renal transplant: an ethical rather than medical issue.

    Science.gov (United States)

    Sun, Chiao-Yin; Lee, Chin-Chan; Chang, Chiz-Tzung; Hung, Cheng-Chih; Wu, Mai-Szu

    2006-01-01

    Donor organ shortage is a universal problem. The organ source has been extended to controversial death-penalty outlaws in certain countries. It was claimed that commercial transplant had a worse short-term clinical outcome. The aim of this study is to investigate the long-term outcome of patients receiving commercial cadaveric renal transplant. Seventy-five renal transplant recipients receiving long-term follow-up were included. Thirty-one patients received overseas commercial cadaveric transplant. Forty-four patients had legal domestic transplant in Taiwan. The age of the patients receiving the commercial cadaveric transplant was significantly older than those with legal domestic transplant (commerical vs. legal: 46.1 +/- 11.4 vs. 35.6 +/- 9.0 yr old, p < 0.001). The renal function estimated by creatinine and 1/creatinine up to eight yr showed no significant difference between the two groups. The graft survivals of the two groups were not different. The mortality rate between the two groups was comparable in 10 yr (91.1% in domestic and 88.9% in overseas). There was no significant difference in de novo viral hepatitis, cytomegalovirus infection, and acute rejection. The clinical outcome of overseas commercial cadaveric transplant was not different from the domestic legal transplant. To stop the unethical procedure, ethnicity and humanity are the major concerns.

  19. Intractable urinary tract infection in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Satish Renuka

    2009-01-01

    Full Text Available Urinary tract infections (UTI are the most common bacterial infections after renal transplantation and are associated with significant morbidity and mortality. Recurrent or relapsing infections are not uncommon in the early post-transplant period and superadded fungal UTI can occur in these patients, posing a difficult therapeutic problem. Literature on recurrent UTI after transplant as well as the ideal approach to such patients is scanty. We present the case of a renal al-lograft recipient who presented with relapsing bacterial UTI complicated by systemic fungemia; also, a brief review of fungal UTI is attempted.

  20. Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis.

    Science.gov (United States)

    Solak, Y; Atalay, H; Nar, A; Ozbek, O; Turkmen, K; Erekul, S; Turk, S

    2011-04-01

    Fungal pathogens are increasingly encountered after renal transplantation. Aspergillus causes significant morbidity and mortality in transplant patients. Fungal thyroiditis is a rare occurrence owing to unique features of the thyroid gland. Most cases are caused by Aspergillus species and have been described in immunocompromised patients. Presentation may be identical with that of subacute thyroiditis, in which hyperthyroidism features and painful thyroid are the prominent findings. Diagnosis can be ascertained by fine-needle aspiration of thyroid showing branching hyphae of Aspergillus. We describe a renal transplant patient who developed Aspergillus thyroiditis as part of a disseminated infection successfully treated with voriconazole.

  1. Residual amoebic liver abscess in a prospective renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Ashish V Choudhrie

    2012-01-01

    Full Text Available Amoebic liver abscess (ALA is by far the most common extraintestinal manifestation of invasive amoebiasis. The vast majority of these resolve with treatment; however, a small percentage of the treated ALAs are known to persist asymptomatically. Herein, we present a prospective renal allograft recipient with a residual liver abscess who had a successful renal transplant after treatment. In our opinion, persistence of a radiological finding of residual abscess in the absence of clinical disease does not appear to be a contraindication to renal transplantation.

  2. Shotgun Proteomics Identifies Proteins Specific for Acute Renal Transplant Rejection

    Energy Technology Data Exchange (ETDEWEB)

    Sigdel, Tara K.; Kaushal, Amit; Gritsenko, Marina A.; Norbeck, Angela D.; Qian, Weijun; Xiao, Wenzhong; Camp, David G.; Smith, Richard D.; Sarwal, Minnie M.

    2010-01-04

    Acute rejection (AR) remains the primary risk factor for renal transplant outcome; development of non-invasive diagnostic biomarkers for AR is an unmet need. We used shotgun proteomics using LC-MS/MS and ELISA to analyze a set of 92 urine samples, from patients with AR, stable grafts (STA), proteinuria (NS), and healthy controls (HC). A total of 1446 urinary proteins were identified along with a number of NS specific, renal transplantation specific and AR specific proteins. Relative abundance of identified urinary proteins was measured by protein-level spectral counts adopting a weighted fold-change statistic, assigning increased weight for more frequently observed proteins. We have identified alterations in a number of specific urinary proteins in AR, primarily relating to MHC antigens, the complement cascade and extra-cellular matrix proteins. A subset of proteins (UMOD, SERPINF1 and CD44), have been further cross-validated by ELISA in an independent set of urine samples, for significant differences in the abundance of these urinary proteins in AR. This label-free, semi-quantitative approach for sampling the urinary proteome in normal and disease states provides a robust and sensitive method for detection of urinary proteins for serial, non-invasive clinical monitoring for graft rejection after

  3. Invasive fungal infections in renal transplant recipients.

    Science.gov (United States)

    Badiee, Parisa; Alborzi, Abdolvahab

    2011-12-01

    Invasive fungal infections are a significant and often lethal problem in transplant patients. Infections caused by geographically limited endemic fungi are infrequent, and Aspergillus species, Mucorales species, Candida species, and Cryptococcus neoformans are the opportunistic fungi responsible for most such infections. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages. The high rates of mortality and graft loss owing to fungal infections render early diagnosis and treatment imperative in immunosuppressed patients. Current methods for the diagnosis of systemic fungal infections include imaging procedures, endoscopic methods and biopsies, microscopic and culture techniques, antibody and antigen-based serologic testing, and the detection (via polymerase chain reaction) of fungal deoxyribonucleic acid in blood or bronchoalveolar lavage fluid, as well as the careful analysis of signs and symptoms. Antifungal therapy should be initiated early in patients with a suspected fungal infection (even before laboratory findings have confirmed that diagnosis) and should be administered with appropriate adjustment of immunosuppressive regimens. To manage fungal infections in patients with renal failure, optimizing the pharmacokinetics of antifungal drugs to reduce the risk of nephrotoxicity is crucial.

  4. The use of everolimus in renal-transplant patients

    Directory of Open Access Journals (Sweden)

    Julio Pascual

    2009-06-01

    Full Text Available Julio PascualServicio de Nefrología, Hospital Ramón y Cajal, 28034 Madrid, SpainAbstract: Despite advances in immunosuppressive therapy, long-term renal-transplantation outcomes have not significantly improved over the last decade. The nephrotoxicity of calcineurin inhibitors (CNIs is an important cause of chronic allograft nephropathy (CAN, the major driver of long-term graft loss. Everolimus is a proliferation signal inhibitor with a mechanism of action that is distinct from CNIs. The efficacy and tolerability of everolimus in renal-transplant recipients have been established in a wide range of clinical trials. Importantly, synergism between everolimus and the CNI cyclosporine (CsA permits CsA dose reduction, enabling nephrotoxicity to be minimized without compromising efficacy. Currently, everolimus is being investigated in regimens where reduced exposure CNIs are used from the initial post-transplant period to improve renal function and prevent CAN. By inhibiting the proliferation of smooth muscle cells, everolimus may itself delay the progression or development of CAN. Although everolimus is associated with specific side effects, these can generally be managed. By targeting the main causes of short- and long-term graft loss, everolimus has a key role to play in renal transplantation, which is being explored further in a number of ongoing Phase III–IV trials.Keywords: calcineurin inhibitors, chronic allograft nephropathy, cyclosporine, everolimus, renal function, renal transplantation

  5. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  6. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2012-02-01

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, <\\/= 5 mg\\/day, > 5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  7. Disseminated Mycobacterium haemophilum infection in a renal transplant recipient.

    Science.gov (United States)

    Brix, Silke R; Iking-Konert, Christof; Stahl, Rolf A K; Wenzel, Ulrich

    2016-10-31

    Opportunistic infections are a major concern in renal and transplant medicine. We present the case of a renal transplant recipient with a generalised Mycobacterium haemophilum infection after an increase in immunosuppressive therapy and treatment with a tumour necrosis factor-α (TNF-α) inhibitor. Infection involved skin and soft tissue, joints and bones, as well as the renal transplant with an interstitial nephritis. Rapid diagnosis using PCR and DNA sequencing allowed early appropriate treatment. Triple antibiotic therapy and reduction in immunosuppression resulted in a slow but sustained recovery. Immunosuppression causes severe opportunistic infections. TNF-α inhibitors are very effective and well tolerated but have an increased susceptibility to infections with mycobacteria. Mycobacterial infections represent a significant clinical risk to transplant recipients because of their aggressive clinical course and the need for complex toxic antibiotic treatments. In these patients, M. haemophilum is a cause of skin infections.

  8. Evaluation of allograft perfusion by radionuclide first-pass study in renal failure following renal transplantation

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    Baillet, G.; Ballarin, J.; Urdaneta, N.; Campos, H.; Vernejoul, P. de; Fermanian, J.; Kellershohn, C.; Kreis, H.

    1986-04-01

    To assess the diagnostic value of indices measured on a first-pass curve, we performed 72 radionuclide renal first-pass studies (RFP) in 21 patients during the early weeks following renal allograft transplantation. The diagnosis was based on standard clinical and biochemical data and on fine needle aspiration biopsy (FNAB) of the transplant. Aortic and renal first-pass curves were filtered using a true low-pass filter and five different indices of renal perfusion were computed, using formulae from the literature. Statistical analysis performed on the aortic and renal indices indicated excellent reproducibility of the isotopic study. Although renal indices presented a rather large scatter, they all discriminated well between normal and rejection. Three indices have a particularly good diagnostic value. In the discrimination between rejection and Acute Tubular Necrosis (ATN), only one index gave satisfying results. The indices, however, indicate that there are probably ATN with an alternation of renal perfusion and rejection episodes where perfusion is almost intact. We conclude that radionuclide first-pass study allows accurate and reproducible quantitation of renal allograft perfusion. The measured parameters are helpful to follow up the course of a post-transplantation renal failure episode and to gain more insight into renal ischemia following transplantation.

  9. Reproductive health in Irish female renal transplant recipients.

    LENUS (Irish Health Repository)

    Kennedy, C

    2012-02-01

    OBJECTIVE: To report the pregnancy outcomes in Irish female renal transplant recipients on modern maintenance immunosuppression. METHODS: The Republic of Ireland transplant database was accessed to identify the patient cohort in question. All female renal transplant recipients whose transplantation was in Ireland before or during their reproductive years were included. A questionnaire was sent to the identified women. A chart review was performed for those women who reported a pregnancy following renal transplantation. RESULTS: Two hundred and ten women met the inclusion criteria. There was a response rate of 70% (n = 148). Eighteen women reported 29 pregnancies. The live birth rate was 76%. The mean gestation of the live births was 36.2 weeks with a mean birth weight of 3.0 kg. There were six cases of pre-eclampsia. Twin pregnancies and those entering pregnancy with a creatinine greater than 135 micromol\\/l had particularly complicated clinical courses. Four women had not conceived post transplant despite actively trying for over 1 year. Two women utilised assisted fertility methods (in vitro fertilisation), one of whom became pregnant. CONCLUSIONS: A significant proportion of women who attempt to conceive following renal transplantation are successful, without the use of assisted fertility. Pregnancy in this setting warrants meticulous multidisciplinary care.

  10. Sirolimus Versus Tacrolimus as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.

    Science.gov (United States)

    Liu, Jin-Yu; Song, Ming; Guo, Min; Huang, Feng; Ma, Bing-Jun; Zhu, Lan; Xu, Gang; Li, Juan; You, Ru-Xu

    Sirolimus and tacrolimus are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of sirolimus and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane controlled trials register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection (AR), and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost-effectiveness. Altogether, 1189 patients from 8 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of AR and patient withdrawn. Nevertheless, tacrolimus increased the risk of infection. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events after renal transplant. Tacrolimus is an effective and safe immunosuppressive agent, and it may be more cost-effective than cyclosporine for the primary prevention of AR in renal transplant recipients. However, it should be noted that such superiority was reversal when the cost of sirolimus and tacrolimus changed.

  11. Outpatient parenteral antibiotic therapy in a renal transplant population: A single-center experience

    Directory of Open Access Journals (Sweden)

    Jade Harrison

    2015-01-01

    Full Text Available Outpatient parenteral antimicrobial therapy (OPAT is a well-established method in medical specialties. Its use in renal transplant recipients has not been thoroughly explored. No guidelines within this patient subset exist. This study describes OPAT outcomes within a UK teaching hospital renal transplant population. Renal function, mapped by estimated glomerular filtration rate (eGFR, and clinical response to infection were collected retrospectively. A total of 635 antimicrobial episodes were administered to nine renal transplant patients over 12 discrete OPAT courses during the study period. Eleven of 12 OPAT courses (91.67% produced a clinical improvement in infection. One course was terminated due to immunosuppressive-related neutropenia. No patient required admission due to failure of OPAT or adverse events. There was no significant change in graft function throughout the OPAT courses compared with baseline renal function (ANOVA, P = 0.06. One minor line infection was reported. This was treated conservatively and did not interrupt the OPAT. OPAT is safe and clinically effective in our renal transplant recipients with no significant deterioration in eGFR. The incidence of adverse events, specifically line complications, was lower in our population than those reported in the literature. Future work should develop OPAT guidelines designed for transplant recipients to outline the degree of monitoring required.

  12. Effect of Renal Transplantation in Restless Legs Syndrome.

    Science.gov (United States)

    Kahvecioglu, Serdar; Yildiz, Demet; Buyukkoyuncu, Nilufer; Celik, Huseyin; Tufan, Fatih; Kılıç, Ahmet Kasım; Gul, Bulent; Yildiz, Abdulmecid

    2016-02-01

    Restless legs syndrome is a disorder in which patients have irresistible urge to move legs during rest. Restless legs syndrome seems to be common in end-stage renal disease. After a successful renal transplant, symptoms ameliorate with renal function improvement and restless legs syndrome is seen less in this population. Here, we aimed to investigate restless legs syndrome frequency and associated factors in renal transplant patients. In a cross-sectional study with 193 patients (116 hemodialysis patients, 45 transplant patients, and 32 controls), the presence of restless legs syndrome was assessed using the Restless Legs Syndrome Questionnaire. Medical history, demographic, and laboratory data were collected from the patients' medical records. Patients were questioned about the presence of restless legs syndrome using the Restless Legs Syndrome Questionnaire. Patients were evaluated with Beck Depression Scale for depression and Pittsburgh tests for sleep disturbances. While the rate of restless legs syndrome was similar between transplants and controls, it was significantly greater in hemodialysis patients. Hemodialysis patients and controls had similar depression scores that were higher compared with transplant patients. Pittsburgh score was similar in transplant patients and controls and significantly increased in the hemodialysis patients. The rate of insomnia was significantly higher in the hemodialysis patients compared with the other 2 groups. Logistic regression analysis revealed independent correlates of restless legs syndrome as insomnia, Beck depression score, and being on hemodialysis. Linear regression analysis showed that independent correlates of higher Pittsburgh score were higher depression score, higher age, and presence of restless legs syndrome. The prevalence of restless legs syndrome is significantly lower in transplant patients than it is in patients on maintenance dialysis. In renal transplant patients, restless legs syndrome frequency was

  13. Prevalence of silent gastrointestinal complications in maintenance renal transplant population

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    Teplitsky Susan

    2010-01-01

    Full Text Available This study aims to determine the prevalence of silent GI complications within a stable renal transplant population and to investigate whether the conversion to enteric-coated myco-phenolate sodium (EC-MPS, Myfortic; would improve symptom scores. This was a single-center, open-label, non-randomized, prospective study. Patients without any history of GI com-plaints were evaluated by means of the gastrointestinal symptom rating scale (GSRS, with subse-quent switch to EC-MPS in a group of patients. Silent complications were defined as patients who voiced no GI complaints at clinic visits despite a score of ≥ 2 on GSRS scale. A total of 236 stable patients participated in the trial. The prevalence of baseline scores ≥ 2 was relatively high with abdominal pain 29.66%, reflux 37.28%, indigestion 50%, constipation 58.47% and diarrhea 33.4%. Of 236 patients, 80 were converted to EC-MPS. There was statistically significant improvement on all scales in the subgroup of patients with GSRS score ≥ 2 (P< 0.05. In conclusion, the GSRS scale identified a high percentage of silent gastrointestinal complications in this renal transplant population. The converted patients with higher GSRS scores reported a sustained improvement.

  14. Neither cyclosporine nor tacrolimus deteriorate endothelial function in renal transplant recipients assessed with reactive hyperernia index.

    Science.gov (United States)

    Grabczewska, Z; Obońska, K; Adamowicz, A; Kasprzak, M; Włodarczyk, Z; Kubica, J

    2013-05-01

    Cardiovascular mortality in renal transplant recipients is nearer 10-fold higher than in general population. Immunosuppressive therapy is one possible cause, for these drugs can modify cardiovascular risk factors, which can induce endothelial dysfunction, the first step in the process of atherosclerosis. The aim of this study was to compare vasodilatatory function of endothelium in renal transplant recipients in relation to the immunosuppressive drug-cyclosporine or tacrolimus. We examined 40 patients at 48.9 ± 36 months post-renal transplantation: 22 taking tacrolimus (group 1) and 18 taking cyclosporine (group 2). The renal transplant recipients were compared with a control group of 18 healthy people. Endothelial function was assessed by peripheral arterial tonometry (PAT) using the EndoPAT 2000 device to measure RHI (reactive hyperemia index) and AI% (augmentation index%). The overall median values of RHI were higher than the value accepted as a normal (1.67). The RHI median value in group 1 was 2.00 (quartile 1: 1.66; quartile 2: 2.72), not different from that in group 2 [1.90 (quartile 1: 1.56; quartile 2: 2.17)] or the controls [2.11 (quartile 1: 1.77; quartile 2: 2.50)]. Multivariate analysis revealed age to be the independent factor influencing RHI in all examined groups but treatment with calcium channel blockers appeared to be the only independent factor influencing RHI among renal transplant recipients. AI% values were not significantly different between the 2 groups of renal transplant recipients, but it was significantly higher among the controls than among subjects treated with tacrolimus. Vasodilatatory function of endothelium assessed by PAT in renal transplant recipients was not worse than in healthy people. It was not different between cyclosporine or tacrolimus. Arterial stiffness measured as AI% depend on age but not the calcineurin inhibitor, which showed little effect. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Surgical complications in pediatric and adolescent renal transplantation

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    El Atat Rabih

    2010-01-01

    Full Text Available To report the surgical complications among our pediatric and adolescent renal transplants and to compare these results with other reported series in the literature. A total of 50 pediatric and adolescent renal transplants were included in this study. There were 30 boys and 20 girls with a mean age of 13 years (range 6 - 18 years. 70% of patients received their kidneys from living donors. Two patients underwent renal re-transplantation. Among the 52 transplantations, 17 surgical complications were encountered in 15(30% patients. The incidence of urological and vascular complications was respectively 13.2% and 18.9%. These complications included vesico-ureteral reflux (9.4%, urinary leakage (3.8%, lymphocele (5.8%, peri-renal hematoma (1.9%, renal artery stenosis (3.7%, and thrombosis of the allograft (7.5%. The patients with vesico-ureteral reflux were treated by antibiotic prophylaxis. In four recipients, thrombosis of the allo-graft with subsequent graft loss occurred. The graft survival rate was 90% in 1 year, 77% in 5 years and 40% in 10 years follow-up. The patient survival rate was 94.4% in 1 year and 84% after 8 years follow-up. We conclude that surgical complications can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication are critical for graft and patient survival.

  16. Forgotten ureteric stents in renal transplant recipients: three case reports.

    Science.gov (United States)

    Bardapure, Mallikarjun; Sharma, Ajay; Hammad, Abdul

    2014-01-01

    Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  17. Forgotten ureteric stents in renal transplant recipients: Three case reports

    Directory of Open Access Journals (Sweden)

    Mallikarjun Bardapure

    2014-01-01

    Full Text Available Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  18. Review of Surgical Techniques of Experimental Renal Transplantation in Rats.

    Science.gov (United States)

    Shrestha, Badri; Haylor, John

    2017-08-01

    Microvascular surgical techniques of renal transplant in rats have evolved over the past 5 decades to achieve successful rat renal transplant; these modifications have included surgical techniques to address the anatomic variations in the renal blood vessels and those to reduce ischemic and operation durations. Here, we review the surgical techniques of renal transplant in rats and evaluate the advantages and disadvantages of individual techniques of vascular and ureteric anastomoses. For this review, we performed a systematic literature search using relevant medical subject heading terms and included appropriate publications in the review. Since the first description of a rat model of renal transplant by Bernard Fisher and his colleagues in 1965, which used end-to-side anastomosis between the renal vein and renal artery to the recipient inferior vena cava and aorta, several vascular and ureteric anastomosis techniques have been modified. Vascular anastomosis techniques now include end-to-end anastomosis, use of donor aortic and inferior vena cava conduits, sleeve and cuff anastomoses, and application of fibrin glue. Likewise, restoration of the urinary tract can now be achieved by direct anastomosis of the donor ureter to the recipient bladder, end-to-end anastomosis between the donor and recipient ureters, and donor bladder cuff to the recipient bladder. There are advantages and disadvantages attributable to individual techniques. The range of vascular and ureteric anastomosis techniques that has emerged reflects the need for mastering more than one technique to suit the vascular anatomy of individual animals and to reduce operating time for achieving successful outcomes after renal transplant.

  19. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, M.C.; Larcos, G.; Chapman, J. [Westmead Hospital, Westmead, Sydney, NSW (Australia). Departments of Nuclear Medicine and Ultrasound

    1998-06-01

    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  20. Oral manifestations of allograft recipients before and after renal transplantation

    Directory of Open Access Journals (Sweden)

    Gita Rezvani

    2014-01-01

    Full Text Available Renal transplantation is considered the best treatment option for patients with end-stage renal disease. In this study, the prevalence of oral lesions was studied in a cohort of renal transplant recipients before and after transplantation. Fifty-nine kidney transplant recipients were examined one week before and four months after transplantation. The information gathered included age, sex, smoking history, duration on dialysis, drugs and their doses. There were 41 males (69.5% and 18 females (30.5% with a mean age of 37 years. Before surgery, two patients had non-specific lesions and two other patients had leukoedema. Following transplantation, 24 patients (40.7% did not have any specific lesion. In six patients, we observed non-specific erythematous lesions (10.2%. Other recorded observations are as follows: Gingival hyperplasia in five patients (8.5%, oral candidiasis of the erythematous type in five patients (8.5%, hairy leukoplakia in four patients (6.8% and leukoedema in seven patients (11.9%. In our study patients, the prevalence of oral lesions increased after transplantation, although it was lower than that reported in other studies. This could be due to the differences in sample size, differences between Iranian race and other races and different pharmaceutical formulation of the drug produced in Iran.

  1. Continuation of cinacalcet immediately after renal transplantation: a prospective cohort study.

    NARCIS (Netherlands)

    Aalten, J.; Wetzels, J.F.M.; Hoitsma, A.J.

    2010-01-01

    BACKGROUND: cinacalcet is used for treating secondary hyperparathyroidism in dialysis patients, but it is currently unknown whether it can safely be continued immediately after renal transplantation. METHODS: we prospectively studied renal transplant recipients with secondary hyperparathyroidism who

  2. Detection of acute renal allograft rejection by analysis of renal tissue proteomics in rat models of renal transplantation

    Directory of Open Access Journals (Sweden)

    Dai Yong

    2008-01-01

    Full Text Available At present, the diagnosis of renal allograft rejection requires a renal biopsy. Clinical management of renal transplant patients would be improved if rapid, noninvasive and reliable biomarkers of rejection were available. This study is designed to determine whether such protein biomarkers can be found in renal-graft tissue proteomic approach. Orthotopic kidney transplantations were performed using Fisher (F344 or Lewis rats as donors and Lewis rats as recipients. Hence, there were two groups of renal transplant models: one is allograft (from F344 to Lewis rats; another is syngrafts (from Lewis to Lewis rats serving as control. Renal tissues were collected 3, 7 and 14 days after transplantation. As many as 18 samples were analyzed by 2-D Electrophoresis and mass spectrometry (MALDI-TOF-TOF-MS. Eleven differentially expressed proteins were identified between groups. In conclusion, proteomic technology can detect renal tissue proteins associated with acute renal allograft rejection. Identification of these proteins as diagnostic markers for rejection in patients′ urine or sera may be useful and non-invasive, and these proteins might serve as novel therapeutic targets that also help to improve the understanding of mechanism of renal rejection.

  3. Dietary protein, blood pressure and renal function in renal transplant recipients

    NARCIS (Netherlands)

    Berg, van den E.; Engberink, M.F.; Brink, E.J.; Baak, van M.A.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2013-01-01

    Hypertension is highly prevalent among renal transplant recipients (RTR) and a risk factor for graft failure and cardiovascular events. Protein intake has been claimed to affect blood pressure (BP) in the general population and may affect renal function. We examined the association of dietary protei

  4. Re: Robot-Assisted Renal Transplantation in the Retroperitoneum

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    Tsai MK

    2015-03-01

    Full Text Available The authors describe their first 10 cases of minimally invasive renal transplantation experience in the retroperitoneum with the aid of the da Vinci surgical system through a gas-less extra-peritoneal approach with a muscle sparing Gibson incision. The authors claim that they have utilized robotic arms for both vascular anastomosis and abdominal wall lifting which can be limiting in the obese patients. In recent years there is an increasing tendency for minimally invasive renal transplantation such as transperitoneal laparoscopic or robotic assisted renal transplantation. Those techniques still need modifications and search for a better technique is still in progress. In this study, mimicking the well-established open procedure with a smaller incision can be a better alternative, which requires confirmation in the future

  5. Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-01

    Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  6. Relationship between cytomegalovirus and colonization of the oropharynx by gram-negative bacilli following renal transplantation.

    OpenAIRE

    Mackowiak, P A; Goggans, M.; W. Torres; Dal Nogare, A.; Luby, J. P.; Helderman, H.

    1991-01-01

    Numerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV). To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after tran...

  7. Mucormycosis with Orbital Apex Syndrome in a Renal Transplant Recipient

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    Ebru Kursun

    2015-06-01

    Full Text Available Mucormycosis is a rarely encountered invasive fungal infection with high mortality.Solid organ transplantation is one of the risk factors for mucormycosis. Mucormycosis can be classified in six different groups according to the anatomical localization; rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and other less common involvements. This paper presented a mucormycosis case with rhinoorbitocerebral involvementin a renal transplantation receiver, which manifested with orbital apex syndrome. [Cukurova Med J 2015; 40(2.000: 384-389

  8. A rare complication after renal transplantation: Forgotten stent

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    Mustafa Karabıcak

    2015-07-01

    Full Text Available In renal transplantation surgery, double J stents (DJS are often used to reduce complications, protect the anastomosis between ureter and bladder, provide drainage in ureteral obstructions and enhance healing if there is an ureter injury. Urinary tract infections, hematuria and irritative voiding symptoms are the early complications of DJS. Migration, fragmantation, encrustation and rarely sepsis are among the late complications of DJS. In this report we describe a renal transplantation case whose DJS stent was forgotten because the patient did not attend the regular follow-up and noticed 5 years after surgery.

  9. Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2012-02-01

    We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  10. Therapeutic effectiveness of pediatric renal transplantation in 63 cases

    Institute of Scientific and Technical Information of China (English)

    Han Shu; Wang Mu; Zhu Youhua; Zeng Li; Zhou Meisheng; Zhang Lei; Fu Shangxi; Wang Liming

    2008-01-01

    Objective: To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods: From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results: The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%,respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension (26/63, 41.3%), crinosity (14/63, 22.2%),drug-induced hepatic injury(11/63, 17.5%), gingival hyperplasia (10/63, 15.8%), pulmonary infection(9/63, 14.3%),bone marrow suppression(5/63, 7.9%), herpes (4/63, 6.3%) and diabetes (3/63, 4.8%). Conclusion: Renal transplantation is a preferred method for the treatment of children in end-stage renal disease (ESRD). Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.

  11. Allograft and prostatic involvement in a renal transplant recipient with disseminated tuberculosis.

    Science.gov (United States)

    Sreejith, P; Jha, V; Kohli, H S; Rathi, M; Gupta, K L; Sakhuja, V

    2010-01-01

    Tuberculosis is a serious opportunistic infection in renal transplant recipients and is disseminated in nature in one-third of patients. Genito urinary tuberculosis is rare in renal transplant recipients. We report a patient presenting 5 years after renal transplantation with disseminated tuberculosis and allograft and prostatic involvement.

  12. Early transient leg swelling at the side of renal transplant in two children.

    NARCIS (Netherlands)

    Koster-Kamphuis, L.; Die, C.E. van; Vliet, J.A. van der; Monnens, L.A.H.

    2006-01-01

    Two children are described with a huge leg swelling shortly after renal transplantation. The swelling was located at the side of the renal transplant. The swelling was caused by the compression of the iliac vein by the renal transplant combined with perirenal fluid collection. Doppler flow studies a

  13. Can patients with schizophrenia undergo renal transplantation with success?

    Directory of Open Access Journals (Sweden)

    Saoussen Bouhlel

    2014-01-01

    Full Text Available We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient′s compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient′s family, the psychiatric staff and the nephrology team.

  14. Long-term experience of steroid-free pediatric renal transplantation

    DEFF Research Database (Denmark)

    Wittenhagen, Per; Thiesson, Helle C; Baudier, François;

    2014-01-01

    Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate...... in the youngest (pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature....

  15. Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.

    Science.gov (United States)

    Oguz, Y; Yilmaz, M I; Eyileten, T; Caglar, K; Yenicesu, M; Kaya, A; Tasar, M; Saglam, M; Doganci, L; Gulec, B; Oner, K; Oktenli, C; Vural, A

    2006-06-01

    Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.

  16. Psycho-social outcome of parents and young children after renal transplantation.

    Science.gov (United States)

    Douglas, J E; Hulson, B; Trompeter, R S

    1998-01-01

    This cross-sectional study aims to assess whether renal transplantation in children under the age of 6 years has an effect on the child's later behaviour and eating and whether this outcome is related to differences in the levels of stress and coping skills shown by the parents. In this small sample of 14 children aged under 8 years, renal transplantation in the pre-school age range did not have any marked adverse effect on the children's emotional or behavioural state. The children's severe eating problems dramatically improved after transplant. Long-term, early tube-feeding does not impair the development of normal feeding patterns in these children. Parental stress levels were not elevated in the post-transplant period and parents tended to use passive coping strategies to manage the chronic illness in their child.

  17. Incidence of osteonecrosis after renal transplantation

    NARCIS (Netherlands)

    H.J. Metselaar (Herold); van Steenberge, J.P. (J. P.); A.B. Bijnen (Bart); J. Jeekel (Hans); B. van Linge (Bert); W. Weimar (Willem)

    1985-01-01

    textabstractThe incidence of osteonecrosis was 24% in 248 patients who had received 262 kidney transplants 1971-1982. However, based only on patients at risk, i.e. alive with functioning transplants, the incidence at 1, 3 and 6 years was found to be 13, 27 and 36%; after six years no new cases were

  18. Renal transplant improves pulmonary hypertension in patients with end stage renal disease

    Directory of Open Access Journals (Sweden)

    Bozbas Serife

    2011-06-01

    Full Text Available Abstract Background Pulmonary hypertension (PH is present in a significant proportion of patients with end stage renal disease (ESRD and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP determined by Doppler echocardiography. Methods Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results Pulmonary hypertension was detected in 85 of the 500 (17% patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy analyses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3% cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p Conclusion These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

  19. Vaccination in Renal Transplant Patients (VcRtp study)

    LENUS (Irish Health Repository)

    Rathore, F

    2016-02-01

    Adverse outcomes of influenza & pneumococcal infections in solid organ transplant recipients have been well documented. Vaccinations are therefore recommended by multiple guidelines. Despite emerging evidence of the safety & effectiveness among immunosuppressed patients, most vaccines are still underutilized, we conducted a survey among the renal transplant patients in Beaumont Hospital to determine the awareness and uptake of vaccinations. Questionnaires were handed to patients during a clinic visit over a span of 2 weeks and 250 questionnaires were posted out to randomly selected transplant patients, The Questionnaire addressed various aspects including the awareness of importance of vaccinations, source of information, if they were up to date with the vaccines & where did they receive it?

  20. Low-grade proteinuria and microalbuminuria in renal transplantation.

    Science.gov (United States)

    Halimi, Jean-Michel

    2013-07-27

    Nephrotic-range proteinuria has been known for years to be associated with poor renal outcome. Newer evidence indicates that early (1-3 months after transplantation) low-grade proteinuria and microalbuminuria (1) provide information on the graft in terms of donor characteristics and ischemia/reperfusion injury, (2) may occur before the development of donor-specific antibodies, (3) predict the development of diabetes and cardiovascular events, and (4) are associated with reduced long-term graft and patient survivals. Low-grade proteinuria and microalbuminuria are also predictive of diabetes, cardiovascular morbidity, and death in nontransplanted populations, which may help us to understand the pathophysiology of low-grade proteinuria or microalbuminuria in renal transplantation. The impact of immunosuppressive medications, including mammalian target of rapamycin inhibitors, on graft survival is still discussed, and the effect on proteinuria is crucial to the debate. The fact that chronic allograft rejection may exist as early as 3 months after renal transplantation indicates that optimal management of low-grade proteinuria or microalbuminuria should occur very early after transplantation to improve long-term renal function and the overall outcome of renal transplant recipients. The presence of low-grade proteinuria or microalbuminuria early after transplantation must be taken into account to choose adequate immunosuppressive and antihypertensive medications. Limited information exists regarding the benefit of therapeutic interventions to reduce low-grade proteinuria or microalbuminuria. Whether renin angiotensin blockade results in optimal nephroprotection in patients with low-grade proteinuria or microalbuminuria is not proven, especially in the absence of chronic allograft nephropathy. Observational studies and randomized clinical trials yield conflicting results. Finally, randomized clinical trials are urgently needed.

  1. Recovery of renal function after prolonged dialysis and transplantation.

    Science.gov (United States)

    Nunan, T O; Stevens, E A; Croft, D N; Hilton, P J; Jones, N F; Wing, A J

    1983-01-01

    Out of 250 patients with renal failure, seven (2.8%) treated by regular haemodialysis alone (four) or given cadaveric allografts (three) later showed recovery of function of their own kidneys lasting from one to four years. In the patients receiving haemodialysis alone recovery was easily recognised from their serum creatinine concentrations, but in those with transplants recovery was discovered unexpectedly during radionuclide scanning. These findings suggest that recovery of renal function may be more common than generally recognised, which should be borne in mind when beginning renal replacement treatment and particularly when contemplating bilateral nephrectomy. Images p248-a PMID:6409268

  2. Renal Vein Reconstruction for Harvesting Injury in Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Birkan Bozkurt

    2014-03-01

    Full Text Available Kidney transplantation is the best treatment choice in the end-stage renal disease. In the renal transplantation, renal vein damage or shortness which occurs during cadaveric or living donor nephrectomy causes technical difficulties for surgeons. The lack of the donors already especially cadaveric, the acquirement of the graft, gets very much importance. In this report, it is aimed to share the clinical experiment by which it seen, how anastomosis can become appropriate by using the renal vein which is damaged in the way that anastomosis cannot be done anyway by using cadaveric vena cava graft. The renal vein brought to length for anostomosis which is repaired by using cadaveric vena cava graft, is anastomosed successfully by becoming an end-to-side of the external iliac vein of the recipient. Vascular anastomoses are applied easily in technique. The time of the warm ischemia was under 2 hours and the kidney was functional in the post-operative period. Renal vein trombosis was not observed. The renal vein damage occured during cadaveric or living donor nephrectomy, can be repaired by some methods. In the kidneys in which vein requirement is done, the success rates are rather high although acute tubular necrosis and delayed function can be seen more.

  3. SURGICAL CORRECTION OF HEART VALVE DISEASE WITH CARDIOPULMONARY BYPASS IN PATIENTS AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. A. Belokurov

    2013-01-01

    Full Text Available Aim. Evaluation of the possibility heart valve replacement in renal transplant recipients from a position of safe- ty for graft function. Materials and methods. 5 patients, heart valve replacement was performed with a func- tioning kidney transplant at a satisfactory its function. The average age of patients at the time of cardiac surgery was 38,8 ± 12,6 years, among whom were two (40% men and 3 (60% women. The interval between renal transplantation and heart surgery was 40,3 ± 44,1 (2 to 120 months. Prior to kidney transplantation, all patients were on renal replacement therapy with hemodialysis program for 50,2 ± 48,6 months. In 4 of the 5 patients of heart disease was the cause of infective endocarditis. Results. Average time IR was 81,2 ± 21,7 minutes , the average time of aortic clamping 63,6 ± 20,9 minutes and hypothermia during CPB 29,2 ± 3,2 °C. All patients were implanted with double-leaf mechanical prostheses "MedEng-2" and "SarboMedics". All 5 patients in sa- tisfactory condition were discharged from the hospital. The average duration of the postoperative period was 14,2 ± 3,4 days. All patients had relatively smooth flow after surgery, no infectious complications, a satisfactory renal transplant function and prosthetic heart valves. In the late period in four patients and transplant graft func- tion is satisfactory in terms of the observation of 5 years, 3 years and 6 months after surgery. Conclusion. Our experience shows the possibility of successful correction of heart defects in IR in renal transplant recipients. 

  4. A single-center epidemiological study of BK virus infection and analysis of risk factors in patients with renal transplantation

    Directory of Open Access Journals (Sweden)

    Ji-gang LI

    2014-10-01

    Full Text Available Objective To investigate the epidemiological characteristics of BK virus (BKV infection in living renal transplantation patients, and analyze the risk factors of BKV infection and BKV nephropathy (BKVN. Methods The BKV DNA load in urine and blood samples of 43 renal transplant recipients, who had received renal transplantation in 309 Hospital from Feb. 2012 to Feb. 2013, was determined at preoperative period and 0.5, 1, 3, 6, 9, 12 and 15 months after transplantation. Meanwhile, the biopsy of grafted kidney was performed in those patients with continuously elevated serum creatinine and those with higher BKV DNA load. Patients were divided into 3 groups as follows according to the test results: BK viruria group, BK viremia group and pathologically diagnosed BKVN group. Data of each group were then recorded, including gender, age, postoperative diabetes (PTDM, acute rejection (AR, delayed recovery of graft function (DGF, postoperative pulmonary infection, preoperative immune induction therapy, postoperative immunosuppressive regimen, and other information. The risk factors for postoperative BKV infection and BKVN were analyzed. Results After an average of 15-month follow-up, it was found that the incidence of BKV viruria was 46.5%, that of BKV viremia was 14.0%, and that of BKVN was 2.3%. Sixth month after transplantation was found to be the peak time of viruria and viremia. FK506 was significantly associated with viremia in living donor renal transplantation. The immunosuppressive regimen was the immune related independent risk factor for BK viremia developing BKVN after living renal transplantation. Conclusion The incidence of BK viremia and BKVN is lower in living donor renal transplantation than in cadaver renal transplantation, but that of viruria is similar in both groups. Immunosuppressive scheme based on FK506 is an immune related independent risk factor leading to BK viremia proceeding to BKVN in living donor kidney

  5. Prevalence and predictors of acute renal injury in liver transplant recipients.

    Science.gov (United States)

    Rymarz, A; Serwacki, M; Rutkowski, M; Pakosiński, K; Grodzicki, M; Patkowski, W; Kacka, A; Ołdakowska-Jedynak, U; Krawczyk, M

    2009-10-01

    Renal failure is a major factor impacting liver transplant outcomes. Renal functional impairment predicts decreased survival, leading to increased morbidity and mortality. The aim of this study was to estimate the incidence, risk factors, and resolution of acute kidney injury (AKI) among liver transplant recipients during the operative hospital stay. We analyzed data from 99 orthotopic liver transplantations (OLT) performed at our center in 2008. Posttransplantation occurrence of AKI was defined as an increase in serum creatinine (SCr) concentration of 0.3 mg/dL or more, namely, 1.5-fold from baseline. AKI was observed among 31.31% of liver transplant recipients (n = 31). The mean increase in SCr was 2.49 +/- 0.78-fold from baseline. The mean posttransplant SCr level was 2.59 +/- 0.92 mg/dL. Renal replacement therapy was introduced to 16.12% (n = 5) liver recipients developing AKI. Among them, 2 subjects (6.45%) died. The mean SCr level at the time of discharge from the hospital was 1.17 +/- 0.57 mg/dL among the AKI group compared with 0.77 +/- 0.32 mg/dL among the group without AKI. Pretransplant renal impairment expressed by an elevated SCr concentration (relative risk [RR] = 1.25; P = .0386) and treatment with exogenous vasoconstrictors during the operation (RR = 2.27; P = .016) were identified as risk factors for developing AKI after liver transplantation.

  6. Recurrence of Acute Page Kidney in a Renal Transplant Allograft

    Directory of Open Access Journals (Sweden)

    Rajan Kapoor

    2016-01-01

    Full Text Available Acute Page Kidney (APK phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS. Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft.

  7. Recurrence of Acute Page Kidney in a Renal Transplant Allograft.

    Science.gov (United States)

    Kapoor, Rajan; Zayas, Carlos; Mulloy, Laura; Jagadeesan, Muralidharan

    2016-01-01

    Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft.

  8. Ralstonia mannitolilytica infection in renal transplant recipient: First report

    Directory of Open Access Journals (Sweden)

    Mukhopadhyay C

    2003-01-01

    Full Text Available Ralstonia mannitolilytica is being increasingly identified as an opportunist pathogen in immunocompromised patients. We report the first case of post renal transplant infection by R. mannitolilytica, in a 14-year-old recipient. The graft and the patient were saved with prompt microbiological identification, sensitivity testing and subsequent administration of appropriate antibiotic.

  9. Monoclonal Antibody Therapy and Renal Transplantation: Focus on Adverse Effects

    Directory of Open Access Journals (Sweden)

    Gianluigi Zaza

    2014-02-01

    Full Text Available A series of monoclonal antibodies (mAbs are commonly utilized in renal transplantation as induction therapy (a period of intense immunosuppression immediately before and following the implant of the allograft, to treat steroid-resistant acute rejections, to decrease the incidence and mitigate effects of delayed graft function, and to allow immunosuppressive minimization. Additionally, in the last few years, their use has been proposed for the treatment of chronic antibody-mediated rejection, a major cause of late renal allograft loss. Although the exact mechanism of immunosuppression and allograft tolerance with any of the currently used induction agents is not completely defined, the majority of these medications are targeted against specific CD proteins on the T or B cells surface (e.g., CD3, CD25, CD52. Moreover, some of them have different mechanisms of action. In particular, eculizumab, interrupting the complement pathway, is a new promising treatment tool for acute graft complications and for post-transplant hemolytic uremic syndrome. While it is clear their utility in renal transplantation, it is also unquestionable that by using these highly potent immunosuppressive agents, the body loses much of its innate ability to mount an adequate immune response, thereby increasing the risk of severe adverse effects (e.g., infections, malignancies, haematological complications. Therefore, it is extremely important for clinicians involved in renal transplantation to know the potential side effects of monoclonal antibodies in order to plan a correct therapeutic strategy minimizing/avoiding the onset and development of severe clinical complications.

  10. Recurrence of Acute Page Kidney in a Renal Transplant Allograft

    Science.gov (United States)

    Zayas, Carlos; Mulloy, Laura; Jagadeesan, Muralidharan

    2016-01-01

    Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft. PMID:27725836

  11. Iron Deficiency, Anemia and Mortality in Renal Transplant Recipients

    NARCIS (Netherlands)

    Eisenga, Michele F.; Minovic, Isidor; Berger, Stefan P.; Kootstra-Ros, Jenny E.; van den Berg, Else; Riphagen, Ineke J.; Navis, Gerjan; van der Meer, Peter; Bakker, Stephan J. L.; Gaillard, Carlo A. J. M.

    2016-01-01

    Anemia, iron deficiency anemia (IDA), and iron deficiency (ID) are highly prevalent in renal transplant recipients (RTR). Anemia is associated with poor outcome, but the role of ID is unknown. Therefore, we aimed to investigate the association of ID, irrespective of anemia, with all-cause mortality

  12. Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient

    Science.gov (United States)

    Pre-patellar bursitis is typically a monomicrobial bacterial infection. Rarely is a fungal cause identified. We describe a 61 year-old man who had received a renal transplant 21 months prior to presentation whose synovial fluid and surgical specimens grew Phomopsis bougainvilleicola, a pycnidial coe...

  13. Sodium intake and blood pressure in renal transplant recipients

    NARCIS (Netherlands)

    van den Berg, Else; Geleijnse, Johanna M.; Brink, Elizabeth J.; van Baak, Marleen A.; van der Heide, Jaap J. Homan; Gans, Rijk O. B.; Navis, Gerjan; Bakker, Stephan J. L.

    2012-01-01

    Hypertension is common among renal transplant recipients (RTR) and a risk factor for graft failure and mortality. Sodium intake is a well-established determinant of blood pressure (BP) in the general population. However, data in RTR are limited. International guidelines recommend a maximum daily sod

  14. Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient.

    Science.gov (United States)

    Cariello, Paloma F; Wickes, Brian L; Sutton, Deanna A; Castlebury, Lisa A; Levitz, Stuart M; Finberg, Robert W; Thompson, Elizabeth H; Daly, Jennifer S

    2013-02-01

    Prepatellar bursitis is typically a monomicrobial bacterial infection. A fungal cause is rarely identified. We describe a 61-year-old man who had received a renal transplant 21 months prior to presentation whose synovial fluid and surgical specimens grew Phomopsis bougainvilleicola, a pycnidial coelomycete.

  15. Sodium intake and blood pressure in renal transplant recipients

    NARCIS (Netherlands)

    Berg, van den E.; Geleijnse, J.M.; Brink, E.J.; Baak, van M.A.; Homan van der Heide, van der J.J.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background - Hypertension is common among renal transplant recipients (RTR) and a risk factor for graft failure and mortality. Sodium intake is a well-established determinant of blood pressure (BP) in the general population. However, data in RTR are limited. International guidelines recommend a maxi

  16. Iron Deficiency, Anemia and Mortality in Renal Transplant Recipients

    NARCIS (Netherlands)

    Eisenga, Michele F.; Minovic, Isidor; Berger, Stefan P.; Kootstra-Ros, Jenny E.; van den Berg, Else; Riphagen, Ineke J.; Navis, Gerjan; van der Meer, Peter; Bakker, Stephan J. L.; Gaillard, Carlo A. J. M.

    2016-01-01

    Anemia, iron deficiency anemia (IDA), and iron deficiency (ID) are highly prevalent in renal transplant recipients (RTR). Anemia is associated with poor outcome, but the role of ID is unknown. Therefore, we aimed to investigate the association of ID, irrespective of anemia, with all-cause mortality

  17. Sodium intake and blood pressure in renal transplant recipients

    NARCIS (Netherlands)

    Berg, E. van den; Geleijnse, J.M.; Brink, E.J.; Baak, M.A. van; Homan van der Heide, J.J.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background. Hypertension is common among renal transplant recipients (RTR) and a risk factor for graft failure and mortality. Sodium intake is a well-established determinant of blood pressure (BP) in the general population. However, data in RTR are limited. International guidelines recommend a maxim

  18. Iron Deficiency, Anemia and Mortality in Renal Transplant Recipients

    NARCIS (Netherlands)

    Eisenga, Michele F; Minovic, Isidor; Berger, Stefan P; Kootstra-Ros, Jenny E; van den Berg, Else; Riphagen, Ineke J; Navis, Gerjan; van der Meer, Peter; Bakker, Stephan J L; Gaillard, Carlo A J M

    2016-01-01

    Anemia, iron deficiency anemia (IDA) and iron deficiency (ID) are highly prevalent in renal transplant recipients (RTR). Anemia is associated with poor outcome, but the role of ID is unknown. Therefore, we aimed to investigate the association of ID, irrespective of anemia, with all-cause mortality i

  19. Pregnancy in a patient with Goodpasture syndrome and renal transplantation.

    Science.gov (United States)

    Wells, S R; Kuller, J A; Thorp, J M

    1996-02-01

    Patients with Goodpasture syndrome have classically had decreased fertility and associated pregnancy wastage. Renal transplantation can increase the likelihood of successful pregnancy. We describe a patient who carried a pregnancy into the third trimester and had a good neonatal outcome. However, she developed superimposed preeclampsia with subsequent graft rejection.

  20. Sodium intake and blood pressure in renal transplant recipients

    NARCIS (Netherlands)

    van den Berg, Else; Geleijnse, Johanna M.; Brink, Elizabeth J.; van Baak, Marleen A.; van der Heide, Jaap J. Homan; Gans, Rijk O. B.; Navis, Gerjan; Bakker, Stephan J. L.

    Hypertension is common among renal transplant recipients (RTR) and a risk factor for graft failure and mortality. Sodium intake is a well-established determinant of blood pressure (BP) in the general population. However, data in RTR are limited. International guidelines recommend a maximum daily

  1. Gordonia terrae kidney graft abscess in a renal transplant patient.

    Science.gov (United States)

    Nicodemo, A C; Odongo, F C A; Doi, A M; Sampaio, J L M

    2014-08-01

    We present the first report, to our knowledge, of a renal abscess cause by an infection from Gordonia terrae in a kidney transplant patient. The patient simultaneously had pulmonary tuberculosis and a perirenal allograft abscess caused by G. terrae. After treatment with imipenem, in addition to anti-tuberculous drugs, the patient was cured.

  2. Sonographic appearance of renal transplant osseous metaplasia: case report

    Energy Technology Data Exchange (ETDEWEB)

    Chan, R.; Common, A.A. [Univ. of Toronto, St. Michael' s Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada); Sugar, L. [Univ. of Toronto, St. Michael' s Hospital, Dept. of Pathology, Toronto, Ontario (Canada)

    1999-12-01

    We report a case of pathologically proven osseous metaplasia occurring in renal allograft 7 years after transplantation, appearing as multiple, echogenic, band-like lesions with acoustic shadowing on ultra-sonography (US). To our knowledge, such a case has not yet been described in the literature. (author)

  3. Transplant graft vasculopathy: an emerging target for prevention and treatment of renal allograft dysfunction.

    Science.gov (United States)

    Kang, Duk-Hee; Kang, Shin-Wook; Jeong, Hyeon Joo; Kim, Yu Seun; Yang, Chul Woo; Johnson, Richard J

    2004-12-31

    Maintenance of healthy endothelium is essential to vascular homeostasis, and preservation of endothelial cell function is critical for transplant allograft function. Damage of microvascular endothelial cells is now regarded as a characteristic feature of acute vascular rejection and chronic allograft nephropathy, which is an important predictor of graft loss and is often associated with transplant vasculopathy. In this review, we will discuss the role of microvascular endothelium, in renal allograft dysfunction, particularly as it relates to markers of endothelial dysfunction and endothelial repair mechanisms. We also discuss the potential for therapies targeting endothelial dysfunction and transplant graft vasculopathy.

  4. Outcomes of renal patients from the Ivory Coast transplanted abroad: time for a local kidney transplantation program.

    Science.gov (United States)

    Ackoundou-N'Guessan, C; Gnionsahe, D A; Dekou, A H; Tia, W M; Guei, C M; Moudachirou, A M

    2010-11-01

    The outcomes of transplanted kidney recipients from "transplant tourism" have been reported to be alarming. The present study was an attempt to examine the results of renal patients from the Ivory Coast transplanted abroad returning home for follow-up. This retrospective analysis includes renal patients from the Ivory Coast transplanted abroad between 1995 and 2009 and followed up by our nephrology clinic. We collected pre- and posttransplant parameters for statistical analyses. The 16 patients had a median age of 48 years (range = 32.5-53.75). The median age of kidney donors was 44 years (range = 30.75-51.25). Initial kidney disease was hypertension in 10 patients (62.5%) and diabetes in three patients (18.8%). They received organs from living donors (37.5% related [LRD] and 37.5% unrelated [LURD]). Initial immunosuppression consisted of induction (72.7%), tacrolimus (75%), and mycophenolate mofetil (100%). Two patients (12.5%) experienced late acute rejections, resulting in graft loss. The overall graft survival was 93% at 1 year and 80% at 5 years. Five patients died over the study period, corresponding to an overall mortality rate of 9.25/100 patient-years. The overall median patient survival was 6.25 years (range = 4.19-7.58). Patient survivals at 1 and 5 years were 93% and 53%, respectively. No factors seemed to influence survival (either graft or patient) upon multivariate analysis. Comparison between LRD and LURD recipients revealed no statistical difference among posttransplant characteristics and survivals. Mortality of renal patients from the Ivory Coast transplanted abroad is high. Financial exhaustion after transplantation renders follow-up precarious. A local kidney transplantation program in the Ivory Coast appears more urgent than ever. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Gastrointestinal complications in renal transplant recipients: MITOS study.

    Science.gov (United States)

    Gil-Vernet, S; Amado, A; Ortega, F; Alarcón, A; Bernal, G; Capdevila, L; Crespo, J F; Cruzado, J M; De Bonis, E; Esforzado, N; Fernandez, A M; Franco, A; Hortal, L; Jiménez, C

    2007-09-01

    An epidemiologic multicenter study was performed to evaluate the prevalence and management of gastrointestinal (GI) complications in solid organ transplant patients. A total of 1788 recipients were included, 1132 of which corresponded to renal transplanted patients. The mean age for the renal transplanted patients was 52 +/- 13.2 years. The mean time from the transplantation was 5.4 +/- 5.4 years. 17.7% showed some pretransplant GI disease, while 53% presented this type of complication in the posttransplant period. Diarrhea was the most prevalent GI complication (51.5%) and digestive perforation was the GI disorder that affected the patients daily living the most. From the patients with GI complications, 71% received pharmacological treatment, using gastric protectors in 91.3% of the cases. Regarding immunosuppressive drugs, in 30.9% of the cases the dose of the drug was reduced, in 9.3% discontinued temporarily and in 7.5% discontinued permanently. These changes mainly affected the MMF (89%, 83% and 74% for dose change, temporary and permanent discontinuation, respectively). The prevalence of GI complications in renal transplant exceeded 50%, and affected patients' daily living. The management of these complications was based on treatment with gastric protectors, dose reduction and/or partial or definitive MMF discontinuation.

  6. Successful renal transplantation after recovery from acute disseminated encephalomyelitis in a child with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Bhosale Guruprasad

    2010-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM, seen mostly in children, is an acute demyelinating disease, affecting mainly the white matter of brain and spinal cord. We report an unusual case of ADEM in an 11-year old boy with end-stage renal disease, who underwent hemopoietic stem cell transplantation prior to renal transplantation. He needed admission to the intensive care unit and required mechanical ventilation. He responded to intravenous injection of steroids and upon recovery, underwent renal transplantation successfully.

  7. renal transplantation during the twentieth century

    African Journals Online (AJOL)

    2001-06-01

    Jun 1, 2001 ... femoral vessels and a cutaneous ureterostomy was performed. The transplanted ... period radiation was extensively used for immunosuppression. .... critically injured patients from road traffic accidents resulting in reduced ...

  8. Pulmonary complications in 110 consecutive renal transplant ...

    African Journals Online (AJOL)

    transplant recipients OR cyclosporin and low-dose steroid ... Acute pulmonary oedema: (i) fluid overload on clinical examination plus a .... (+)bone marrow granulomas (-)ZN. 120 ... Minnesota randomised prospective trial of CyA versus.

  9. Urinary Tract Infection among Renal Transplant Recipients in Yemen.

    Science.gov (United States)

    Gondos, Adnan S; Al-Moyed, Khaled A; Al-Robasi, Abdul Baki A; Al-Shamahy, Hassan A; Alyousefi, Naelah A

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors.

  10. Urinary Tract Infection among Renal Transplant Recipients in Yemen.

    Directory of Open Access Journals (Sweden)

    Adnan S Gondos

    Full Text Available Urinary tract infection (UTI is the most common complication following kidney transplantation (KT, which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%. The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors.

  11. Hemolytic uremic syndrome recurrence after renal transplantation.

    Science.gov (United States)

    Loirat, Chantal; Fremeaux-Bacchi, Véronique

    2008-09-01

    About 60% of non-Stx-associated aHUS are due to the defect of protection of endothelial cells from complement activation, secondary to mutations in the genes of CFH, MCP, IF, BF, or C3. In addition, 10% of patients have anti-CFH antibodies. While the risk of post-transplant recurrence is less than 1% in Stx-HUS patients, it is approximately 80% in CFH or IF-mutated patients, 20% in MCP-mutated patients, and 30% in patients with no mutation. Patients with anti-CFH antibodies probably also are at risk of recurrence. While MCP-mutated patients can reasonably go to transplantation, recent reports suggest that plasmatherapy started before surgery and maintained life-long may prevent recurrence in CFH-mutated patients. Four successful liver-kidney transplantation utilizing plasmatherapy in CFH-mutated children have been reported recently. In summary, the risk of post-transplant recurrence can now be approached according to genotype. Therefore, aHUS patients should undergo complement determination, screening for anti-CFH antibodies, and genotyping before transplantation. Kidney or kidney + liver transplantation with concomitant plasmatherapy need to be evaluated by prospective trials in patients with hereditary complement abnormalities.

  12. Sexuality, fertility, and renal transplantation: a survey of survivors.

    Science.gov (United States)

    Schover, L R; Novick, A C; Steinmuller, D R; Goormastic, M

    1990-01-01

    A questionnaire on sexual function and fertility was completed by 54 men and 36 women, at an average of 3 years after successful renal transplant. Sexual desire increased significantly compared to reports of levels 6 months pretransplant. Men also had improved erectile function and ability to reach noncoital orgasms. About a quarter of men and women remained sexually dysfunctional, however. The frequency of sexual activity and overall sexual satisfaction did not improve significantly. Marital status and satisfaction were in the normal range for this group, except that those who became ill before adulthood were less likely to have married or have had children. Infertility was a major concern for 10% of the sample. Regular menstrual cycles were present in 64% of women under age 50, representing a significant improvement after transplantation. Three men fathered a child and two women became pregnant after transplantation. Most patients wanted more information on sexuality, fertility, and renal disease.

  13. Urinary tract infections and asymptomatic bacteriuria in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Rabi Yacoub

    2011-01-01

    Full Text Available Asymptomatic bacteriuria and urinary tract infection are common complications after kidney transplantation. In this population, if urinary tract infection occurred in the first six months post procedure, it carries a grave impact on both graft and patient survival. Renal transplant recipients with urinary tract infection are often clinically asymptomatic as a consequence of immunosuppression. Urinary tract infection, however, may progress to acute pyelonephritis, bacteremia and the full blown picture of urosepsis. PubMed and Cochrane databases were searched. The purpose of this review is to discuss the screening and treatment of urinary tract infection and asymptomatic bacteriuria in renal transplant recipients and to evaluate the guidelines on the basis of a review of published evidence.

  14. Return to work after renal transplantation: a study of the Brazilian Public Social Security System.

    Science.gov (United States)

    Messias, Alexandre Augusto; Reichelt, Angela J; Dos Santos, Edson F; Albuquerque, Galton C; Kramer, José S P; Hirakata, Vania N; Garcia, Valter D

    2014-12-15

    Return to work is an objective parameter used worldwide to evaluate the success of organ transplantation and is especially feasible after renal transplantation. This study sought to describe the frequency of return to work after renal transplantation and related characteristics. Retrospective cohort of 511 isolated kidney transplant recipients was recruited from a Brazilian referral center from January 2005 to December 2009; all were matched to the public social security database to determine inclusion and benefit awards, as well as the rate of resumption of contributions to the public social security system, a surrogate marker of work rehabilitation. Characteristics associated with work return were analyzed. No social security records were found for 28 subjects. The remaining 483 subjects had a mean age of 45±13 years; 62% were male; 401 (83%) received some public social security benefit; 298 were paying dues and could, therefore, receive temporary or permanent disability benefits. Of these, 78 subjects made social security payments after transplantation, resulting in a work return rate of 26% (95% confidence interval, 21-32). Younger age, living donor graft, and chronic glomerulonephritis were significantly associated with return to work. In Brazil, most renal transplant recipients are on social security benefits, but only a small proportion return to work after surgery. Clinical characteristics may help define work resumption trends.

  15. Renal transplantation in systemic lupus erythematosus: outcome and prognostic factors in 50 cases from a single centre.

    Science.gov (United States)

    Cairoli, Ernesto; Sanchez-Marcos, Carolina; Espinosa, Gerard; Glucksmann, Constanza; Ercilla, Guadalupe; Oppenheimer, Federico; Cervera, Ricard

    2014-01-01

    End-stage renal disease (ESRD) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). To analyze the outcome and prognostic factors of renal transplantation in patients with ESRD due to SLE from January 1986 to December 2013 in a single center. Fifty renal transplantations were performed in 40 SLE patients (32 female (80%), mean age at transplantation 36±10.4 years). The most frequent lupus nephropathy was type IV (72.2%). Graft failure occurred in a total of 15 (30%) transplantations and the causes of graft failure were chronic allograft nephropathy (n=12), acute rejection (n=2), and chronic humoral rejection (1). The death-censored graft survival rates were 93.9% at 1 year, 81.5% at 5 years, and 67.6% at the end of study. The presence of deceased donor allograft (P=0.007) and positive anti-HCV antibodies (P=0.001) negatively influence the survival of the renal transplant. The patient survival rate was 91.4% at the end of the study. Recurrence of lupus nephritis in renal allograft was observed in one patient. Renal transplantation is a good alternative for renal replacement therapy in patients with SLE. In our cohort, the presence of anti-HCV antibodies and the type of donor source were related to the development of graft failure.

  16. Unusual complication of percutaneous nephrostomy in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Martina Paetzel

    2010-11-01

    Full Text Available Context: Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure. Case Report: Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter’s tip, requiring immediate surgical action. Conclusion: The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.

  17. Cadaver renal transplant outcome in recipients with autolymphocytotoxic antibodies.

    Science.gov (United States)

    Ettenger, R B; Jordan, S C; Fine, R N

    1983-05-01

    The major impact of autolymphocytotoxic antibodies (ALCA) on renal transplantation has been in the interpretation of the pretransplant crossmatch as a cause of false-positive results. Less attention has been paid to the direct affects of ALCA on renal allografts. We have examined the sera of 38 recipients of 41 cadaver renal allografts for the presence of ALCA. There were 9 patients with ALCA who received 10 allografts. In these allografts with ALCA, actuarial graft survival was significantly improved (P less than 0.05) over that of 31 transplants without ALCA. In recipients with ALCA, graft survival was 90% at six months and 60% at one and two years; in recipients without ALCA, graft survival was 48% at six months, 35% at one year and 24% at two years. ALCA may be exerting graft-enhancing properties by means of an autoregulatory effect upon the recipient's immunologic system.

  18. Human Leukocyte Antigen Alleles and Cytomegalovirus Infection After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Futohi

    2015-11-01

    . Results of multivariate logistic regression analysis showed that deceased donor renal transplantation (OR = 3.018, 95%CI: 1.662 - 5.480, P < 0.001, presence of HLA-B44 (OR = 4.764, 95%CI: 1.259 - 18.032, P = 0.022 and lack of HLA-B8 (OR = 3.246, 95%CI: 1.030 - 10.230, P = 0.044 were the independent risk factors for developing CMV infection, after kidney transplantation. Conclusions The findings of this study showed that deceased donor renal transplantation and the presence of HLA-B44 can make the kidney recipient susceptible to CMV infection after kidney transplantation; on the other hand, the presence of HLA-B8 can have a protective effect.

  19. Invasive filamentous fungal infections associated with renal transplant tourism.

    Science.gov (United States)

    Shoham, S; Hinestrosa, F; Moore, J; O'Donnell, S; Ruiz, M; Light, J

    2010-08-01

    'Transplant tourism,' the practice of traveling abroad to acquire an organ, has emerged as an issue in kidney transplantation. We treated a patient who developed invasive aspergillosis of the allograft vascular anastomosis after receiving a kidney transplant in Pakistan, prompting us to review the literature of invasive mycoses among commercial organ transplant recipients. We reviewed all published cases of infections in solid organ transplant recipients who bought their organs abroad and analyzed these reports for invasive fungal infections. Including the new case reported here, 19 cases of invasive fungal infections post commercial kidney transplant occurring in 17 patients were analyzed. Infecting organisms were Aspergillus species (12/19; 63%), Zygomycetes (5/19; 26%), and other fungi (2/19; 5%). Invasive mold infections were present at the transplanted graft in 6/17 patients (35%) with graft loss or death in 13/17 (76%) of patients and overall mortality (10/17) 59%. Invasive fungal infections, frequently originating at the graft site, have emerged as a devastating complication of commercial renal transplant and are associated with high rates of graft loss and death.

  20. Is Serum Transforming Growth Factor beta-1 Superior to Serum Creatinine for assessing Renal Failure and Renal Transplant Rejection

    OpenAIRE

    Gyanendra Kumar Sonkar, Usha; R.G. Singh

    2009-01-01

    A sustained overexpression of Transforming Growth Factor beta1 (TGF beta1), a cytokine has beenimplicated in the pathogenesis of fibrosis of kidney leading to end stage . The main aim of present studywas to find the utility of TGF beta1 and serum creatinine in differentiating chronic renal failure (CRF)from acute renal failure (ARF), renal transplant rejection (Tx Rej) and stable renal transplant (Tx Stb)and to study has attempted histopathological correlation of rejection cases with TGF beta...

  1. [Preventive renal transplantation: considerations and future plans].

    Science.gov (United States)

    Segoloni, G P

    2008-01-01

    A kidney transplant before the start of dialysis or after only a short period of dialysis is acknowledged as the best therapeutic option for the uremic patient. However, the number of patients in Italy waiting for a kidney is stable (around 6,400 at the latest report) and the annual number of transplants is not increasing (a slight decrease is forecast for 2007). Opening the deceased-donor waiting list to patients who are not yet on dialysis remains a matter of debate and has been possible only in Tuscany thanks to the high rate of kidney procurement in this region. As far as the Piedmont region is concerned, the balance between performed transplants and new candidates for transplantation is stable, with a mean waiting time of nearly 2 years. Taking into account also the current decline in donations, the possibility of placing pre-dialytic patients on the waiting list requires further evaluation. Nevertheless, some strategies may be within reach. Above all, the use of kidneys from living donors, which represents the ideal condition for preventive transplantation, should be extended. For patients lacking a suitable living donor, a program of earlier admission to waiting lists should be activated.

  2. BK polyoma virus infection and renal disease in non-renal solid organ transplantation.

    Science.gov (United States)

    Kuppachi, Sarat; Kaur, Deepkamal; Holanda, Danniele G; Thomas, Christie P

    2016-04-01

    BK virus (BKV) is a non-enveloped DNA virus of the polyomaviridae family that causes an interstitial nephritis in immunosuppressed patients. BKV nephropathy is now a leading cause of chronic kidney disease and early allograft failure following kidney transplantation. It is also known to cause renal disease with a progressive decline in kidney function in non-renal solid organ transplant (NRSOT) recipients, although the disease may not be recognized nor its impact appreciated in this patient population. In this report, we review the existing literature to highlight our current understanding of its incidence in NRSOT populations, the approaches to diagnosis and the potential treatment options.

  3. Non-contrast magnetic resonance angiography in renal transplantation and renal donation

    DEFF Research Database (Denmark)

    Blankholm, Anne Dorte

    2015-01-01

    examination of living kidney donors. We compared CTA to an extensive MRI protocol without the use of contrast agents, including NCMRA, and to observations from living donor nephrectomy, which served as the reference standard. We concluded that an optimised MRI protocol without contrast agents could...... be substituted for CTA for preoperative vessel assessment in living kidney donors.......Renal transplantation is the treatment of choice in cases of severe renal disease. The majority of candidates for kidney transplantation have arteriosclerosis to some extent; thus, preoperative imaging of the vessels is needed. Different imaging modalities are available and are used...

  4. Listeria monocytogenes in renal transplant recipients Listeria monocytogenes em pacientes pós-transplante renal

    Directory of Open Access Journals (Sweden)

    Cristina Barroso HOFER

    1999-11-01

    Full Text Available Five cases of Listeria monocytogenes bacteriemia were observed from April to December 1985, among renal transplant recipients from the same hospital in São Paulo, Brazil. The patients were adults (mean age: 40.6 years, and the basic complain was fever, with no report of meningeal syndrome. Laboratory tests revealed the presence of two serovars, 1/2a and 4b, which were classified into three lysotypes. The four strains of serovar 4b showed the same antibiotype, with resistance to cefoxitin, clindamycin, oxacillin and penicillin.No período de abril a dezembro de 1985, foram observados cinco casos de listeriose em transplantados renais num mesmo hospital de São Paulo, SP. Os pacientes eram adultos (média de 40,6 anos tendo como queixa básica a febre. Laboratorialmente, em todos foram reconhecidos Listeria monocytogenes, caracterizada por dois sorovares 1/2a e 4b e três lisotipos distintos. As amostras do sorovar 4b apresentaram o mesmo antibiotipo: resistentes à cefoxitina, clindamicina, oxacilina e penicilina.

  5. Preemptive Renal Transplantation-The Best Treatment Option for Terminal Chronic Renal Failure.

    Science.gov (United States)

    Arze Aimaretti, L; Arze, S

    2016-03-01

    Renal transplantation is the best therapeutic option for end-stage chronic renal disease. Assuming that it is more advisable if performed early, we aimed to show the clinical, social, and economic advantages in 70% of our patients who were dialyzed only for a short period. For this purpose, we retrospectively collected data over 28 years in 142 kidney transplants performed in patients with transplantation, 64% of our patients had no public support; however, 64% of them returned to work and got health insurance 2 months later. Full rehabilitation was achieved in all cases, including integration to the family, return to full-time work, school and university, sports, and reproduction. Immunosuppression consisted of 3 drugs, including steroids, cyclosporine, and azathioprine or mycophenolate. The cost in the 1st year, including patient and donor evaluation, surgery, immunosuppression, and follow-up, was $13,300 USD versus $22,320 for hemodialysis. We conclude that preemptive renal transplantation with renal failure, especially in developing countries such as Bolivia, where until last year, full public support for renal replacement therapy was unavailable. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Amirzargar

    2013-01-01

    Full Text Available The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA, which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient′s main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.

  7. Farmacodinâmica do cisatracúrio no transplante renal Farmacodinámica del cisatracúrio en el transplante renal Cisatracurium pharmacodynamics in renal transplantation

    Directory of Open Access Journals (Sweden)

    Ismar Lima Cavalcanti

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A escolha do cisatracúrio, especialmente nos doentes com insuficiência orgânica, parece ser benéfica, devido a sua eliminação órgão independente de Hofmann e menor tendência a liberar histamina. Este trabalho tem como objetivo determinar, em doentes portadores de insuficiência renal crônica, a farmacodinâmica do cisatracúrio durante o transplante renal. MÉTODO: Foram estudados 30 pacientes divididos em dois grupos, 15 com função renal normal submetidos a cirurgia bucomaxilo-facial e 15 portadores de insuficiência renal crônica submetidos a transplante renal sob anestesia geral com etomidato, sufentanil e sevoflurano em concentrações entre 0,5 e 1% de fração expirada. Receberam dose venosa de 0,15 mg.kg-1 de cisatracúrio na indução e 0,05 mg.kg-1 todas as vezes que T1 recuperava 25%. A função neuromuscular foi monitorizada de forma contínua por aceleromiografia utilizando o padrão de estimulação seqüência de quatro estímulos, através da estimulação supramáxima do nervo ulnar. RESULTADOS: Os resultados referentes à farmacodinâmica do cisatracúrio mostram que o início de ação (4,1 e 4,9 min, a duração clínica (68,9 e 75,4 min e o índice de recuperação (20,2 e 28 min foram semelhantes entre os grupos normal e insuficiência renal, respectivamente. Os tempos para a relação T4/T1 atingir 0,7 (34,3 e 51,4 min e 0,9 (49,7 e 68,6 min a partir do último 25% de T1 apresentaram diferença estatisticamente significante entre os grupos, com os maiores valores no grupo insuficiência renal. A razão de acumulação foi igual a 1,08. CONCLUSÕES: O início de ação, a duração clínica e o índice de recuperação são semelhantes entre os dois grupos, o tempo para a relação T4/T1 atingir 0,7 ou 0,9 foi maior no grupo insuficiência renal do que no grupo normal e o cisatracúrio não apresentou efeito acumulativo no grupo insuficiência renal.JUSTIFICATIVA Y OBJETIVOS: La escoja

  8. Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center

    OpenAIRE

    Ferreira, Flávia Regina; Ogawa, Marilia Marufuji; Nascimento, Luiz Fernando Costa; Tomimori, Jane

    2014-01-01

    BACKGROUND: Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE: To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS: Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral cente...

  9. Tacrolimus Versus Cyclosporine as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.

    Science.gov (United States)

    Liu, Jin-Yu; You, Ru-Xu; Guo, Min; Zeng, Lu; Zhou, Pu; Zhu, Lan; Xu, Gang; Li, Juan; Liu, Dong

    2016-01-01

    Tacrolimus and cyclosporine are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of cyclosporine and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane Controlled Trials Register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection, and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and quality-adjusted life years gained and incremental cost-effectiveness. Altogether, 6137 patients from 27 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of patient mortality, graft loss, acute rejection, and hypercholesterolemia. Nevertheless, tacrolimus increased the risk of new-onset diabetes. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events following renal transplant. Tacrolimus is an effective and safe immunosuppressive agent and it may be more cost-effective than cyclosporine for the primary prevention of graft rejection in renal transplant recipients. However, new-onset diabetes should be closely monitored during the medication period.

  10. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-10-29

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, ≤5 mg\\/day, >5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  11. Machine perfusion for improving outcomes following renal transplant: current perspectives

    Directory of Open Access Journals (Sweden)

    Cannon RM

    2016-03-01

    Full Text Available Robert M Cannon,1 Glen A Franklin1,2 1The Hiram C Polk Jr MD Department of Surgery, University of Louisville, 2Kentucky Organ Donor Affiliates, Louisville, KY, USAAbstract: There is a disparity between the number of kidneys available for transplantation and the number of patients awaiting an organ while on dialysis. The current kidney waiting list in the US contains more than 100,000 patients. This need has led to the inclusion of older donors with worsening renal function, as well as greater utilization of kidneys from non-heartbeating (donation after cardiac death donors. Coinciding with this trend has been a growing interest in technology to improve the function of these more marginal organs, the most important of which currently is machine perfusion (MP of donated kidneys after procurement. While this technology has no standard guidelines currently for comprehensive use, there are many studies that demonstrate higher organ yield and function after a period of MP. Particularly with the older donor and during donation after cardiac death cases, MP may offer some significant benefits. This manuscript reviews all of the current literature regarding MP and its role in renal transplantation. We will discuss both the experience in Europe and the US using machine perfusion for donated kidneys.Keywords: machine perfusion, renal transplantation, kidney pumping, renal failure, organ donation

  12. Living donor renal transplantation in patients with antiphospholipid syndrome

    Science.gov (United States)

    Choi, Ji Yoon; Jung, Joo Hee; Shin, Sung; Kim, Young Hoon; Han, Duck Jong

    2016-01-01

    Abstract Introduction: Antiphospholipid syndrome (APS), autoantibodies directed against phospholipid-binding proteins are associated with cause vascular thrombosis. Patients with APS requiring renal transplantation are at risk of early graft loss due to arterial or venous thrombosis, or thrombotic microangiopathy (TMA). Here, we report 3 cases of successful renal transplantation in patients with APS. Clinical Findings: A 53-year-old man with end-stage renal disease (ESRD) had experienced bilateral deep venous thrombosis (DVT) in the lower extremities 16 years ago and was administered warfarin. However, he frequently experienced recurrent DVT despite of anticoagulation therapy. Before the surgery, APS was confirmed based on positive results lupus anticoagulant in serological tests. A 40-year-old man with polycystic kidney disease and a history recurrent DVT tested positive for lupus anticoagulant and anticardiolipin antibodies. Lastly, a 42-year-old woman with ESRD was diagnosed with APS 7 years ago. She also developed DVT and tested positive for lupus anticoagulant and anti-B2-glycoprotein 1. The anticoagulation protocol was as follows in all cases: Warfarin was stopped 5 days before living donor renal transplantation and intravenous heparin therapy was started. During surgery, bolus heparin injections (3000 U) were administered to prevent arterial or venous thrombosis. Heparin was substituted with warfarin on postoperative day 4. The third patient (42/F) developed clinical rejection indicated by increased serum creatinine levels and donor-specific antibodies (DSA) and received steroid pulse therapy, plasmapheresis, and rituximab. This treatment restored graft function to within the normal range. The latest graft function in all patients was maintained at normal levels in the outpatient clinic. Conclusions: Living donor renal transplantation may be successful in patients with APS following perioperative anticoagulation therapy. However, because of the high risk of

  13. Single-center assessment of nutritional counseling in preventing excessive weight gain in pediatric renal transplants recipients.

    Science.gov (United States)

    Cameron, Camilla; Krmar, Rafael T

    2016-05-01

    Post-transplantation obesity is a common complication that is associated with a higher risk for decreased allograft function and hypertension. However, the role of diet intervention on reducing post-transplantation obesity is relatively unknown. We investigated the clinical relevance of dietary counseling on the prevalence of overweight/obesity during the first two yr following renal transplantation. The computerized patient records of 42 recipients (31 males) aged 6.3 ± 4.8 yr at transplantation were reviewed. All patients systematically underwent yearly dietary assessment/counseling (motivational interviewing technique) and measurement of renal function and ABPM. At transplantation, 14.2% of patients were overweight/obese, which increased to 42.8% by two yr post-transplantation (p = 0.004). The majority of patients experienced a significant increase in BMI SDS during the first six months post-transplantation that remained sustained throughout the duration of the follow-up period (p = 0.001). By two yr post-transplantation, there were no observable differences between patients classified as having normal BMI or being overweight/obese with regard to renal function and controlled hypertension. The application of yearly tailored dietary assessment/counseling had a poor effect on preventing post-transplantation weight gain, suggesting the need for more comprehensive interventions to reduce post-transplant obesity.

  14. The Cost and Utility of Renal Transplantation in Malaysia.

    Science.gov (United States)

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-11-01

    Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death. Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively. Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.

  15. Post-renal transplant erythrocytosis: a case report.

    Science.gov (United States)

    Almonte, Mavel; Velásquez-Jones, Luis; Valverde, Saúl; Carleton, Bruce; Medeiros, Mara

    2015-02-01

    PTE is defined as hematocrit >51% or hemoglobin >17 g/dL after renal transplantation. Risk factors include native kidneys with adequate erythropoiesis pretransplant, smoking, renal artery stenosis, and cyclosporine treatment. We report the case of a 14-yr-old female kidney transplant patient, with triple therapy immunosuppression and stable graft function who developed PTE at 12 months post-transplant with hemoglobin 17.3 g/dL, hematocrit 54.2%, stable graft function, and normotensive with normal cardiac echocardiogram and erythropoietin levels. The only risk factor found was tobacco use. As she had no spontaneous improvement, enalapril treatment was started at 19 months post-transplant with a hemoglobin level of 17.5 g/dL and hematocrit 53%; by 23 months post-transplant, hemoglobin lowered to 15 g/dL and hematocrit to 44.5% and continued to be in normal range thereafter. PTE is a rare condition in childhood and can be successfully treated with enalapril. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Aminoaciduria as a marker of acute renal transplant rejection--a patient study.

    Science.gov (United States)

    Macpherson, N A; Moscarello, M A; Goldberg, D M; Ish-Shalom, N; Arbus, G S

    1991-04-01

    Over 12 months, urine samples were systematically collected from 40 children who underwent renal transplantation for the treatment of end-stage renal disease. Sequential determinations of the excretion of individual amino acids relative to that of creatinine were carried out on 15 subjects. Nine of these (including three who sustained episodes of acute rejection) retained a native kidney in-situ, while in six patients (including three who underwent an episode of acute rejection) both native kidneys had been removed. In both subgroups, the amino acid/creatinine ratios of early morning urine samples were higher shortly before clinical manifestations of acute rejection became evident than in patients who, following renal transplantation, had stable kidney function, chronic graft rejection, or acute tubular necrosis, with one exception: a patient with one native kidney in-situ in whom acute tubular necrosis developed immediately after transplantation. The amino acids showing the greatest increase included Thr, Ser, Gly, and Ala. These values fell dramatically immediately prior to the clinical episode of acute rejection, with Thr, Ala, and Phe showing the most consistent changes. These alterations in urinary amino acid excretion occurred several days before changes in urinary protein excretion or the serum concentrations of urea and creatinine, and may have a role to play in the monitoring of renal transplant recipients.

  17. Type 4 renal tubular acidosis in a kidney transplant recipient

    Directory of Open Access Journals (Sweden)

    Manjunath Kulkarni

    2016-02-01

    Full Text Available We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim – sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment.

  18. Type 4 renal tubular acidosis in a kidney transplant recipient.

    Science.gov (United States)

    Kulkarni, Manjunath

    2016-02-01

    We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim - sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment.

  19. [BK virus infection in a pediatric renal transplant recipient].

    Science.gov (United States)

    Bonaventura, R; Vázquez, A; Exeni, A; Rivero, K; Freire, M C

    2005-01-01

    BK Human Polyomavirus causes an asymptomatic primary infection in children, then establishing latency mainly in the urinary tratt. Viral reactivation can lead to renal pathology in individuals with impaired cellular immune response. This is particularly important in pediatric transplant recipients, who can suffer a primary infection when immunosupressed. We followed up the case of a 5 years old patient who received a renal transplant in October 2003, and presented damaged graft 45 days after the intervention. The patient suffered 3 episodes of renal function failure between October 2003 and June 2004. Blood, urine, renal biopsy and lymphocele liquid samples were analyzed. A differential diagnosis between acute rejection and infectious causes was established by testing for BK, CMV and ADV viruses, and the cytological study of renal tissue. Laboratory findings together with clinical signs suggest the patient was infected by BK virus. As a final consideration, the great importance of differentiating between acute rejection and BK infection is emphasized, since immunosuppressant management is opposite in each case.

  20. Comparison between doppler ultrasonography and renal scintigraphy in assessment of post-transplant renal function

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeo Chang; Shin, Byung Seok; Ohm, Joon Young; Kim, Seong Min; Ahn, Moon Sang; Yang, Shin Seok [Chungnam National University Hospital, Daejeon (Korea, Republic of); Park, Mi Hyun [Dept. of Radiology, Dankook University Hospital, Cheonan (Korea, Republic of)

    2016-05-15

    To compare the usefulness of Doppler ultrasonography and renal scintigraphy in the assessment of short- and long-term function of transplanted kidneys. We retrospectively reviewed the cases of 79 patients who underwent Doppler ultrasonography and technetium-99m diethylene triamine pentaacetic acid renal scintigraphy on the same day, within 4 days of renal transplantation. Image parameters were evaluated for statistical differences. There was a strong positive correlation between the glomerular filtration rate (GFR) as measured by renal scintigraphy and the estimated GFR (eGFR) based on serum creatinine levels (correlation coefficient = 0.71). Scan grade according to the time-activity curve, resistive index, and end diastolic velocity showed moderate correlations with the eGFR (correlation coefficients = -0.557, -0.329, and 0.370, respectively) in the early post-transplantation period. The mean survival time was longer in patients with lower resistive indices (≤ 0.68, 54.9 months vs. > 0.68, 29.5 months) and lower pulsatility indices (≤ 1.32, 53.8 months vs. > 1.32, 28.7 months); however, there were no statistically significant differences in the long-term follow-up period (p = 0.121 for resistive index and p = 0.074 for pulsatility index). Renal scintigraphy is a more sensitive method than Doppler ultrasonography for assessing transplanted kidney function in the early post-transplantation period. Doppler ultrasonography might reflect the long-term survival time. However, it is difficult to predict long-term renal function using either method.

  1. Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation.

    Science.gov (United States)

    Krmar, Rafael T; Ferraris, Jorge R

    2017-08-25

    Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.

  2. Glomerular Filtration Rate Estimation in Renal and Non-Renal Solid Organ Transplantation

    DEFF Research Database (Denmark)

    Hornum, Mads; Feldt-Rasmussen, Bo

    2017-01-01

    Following transplantation (TX) of both renal and non-renal organs, a large proportion of patients have renal dysfunction. There are multiple causes for this. Chronic nephrotoxicity and high doses of calcineurin inhibitors are important factors. Preoperative and perioperative factors like...... hypertension, hypotension, drugs and infections may play a causative role as well. Organ-specific causes include hepatorenal syndrome, cirrhosis, low cardiac function, low respiratory function and diabetes developed both before and after TX. It is important to be able to perform precise and valid measurements...

  3. Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Masmoudi Sayda

    2000-01-01

    Full Text Available Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

  4. Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients

    DEFF Research Database (Denmark)

    Arora, Satish; Gude, Einar; Sigurdardottir, Vilborg

    2012-01-01

    The NOCTET (NOrdic Certican Trial in HEart and lung Transplantation) trial demonstrated that everolimus improves renal function in maintenance thoracic transplant (TTx) recipients. Nevertheless, introduction of everolimus is not recommended for patients with advanced renal failure. We evaluated...... NOCTET data to assess everolimus introduction amongst TTx recipients with advanced renal failure....

  5. Urinary potassium excretion, renal ammoniagenesis, and risk of graft failure and mortality in renal transplant recipients1-3

    NARCIS (Netherlands)

    Eisenga, Michele F.; Kieneker, Lyanne M.; Soedamah-Muthu, Sabita S.; Berg, Van Den Else; Deetman, Petronella E.; Navis, Gerjan J.; Gans, Reinold O.B.; Gaillard, Carlo A.J.M.; Bakker, Stephan J.L.; Joosten, Michel M.

    2016-01-01

    Background: Renal transplant recipients (RTRs) have commonly been urged to limit their potassium intake during renal insufficiency and may adhere to this principle after transplantation. Importantly, in experimental animal models, low dietary potassium intake induces kidney injury through stimula

  6. Fatal Progressive Multifocal Leukoencephalopathy in a Kidney Transplant Recipient 19 Years After Successful Renal Allograft Transplantation

    DEFF Research Database (Denmark)

    Carlson, N; Hansen, Jesper Melchior

    2014-01-01

    in circumstances of extreme immunodeficiency. Development of fulminant PML is rare and treatment options are limited. CASE REPORT: We have presented a case of JCV reactivation resulting in PML 19 years after renal allograft transplantation and after recent conversion of immunosuppressive treatment. One year after...

  7. Early onset primary pulmonary cryptococcosis in a renal transplant patient

    Directory of Open Access Journals (Sweden)

    Tarai B

    2010-01-01

    Full Text Available We report a case of primary pulmonary cryptococcosis in a post-renal transplant patient. A 65-year-old male renal transplant patient was admitted to the hospital with a low grade fever of 1 month, radiologically mimicking tuberculosis (TB. Broncho-alveolar fluid (BAL shows capsulated yeast, and Cryptococcus neoformans was grown on culture supported by cytology and histopathological examination. Cryptococcal antigen was positive (32-fold in serum and was negative in cerebrospinal fluid (CSF. The patient was given amphotericin B and 5-flucytosine and clinical improvement was seen on a weekly follow up. The serum cryptococcal antigen test might contribute to the early detection and treatment of pulmonary cryptococcosis. The results of antifungal susceptibility were aid in selecting the drug of choice for treatment.

  8. GU Evaluation and Management of Renal Transplant Candidates and Recipients

    Directory of Open Access Journals (Sweden)

    Peter N. Bretan

    2004-01-01

    Full Text Available There are more than 200,000 end stage renal disease (ESRD patients who are potential transplant candidates and more than 100,000 previously transplanted renal recipients with functioning allografts in the United States 1. Fifty-seven percent of these patients are male and forty percent are greater than 50 years of age 2, 3. Diabetes is the most common cause of kidney failure. It is evident that many patients are at high risk for development of urologic problems and thus it is estimated that the average urologist will care for up to ten of these patients yearly4. Thus a review of the genitourinary (GU evaluation and management of these patients is timely.

  9. Pityriasis Versicolor on Penile Shaft in a Renal Transplant Recipient

    Science.gov (United States)

    Ryu, Han-Won; Cho, Jae-We

    2012-01-01

    Pityriasis versicolor is a superficial infection of the stratum corneum, which is caused by the Malassezia species. Tge Malassezia species consist of 12 subspecies, including M. furfur, M. pachydermatis, M. symphodialis and M. globasa. The Malassezia species are classified as a normal flora, particularly in the sebum rich areas of the skin, and they convert from saprophytic yeast to parasitic mycelial morpholgic form to cause clinical disease. But majorities of their distributions are in the upper back, the neck, the thighs, and the forearm, and not in the penis. It is well known that the renal transplant patients, who take immunosuppressive agents, have impairment in the protective cell mediated immunity. Thus, they are more susceptible to infectious diseases, such as a fungal infection. Therefore, clinical manifestations show higher incidence of disease, but they mostly occur in an expected distribution. We here report a case of pityriasis versicolor in a renal transplant recipient on penile shaft, which is an unusual area. PMID:22879720

  10. Pityriasis versicolor on penile shaft in a renal transplant recipient.

    Science.gov (United States)

    Ryu, Han-Won; Cho, Jae-We; Lee, Kyu-Suk

    2012-08-01

    Pityriasis versicolor is a superficial infection of the stratum corneum, which is caused by the Malassezia species. Tge Malassezia species consist of 12 subspecies, including M. furfur, M. pachydermatis, M. symphodialis and M. globasa. The Malassezia species are classified as a normal flora, particularly in the sebum rich areas of the skin, and they convert from saprophytic yeast to parasitic mycelial morpholgic form to cause clinical disease. But majorities of their distributions are in the upper back, the neck, the thighs, and the forearm, and not in the penis. It is well known that the renal transplant patients, who take immunosuppressive agents, have impairment in the protective cell mediated immunity. Thus, they are more susceptible to infectious diseases, such as a fungal infection. Therefore, clinical manifestations show higher incidence of disease, but they mostly occur in an expected distribution. We here report a case of pityriasis versicolor in a renal transplant recipient on penile shaft, which is an unusual area.

  11. Incidence of Recurrent Urinary Tract Infection after Renal Transplantation

    Directory of Open Access Journals (Sweden)

    MohammadReza Pourmand

    2015-10-01

    Full Text Available Background: The pathologies classified as urinary tract infections (UTI can have a deleterious effect on patients who have undergone a renal transplantation.  Often recurrent UTIs will occur, leading to high morbidity, failure of the grafting process overall and even death.  The study presented here seeks to expand the knowledge of recurrent UTIs in the context of renal transplantation, what risks recurrent UTIs pose to transplant patients and evaluate possible treatments.Methods: Renal transplantations were performed on 94 patients.   For six months post-surgery the patients were evaluated for the presence of recurrent UTIs.  The criteria for determining a patient as having a UTI was given as finding   more than 103    and 105  pure colonies within one ml of urine for asymptomatic and symptomatic patients, respectively.   The criteria of recurrent UTI was defined as two or more conclusive UTIs within the first six months after the surgery or three more within a year after renal transplantation.Results: Of the 94 hospitalized patients, 29 UTIs were diagnosed (30.8%. The majority of diagnosed UTIs were in female patients (11.15, 73.3% vs.4.15, 26.7%; p-value = 0.003.   Those patients with diabetes mellitus correlated with a better chance of having a UTI (p-value = 0.019; CI = 1.2-12.2. The incidence rate of UTI was 51.7%, female predominant 73.3%. No  other  pathologies  were  shown  to  affect  the  chance  of  developing recurrent UTIs.   Typically Escherichia coli was the bacterium isolated fromurine  cultures  (48.3%  from  those  who  developed  recurrent  UTI.    The isolates tended to possess resistance to TMP / SMX and piperacillin but weresusceptible to imipenem.Conclusion:   Recurrent UTIs in renal transplant patients can be mitigated with proper identification of risk factors.

  12. Dengue in renal transplant recipients: Clinical course and impact on renal function

    Science.gov (United States)

    Fernandes, Paula Frassinetti Castelo Branco Camurça; Siqueira, Reed André; Girão, Evelyne Santana; Siqueira, Rainne André; Mota, Márcia Uchoa; Marques, Leyla Castelo Branco Fernandes; Andrade, Silvana Cristina Albuquerque; Barroso, Wilson Mendes; Silva, Sônia Leite; Rodrigues dos Santos, Bruno Gomes; de Oliveira, Claúdia Maria Costa

    2017-01-01

    AIM To present clinical characteristics from renal transplant recipients with dengue fever and its impact on graft function. METHODS We retrospectively evaluated 11 renal transplant recipients (RTR) with dengue infection confirmed by laboratory test, between January 2007 and July 2012, transplanted in the Renal Transplant Center of Walter Cantídio University Hospital from Federal University of Ceará. RESULTS Positive dengue serology (IgM) was found in all patients. The mean time between transplant and dengue infection was 43 mo. Fever was presented in all patients. Nine patients presented with classical dengue and two (18%) with dengue hemorrhagic fever. All cases had satisfactory evolution with complete recovery of the symptoms. The time for symptom resolution varied from 2 to 20 d, with an average of 9 d. An increase of creatinine after the infection was observed in three (27.2%) patients with no clinically impact on the kidney graft function. CONCLUSION RTR with dengue infection seems to have a clinical presentation and evolution similar to those seen in the general population, with no long-term damage to patient and to the graft. PMID:28280696

  13. Native kidney post-transplant lymphoproliferative disorder in a non-renal transplant patient.

    Science.gov (United States)

    Araya, Carlos E; Mehta, Mansi B; González-Peralta, Regino P; Hunger, Stephen P; Dharnidharka, Vikas R

    2009-06-01

    PTLD is an important post-transplant complication. Although PTLD affects kidney allografts after renal transplantation, it has not been reported in native kidneys of other solid organ recipients. Herein, we report a child who underwent an orthotropic liver transplant for cryptogenic cholestatic hepatitis and developed fever, generalized lymphadenopathy, chronic EBV viremia, and lymphatic PTLD. Subsequently, she also developed gross hematuria and nephrotic range proteinuria. Kidney histology revealed EBV-positive mononuclear infiltrates within the renal parenchyma consistent with PTLD. Electron microscopy examination demonstrated subepithelial electron-dense deposits consistent with a membranous glomerulopathy pattern. The PTLD was successfully treated with reduced immunosuppression and cyclic cyclophosphamide, rituximab, and prednisone, but the renal disease progressed to end-stage renal failure within two yr. Repeat kidney histology showed chronic nephropathy and membranous glomerulopathy without PTLD infiltrates or detectable EBV staining, although chronic viremia persisted. To our knowledge, this is the first such child to be reported and highlights the importance of remaining vigilant for renal PTLD even in non-kidney organ recipients.

  14. Basosquamous Cell Carcinoma Developing from a Renal Transplantation Recipient

    Directory of Open Access Journals (Sweden)

    Akira Tsukada

    2012-10-01

    Full Text Available We describe a case of basosquamous cell carcinoma arising from a 52-year-old Japanese renal transplantation recipient (RTR. In the present case, we investigated the immunohistochemical profiles of tumor-infiltrating lymphocytes, focusing on cytotoxic granules, granulysin-bearing cells and immunosuppressive cells, such as regulatory T cells and tumor-associated macrophages. Our present study suggests some of the possible mechanisms for the carcinogenesis of cutaneous malignancy in RTRs.

  15. Multiple Cavitating Nodules in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Sharla-Rae J Olsen

    2009-01-01

    Full Text Available Pulmonary nodules are common following solid organ transplantation and vary in etiology. Nodules with central cavitation are most likely to be of infectious origin in the post-transplant population. A novel presentation of post-transplant lymphoproliferative disorder manifesting as multiple cavitating pulmonary nodules is described. The patient, a 45-year-old female renal transplant recipient, presented with constitutional symptoms and a chest x-ray showing multiple bilateral cavitating lesions. A computed tomography scan confirmed innumerable, randomly dispersed, cavitating nodules in the lung parenchyma. Multiple large hypodense lesions were identified in the liver and spleen. The appearance of the native and transplanted kidneys was normal. A liver biopsy identified an Epstein-Barr virus-negative, diffuse, large B cell lymphoma. Repeat imaging after treatment with a cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone/prednisolone regimen demonstrated dramatic resolution of all lesions. The present case represents a unique radiographic presentation of post-transplant lymphoproliferative disorder not previously reported in the literature.

  16. Outcomes of Renal Transplantation in HIV-1 Associated Nephropathy.

    Directory of Open Access Journals (Sweden)

    Sana Waheed

    Full Text Available Several studies have demonstrated that renal transplantation in HIV positive patients is both safe and effective. However, none of these studies have specifically examined outcomes in patients with HIV-associated nephropathy (HIVAN.Medical records of all HIV-infected patients who underwent kidney transplantation at Johns Hopkins Hospital between September 2006 and January 2014 were reviewed. Data was collected to examine baseline characteristics and outcomes of transplant recipients with HIVAN defined pathologically as collapsing focal segmental glomerulosclerosis (FSGS with tubulo-interstitial disease.During the study period, a total of 16 patients with HIV infection underwent renal transplantation. Of those, 11 patients were identified to have biopsy-proven HIVAN as the primary cause of their end stage renal disease (ESRD and were included in this study. They were predominantly African American males with a mean age of 47.6 years. Seven (64% patients developed delayed graft function (DGF, and 6 (54% patients required post-operative dialysis within one week of transplant. Graft survival rates at 1 and 3 years were 100% and 81%, respectively. Acute rejection rates at 1 and 3 years were 18% and 27%, respectively. During a mean follow up of 3.4 years, one patient died.Acute rejection rates in HIVAN patients in this study are higher than reported in the general ESRD population, which is similar to findings from prior studies of patients with HIV infection and ESRD of various causes. The high rejection rates appear to have no impact on short or intermediate term graft survival.

  17. Impact of Hepatitis C on Renal Transplantation: A Long-Term Study

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    Hassan A

    1999-01-01

    Full Text Available Viral hepatitis, especially "C" type (HCV, is an important cause of morbidity and mortality among recipients of renal transplants. In a retrospective long-term study, we reviewed 399 renal transplant patients (133F, 266M who received 415 kidneys during the past eight-years. We evaluated their HCV infection and liver status. Stored sera (frozen at 80 C as well as fresh sera collected at the time of transplant and/or at the last observation were used. The donors were cadavers in 386 and living related in 29 renal transplants. The mean follow-up period was 74 months (range 24-124 months. At the time of transplantation 105 recipients (26% were HCV positive. A the last follow-up 105 (26% recipients remained positive, 12 (2.8% seroconverted from negative to positive due to graft and/or blood transfusion and 277 remained negative. Liver biopsy was obtained from 71 to 117 (60.6% HCV +ve patients. Liver biopsy showed normal histology in 57 (80% patients, chronic active hepatitis in 42 (59% patients according to scoring of Knodle′s classification. Recurrence of glomerulonephritis in renal allografts occurred in 21 patients. Membrano proliferative glomerulonephritis ( PGN occurred in nine patients; seven (78% of them were HCV +ve compared to 29% HCV +ve in the whole group (117/399 (P< 0.001. The actuarial patient and graft survival was similar in HCV-ve and HCV +ve patients. We conclude that HCV is an important cause of liver disease in renal allograft recipients, it might be the cause of recurrence of MPGN, however, it affects neither patients nor graft survival.

  18. Nonobstructing Colonic Dilatation and Colon Perforations Following Renal Transplantation

    Science.gov (United States)

    Koneru, Baburao; Selby, Rick; O’Hair, Daniel P.; Tzakis, Andreas G.; Hakala, Thomas R.; Starzl, Thomas E.

    2010-01-01

    Nonobstructing colonic dilatation has not been commonly reported following renal transplantation, and colon perforations carry a high morbidity and mortality in this population. During a 7-year period, nonobstructing colonic dilatation developed in 13 adults 1 to 13 days after renal transplantation. Twelve (92%) of the 13 had poorly functioning allografts. Five (83%) of the 6 with and 2 (29%) of the 7 without colonoscopy had resolution of nonobstructing colonic dilatation. Of the seven right-sided colon perforations during this period, six were associated with nonobstructing colonic dilatation. An additional 4 patients had diverticular perforations in the left colon. Of a total of 11 patients with colon perforation, 7 had surgery within 24 hours of the perforation and 6 (86%) of these survived. Only 1 (25%) of the 4 having surgery more than 24 hours later survived. Six of the survivors retained functioning allografts. Nonobstructing colonic dilatation seems to be a potential complication of poor graft function after renal transplantation, and colonoscopy is effective in its treatment. In patients with colon perforations, early surgery and reduced immunosuppression are essential in decreasing mortality. PMID:2331220

  19. Atypical Hemolytic Uremic Syndrome Recurrence after Renal Transplantation

    Science.gov (United States)

    Bouatou, Yassine; Bacchi, Véronique Frémeaux; Villard, Jean; Moll, Solange; Martin, Pierre-Yves; Hadaya, Karine

    2015-01-01

    Abstract Risk for atypical hemolytic uremic syndrome (aHUS) recurrence after renal transplantation is low with an isolated membrane cofactor protein mutation (MCP). We report the case of a 32-year-old woman with a MCP who underwent kidney transplantation with a good evolution at 12 months. At 15 and 35 months, 2 episodes of thrombotic microangiopathy (TMA), after a miscarriage and a preeclampsia, were misinterpreted as triggered by tacrolimus. After each episode however serum creatinine returned to baseline. Five years after transplantation, she had a self-limited rhinosinusitis followed 3 weeks later by an oliguric renal failure. Her complement profile was normal. Graft biopsy showed C3 glomerulonephritis with no “humps” on electron microscopy. No significant renal function improvement followed methylprednisolone pulsing. A second biopsy showed severe acute TMA lesions with C3 glomerular deposits. Despite weekly eculizumab for 1 month, dialysis was resumed. A new workup identified the “at-risk” complement factor H haplotype. Thus, aHUS recurrence should be ruled out in aHUS patients considered at low recurrence risk when a TMA is found in graft biopsy. Prompt eculizumab therapy should be considered to avoid graft loss as aHUS recurrence can first present as a C3 glomerulonephritis. PMID:27500215

  20. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial

    OpenAIRE

    Sahmeddini, M. A.; Janatmakan, F.; Khosravi, M. B.; Ghaffaripour, S.; Eghbal, M. H.; Nickeghbalian, S.; Malek-Hosseini, S. A.

    2014-01-01

    Background: Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. Objective: To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. Methods: In this randomized clinical study, 67 adult patients with en...

  1. Pregnancy and contraceptive issues in renal transplant recipients.

    Science.gov (United States)

    Karkar, Ayman

    2008-03-01

    Fertility is improved within months and conception is achieved within one to six years after kidney transplantation. Pregnancy is safe and has little effect on long-term graft survival, but has increased maternal and fetal risks. Pregnancy is contraindicated in the first two years post-kidney transplantation due to increased risk of acute rejections and higher doses of immunosuppressive drugs. Poor renal function, uncontrolled diabetes mellitus and hypertension are other contraindications. Family planning and counseling, and consideration of a suitable contraceptive method are essential before transplantation. Tubal ligation and vasectomy are permanent contraceptives with the least failure results. Combined pills are highly effective and are among the lowest failure rate contraceptives, but they interact with cyclosporine, and are contraindicated in patients with thromboembolism and deep vein thrombosis. Progesterone-only minipill has the advantage of avoiding the risks associated with estrogen, but has a higher failure rate than the combined pills. The barrier methods (condom and diaphragm) are effective and safe contraceptives and can prevent sexually transmitted diseases, but require motivated couples. Intra uterine devices are convenient contraceptives, but have higher failure rate and are associated with increased incidence of pelvic infection. Pregnancy in renal transplant recipients should be managed by a multidisciplinary approach in a tertiary centre.

  2. Pregnancy and Contraceptive Issues in Renal Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Karkar Ayman

    2008-01-01

    Full Text Available Fertility is improved within months and conception is achieved within one to six years after kidney transplantation. Pregnancy is safe and has little effect on long-term graft survival, but has increased maternal and fetal risks. Pregnancy is contraindicated in the first two years post-kidney transplantation due to increased risk of acute rejections and higher doses of immunosuppressive drugs. Poor renal function, uncontrolled diabetes mellitus and hypertension are other contraindications. Family planning and counseling, and consideration of a suitable contraceptive method are essential before transplantation. Tubal ligation and vasectomy are permanent contraceptives with the least failure results. Combined pills are highly effective and are among the lowest failure rate contraceptives, but they interact with cyclosporine, and are contraindicated in patients with thromboembolism and deep vein thrombosis. Progesterone-only minipill has the advantage of avoiding the risks associated with estrogen, but has a higher failure rate than the combined pills. The barrier methods (condom and diaphragm are effective and safe contraceptives and can prevent sexually transmitted diseases, but require motivated couples. Intra uterine devices are convenient contraceptives, but have higher failure rate and are associated with increased incidence of pelvic infection. Pregnancy in renal transplant recipients should be managed by a multidisciplinary approach in a tertiary centre.

  3. Visceral leishmaniasis in a renal transplant recipient treated with allopurinol

    Directory of Open Access Journals (Sweden)

    Harzallah Kais

    2010-01-01

    Full Text Available Leishmaniasis is an infection caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the Phlebotomus sandfly. We report a case of visceral leishmaniasis in a 49-year-old male renal transplant recipient, a resident of the western part of Tunisia, which is an endemic zone for the disease. Just before and after the transplantation, the patient resided in Tunis, which is non-endemic for leishmaniasis. Visceral leishmaniasis occurred eight years after renal transplantation, and the clinical picture was characterized by fever and pancytopenia. Leish-maniae were detected by bone marrow aspiration. Pentavalent antimonal was used for 28 days and was substituted by allopurinol (20 mg/kg per day. One year after the infection, the patient remains totally asymptomatic. Our report suggests that visceral leishmaniasis may complicate the clinical course of organ transplantation and can be fatal, particularly when untreated. Relapses may occur after completion of the apparently effective treatment. Allopurinol could be a solution to avoid these relapses.

  4. Long-term graft and patient survival following renal transplantation in diabetic patients

    DEFF Research Database (Denmark)

    Rømming Sørensen, Vibeke; Schwartz Sørensen, Søren; Feldt-Rasmussen, Bo

    2006-01-01

    , the patient survival rates in the two groups were similar. Thereafter, survival among diabetic patients was poor. Mean HbA1c was relatively high, especially after the transplantation, and this may have contributed to the more rapid progression of cardiovascular disease seen in diabetic patients......OBJECTIVE: To study long-term graft and patient survival following renal transplantation in diabetic and non-diabetic patients. MATERIAL AND METHODS: Over the time period 1985-99, 498 transplantations in 399 non-diabetic patients and 68 transplantations in 62 diabetic patients were performed....... The groups were similar with respect to age and sex. RESULTS: The patient survival rates (diabetic versus non-diabetic patients) were 88% vs 91% (p=NS) at 1 year, 68% vs 73% (p=NS) at 5 years and 31% vs 52% (psurvival rates (diabetic versus non-diabetic patients) were 72% vs 72...

  5. Renal Allograft Outcome After Simultaneous Heart and Kidney Transplantation.

    Science.gov (United States)

    Grupper, Avishay; Grupper, Ayelet; Daly, Richard C; Pereira, Naveen L; Hathcock, Matthew A; Kremers, Walter K; Cosio, Fernando G; Edwards, Brooks S; Kushwaha, Sudhir S

    2017-08-01

    Chronic kidney disease frequently accompanies end-stage heart failure and may result in consideration of simultaneous heart and kidney transplantation (SHKT). In recent years, there has been a significant increase in SHKT. This single-center cohort consisted of 35 patients who underwent SHKT during 1996 to 2015. The aim of this study was to review factors that may predict better long-term outcome after SKHT. Thirteen patients (37%) had delayed graft function (DGF) after transplant (defined as the need for dialysis during the first 7 days after transplant), which was significantly associated with mechanical circulatory support device therapy and high right ventricular systolic pressure before transplant. Most of the recipients had glomerular filtration rate (GFR) ≥50 ml/min/1.73 m(2) at 1 and 3 years after transplant (21 of 26 [81%] and 20 of 21 [95%], respectively). Higher donor age was associated with reduced 1-year GFR (p = 0.017), and higher recipient pretransplant body mass index was associated with reduced 3-year GFR (p = 0.008). There was a significant association between DGF and reduced median GFR at 1 and 3 years after transplant (p <0.005). Patient survival rates at 6 months, 1, and 3 years after transplant were 97%, 91%, and 86% respectively. In conclusions, our data support good outcomes after SHKT. Mechanical circulatory support device therapy and pulmonary hypertension before transplant are associated with DGF, which is a risk factor for poor long-term renal allograft function. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Invited manuscript poster on renal-related education American Society of Nephrology, Nov. 16-21, 2010. Improving access to kidney transplant information has increased preemptive living kidney donation.

    Science.gov (United States)

    Brown, Wendy; McDermott, Jennifer; Figueiredo, Ana Elizabeth; Loucaidou, Marina; Galliford, Jack; Papalois, Vassilios

    2011-01-01

    Transplantation provides the best outcomes and quality of life for people with end-stage renal disease and therefore offers the optimum treatment of choice. Preemptive living donor (LD) transplantation is an increasingly preferable alternative to dialysis as transplantation outcomes indicate lower morbidity and mortality rates and greater graft and patient survival rates compared to those who are transplanted after dialysis has commenced. Despite nursing and medical teams giving information to patients regarding transplantation and living donation, the number of people coming forward for preemptive transplant work-up remained limited. Changing the format, environment, and quality of information given to patients and families seemed necessary in order to increase the number of preemptive transplants. Our data show that we have improved the access to the information seminars with attendance rising from 5 to 15 attendees per seminar (3 per year) in 2005 to average 65 attendees per seminar (6 per year) in 2010. By expanding the access to information for patients, their families and friends, living donation has increased with a growth in the proportion of preemptive LD transplants from 28% (23/81) in 2006 to 44% in 2010 (29/66; p = 0.05). We can conclude that expanding the pool accessing information has increased the number of preemptive (LD) transplants in our center.

  7. CUBN as a novel locus for end-stage renal disease: insights from renal transplantation.

    Directory of Open Access Journals (Sweden)

    Anna Reznichenko

    Full Text Available Chronic kidney disease (CKD is a complex disorder. As genome-wide association studies identified cubilin gene CUBN as a locus for albuminuria, and urinary protein loss is a risk factor for progressive CKD, we tested the hypothesis that common genetic variants in CUBN are associated with end-stage renal disease (ESRD and proteinuria. First, a total of 1142 patients with ESRD, admitted for renal transplantation, and 1186 donors were genotyped for SNPs rs7918972 and rs1801239 (case-control study. The rs7918972 minor allele frequency (MAF was higher in ESRD patients comparing to kidney donors, implicating an increased risk for ESRD (OR 1.39, p = 0.0004 in native kidneys. Second, after transplantation recipients were followed for 5.8 [3.8-9.2] years (longitudinal study documenting ESRD in transplanted kidneys--graft failure (GF. During post-transplant follow-up 92 (9.6% cases of death-censored GF occurred. Donor rs7918972 MAF, representing genotype of the transplanted kidney, was 16.3% in GF vs 10.7% in cases with functioning graft. Consistently, a multivariate Cox regression analysis showed that donor rs7918972 is a predictor of GF, although statistical significance was not reached (HR 1.53, p = 0.055. There was no association of recipient rs7918972 with GF. Rs1801239 was not associated with ESRD or GF. In line with an association with the outcome, donor rs7918972 was associated with elevated proteinuria levels cross-sectionally at 1 year after transplantation. Thus, we identified CUBN rs7918972 as a novel risk variant for renal function loss in two independent settings: ESRD in native kidneys and GF in transplanted kidneys.

  8. Reduced cyclooxygenase involvement in vascular endothelial function in rat renal transplantation

    NARCIS (Netherlands)

    Smit-Van Oosten, Annemieke; Boonstra, Arnold H.; Navis, Gerjan; Van Goor, Harry; Buikema, Hendrik

    2005-01-01

    Background: Cardiovascular disease is a major cause of death following renal transplantation. Mechanisms leading to vascular dysfunction outside the transplanted organ involve common risk factors such as hypertension, hypercholesterolemia, proteinuria, but immune-mediated factors may also be involve

  9. Reduced cyclooxygenase involvement in vascular endothelial function in rat renal transplantation

    NARCIS (Netherlands)

    Smit-Van Oosten, Annemieke; Boonstra, Arnold H.; Navis, Gerjan; Van Goor, Harry; Buikema, Hendrik

    2005-01-01

    Background: Cardiovascular disease is a major cause of death following renal transplantation. Mechanisms leading to vascular dysfunction outside the transplanted organ involve common risk factors such as hypertension, hypercholesterolemia, proteinuria, but immune-mediated factors may also be involve

  10. Disseminated histoplasmosis presenting with ileal perforation in a renal transplant recipient.

    Science.gov (United States)

    Zainudin, B M; Kassim, F; Annuar, N M; Lim, C S; Ghazali, A K; Murad, Z

    1992-08-01

    A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.

  11. The effect of prostaglandin E_1 on recovery of early renal graft functions after transplantation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To investigate the effect of prostaglandin E1 (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. I...

  12. Visceral leishmaniasis in renal transplant recipients: successful treatment with liposomal amphotericin B (AmBisome).

    Science.gov (United States)

    Boletis, J N; Pefanis, A; Stathakis, C; Helioti, H; Kostakis, A; Giamarellou, H

    1999-06-01

    Visceral leishmaniasis (VL) is a rare disease in renal transplant recipients. Liposomal amphotericin B (AmBisome) is known to be effective against VL. However, previously there has been no experience with administration of such treatment to renal transplant recipients. We report herein four patients with VL complicating renal transplantation who were treated successfully with liposomal amphotericin B (total dose, 23-40 mg/kg). Neither adverse reactions nor clinical relapses of VL were observed.

  13. Health information management for research and quality assurance: the Comprehensive Renal Transplant Research Information System.

    Science.gov (United States)

    Famure, Olusegun; Phan, Nicholas Anh-Tuan; Kim, Sang Joseph

    2014-01-01

    The Kidney Transplant Program at the Toronto General Hospital uses numerous electronic health record platforms housing patient health information that is often not coded in a systematic manner to facilitate quality assurance and research. To address this, the comprehensive renal transplant research information system was conceived by a multidisciplinary healthcare team. Data analysis from comprehensive renal transplant research information system presented at programmatic retreats, scientific meetings, and peer-reviewed manuscripts contributes to quality improvement and knowledge in kidney transplantation.

  14. Effect of pre-transplantation hemoglobin concentration on prognosis of renal transplant recipients

    Institute of Scientific and Technical Information of China (English)

    NA Ning; HONG Liang-qing; MIAO Bin; HUA Xue-feng; HUANG Zheng-yu

    2011-01-01

    Background For the renal transplant recipients, anemia is one of the common complications and becomes a major medical issue before transplantation. Haemoglobin (Hb) is used as a prognostic indicator, although the optimal pre-transplantation Hb concentration associated with positive prognosis is still controversial. The aim of this study was to detect the optimal Hb concentration on predicting the graft survival and function.Methods A retrospective cohort study was conducted by reviewing the medical records of the patients who received renal transplantations at our center from January 2004 to June 2008. Patients were divided into two groups: high Hb group (>100 g/L, n=79) and low Hb group (<100 g/L, n=63). There was no significant difference between the two groups regarding sex, age, blood type and tissue types. Renal function among the two groups was measured and compared.Panel reacting antigens (PRA) of all the recipients were negative. The effect of preoperative hemoglobin concentration on the postoperative renal function recovery in both groups was further analyzed.Results A total of 14 acute rejection episodes occurred, including 5 patients in the high Hb group (7.9%) and 9 in the low Hb group (11.4%, P >0.05). The serum creatinine level at one-year post-transplantation of the low Hb group was significantly higher than that of the high Hb group ((117.8±36.3) μmol/L vs. (103.1±35.5) μmol/L, P <0.05). For one-year actuarial patient and graft survival, incidence of delayed graft function (DGF), serum creatinine concentrations at 1, 3, 6 months post-transplantation, the incidence of cytomegalovirus (CMV) infection, post-transplantation anemia (PTA) and post-transplantation diabetes mellitus (PTDM) of both groups, there were no statistically significant differences.Conclusion Pre-transplantation Hb concentration has significant effect on one-year creatinine concentration, but can not significantly affect acute rejection episodes, DGF, PTA, CMV infection

  15. Successful pregnancy in renal transplant recipient with previous known polyomavirus nephropathy.

    Science.gov (United States)

    Midtvedt, Karsten; Bjorang, Ola; Letting, Anne-Sofie

    2007-01-01

    Pregnancy after renal transplantation has become increasingly common. Studies in non-immunocompromised patients have shown that pregnant women have increased susceptibility to infection or reactivation of latent virus such as BK virus. To what extent a renal transplant recipient is at risk for reactivation of polyoma virus during pregnancy remains unknown. We hereby report successful pregnancy outcome in a renal transplant recipient with a known history of BK virus nephropathy treated with cidofovir i.v. To our knowledge, this is the first published experience with a successful pregnancy in renal transplant recipients with known history of polyomavirus-associated nephropathy.

  16. Pregnancy in a renal transplant recipient with HIV-1 infection: a case report.

    Science.gov (United States)

    Agüero, Fernando; Cofan, Frederic; Fortuny, Claudia; Lopez, Marta; Manzardo, Christian; Lonca, Montserrat; Oppenheimer, Frederic; Moreno, Asuncion; Campistol, Josep M; Miro, Jose M

    2016-01-01

    We report the first case of a pregnancy in a renal transplant recipient with HIV infection. She underwent renal transplantation in 2005 and became pregnant in 2009. The patient underwent vaginal delivery and a healthy full-term, female baby was born. Almost 6 years after delivery, both mother and child were doing well. The management of concurrent renal transplantation, HIV infection and pregnancy was extremely challenging. Women with HIV infection who have undergone renal transplantation should be accurately informed of the potential health risks for them and their offspring. Multidisciplinary teams are mandatory in order to properly manage these patients.

  17. Treatment strategies to minimize or prevent chronic allograft dysfunction in pediatric renal transplant recipients: an overview.

    Science.gov (United States)

    Höcker, Britta; Tönshoff, Burkhard

    2009-01-01

    immunosuppression has been associated with better graft survival, an increase of the immunosuppressive level to avoid subclinical rejection should be weighed against the risk of infection. The majority of viral infections affecting kidney allografts are caused by CMV and BKV. Antiviral CMV prophylaxis or pre-emptive therapy with ganciclovir has been shown to have beneficial effects in the pediatric renal transplant population. Treatment of BKV-induced nephropathy is based on reduction of the immunosuppressant therapy, although specific antiviral agents such as cidofovir and leflunomide are known to inhibit BKV. However, cidofovir itself is nephrotoxic and should therefore be administered cautiously to pediatric renal transplant patients. Since CNIs are likewise known for their nephrotoxic effects, especially with long-term use, alteration of the immunosuppressant regimen is necessary in case of deteriorating graft function due to CNI-induced histopathologic changes. Complete CNI avoidance seems inappropriate because, in this situation in pediatric renal transplant recipients, other relatively potent immunosuppressant agents such as lymphocyte-depleting antibodies, which are frequently accompanied by a higher incidence of infections, are needed for rejection prophylaxis. CNI withdrawal and switching of the immunosuppressant regimen from CNI therapy to sirolimus may be an option for some pediatric renal transplant patients with less advanced graft function deterioration. Nevertheless, potential adverse events such as aggravation of proteinuria, hyperlipidemia, myelosuppression, and hypergonadotropic hypogonadism have to be considered, and controlled studies are lacking. At present, an immunosuppressant maintenance therapy composed of low-dose tacrolimus or ciclosporin (CNI minimization) and mycophenolate mofetil with low-dose corticosteroids appears to be the most promising strategy to adopt in pediatric renal transplant recipients at low or normal immunologic risk.

  18. Transplante renal em pacientes infectados pelo HIV Kidney transplantation in HIV infected patients

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    Carina Nilsen Moreno

    2011-02-01

    Full Text Available Este artigo de revisão tem como objetivo apresentar as principais considerações sobre o transplante renal em pacientes HIV positivos. Na última década, com o advento da terapia antirretroviral de alta atividade (Highly Active Antiretroviral Therapy - HAART, a evolução dos pacientes infectados pelo vírus da imunodeficiência humana (Human Immunodeficiency Virus - HIV mudou significativamente, com uma acentuada diminuição das taxas de morbimortalidade nesta população. Neste contexto, o número de pacientes HIV positivos com doença renal crônica com necessidade de terapia dialítica vem aumentando progressivamente. Diante desta nova realidade, o transplante renal, antes considerado uma contraindicação absoluta para tais pacientes, passou a ser considerado uma alternativa de terapia substitutiva da função renal. Questões sobre o uso de imunossupressores neste grupo de pacientes e sua possível ação aumentando a replicação do HIV, além do risco de infecções oportunistas e de desenvolvimento de neoplasias, são amplamente discutidas. Porém, a experiência clínica nessa área mostra que a utilização dessas drogas para pacientes soropositivos parece ser segura, inclusive com relatos de ação antirretroviral de algumas das drogas imunossupressoras. Apesar disso, ainda hoje existem poucos relatos de transplantes nesta população. Em resumo, os dados da literatura sugerem que o transplante renal, seguindo critérios de seleção dos pacientes, parece ser uma alternativa segura como terapia de substituição renal em pacientes HIV positivos.This review presents current considerations for renal transplantation in HIV patients. In the last decade, with the advent of highly active antiretroviral therapy (HAART, life expectancy of patients infected with human immunodeficiency virus (HIV has significantly improved, showing a marked decrease in the rates of morbidity and mortality in this population. In this setting, the number of

  19. Renal transplantation in the Roma ethnicity-do all patients have equal chance for transplantation?

    Science.gov (United States)

    Basic-Jukic, N; Novosel, D; Juric, I; Kes, P

    2013-11-01

    Racial and ethnic disparities exist in access to kidney transplantation worldwide. The Roma people are often socially deprived, uneducated, and unemployed. We investigated all dialysis centers in Croatia to determine number of Roma people on dialysis as well as their access and reasons for eventual failure to enter the waiting list. There are 9463 registered Roma people in Croatia, however, the estimated number reaches 40,000. Twenty-five Roma patients required renal replacement therapy, giving a prevalence of 830 per million people (pmp), compared with 959 pmp among the general population. Average age at the start of dialysis was 29 vs 67 years; waiting time to kidney transplantation was 48.9 vs 53.5 months; mean age at the time of transplantation was 33.18 vs 48.01 years in Roma versus the general population respectively. One patient received a kidney allograft from a living unrelated spousal donor, and all others from deceased individuals. Patients were followed for 51.5 months (range, 6-240). The most frequent post-transplant complications were urinary tract infections. One patient lost a graft due to severe acute rejection caused by noncompliance. Two young patients were also noncompliant with immunosuppressive medications. One patient died with a functioning graft at 20 years after transplantation due to cardiovascular disease. Among 14 Roma patients currently been treated with hemodialysis in Croatia, 10 are old with clinical contraindications for transplantation; 1 is on the waiting list; 1 left hospitalization for pretransplant evaluation twice; 1 refused evaluation; and 1 is currently being evaluated for the waiting list. The Roma people have excellent access to renal transplantation in Croatia. Many of them refuse evaluation. More efforts should be invested in their education to improve compliance and their post-transplant outcomes.

  20. Bilateral Septic Arthritis Complicating Knee Osteonecrosis in Renal Transplant Recipient: Case Report

    Directory of Open Access Journals (Sweden)

    Erhan TATAR

    2012-01-01

    Full Text Available Septic arthritis is rarely seen in transplant patients and differs from the general population with regards to gram negative and/or atypical agents being the prominent causes. In renal transplant patients, osteonecrosis is one of the major musculo-skeletal complications. In transplant patients, immunosupressive drugs, delayed graft function, genetics, HD duration before transplantation, cause of renal failure are among the risk factors for ostenecrosis. In this case report, we present a renal transplant patient with bilateral knee osteonecrosis and septic arthritis due to Escherichia coli.

  1. Malignancies after kidney transplantation: Hong Kong renal registry.

    Science.gov (United States)

    Cheung, C Y; Lam, M F; Chu, K H; Chow, K M; Tsang, K Y; Yuen, S K; Wong, P N; Chan, S K; Leung, K T; Chan, C K; Ho, Y W; Chau, K F

    2012-11-01

    Manystudies have shown that kidney transplant recipients have a higher incidence of cancers when compared with general population. However, most data on the posttransplant malignancies (PTM) are derived from Western literature and large population-based studies are rare. There is also lack of information about the posttransplant cancer-specific mortality rate. We conducted a population-based study of 4895 kidney transplants between 1972 and 2011, with data from the Hong Kong Renal Registry. Patterns of cancer incidence and mortality in our kidney transplant recipients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. With 40 246 person-years of follow-up, 299 PTM was diagnosed. The SIR of all cancers was 2.94 (female 3.58 and male 2.58). Non-Hodgkin lymphoma (NHL), kidney, and bladder cancers had the highest SIRs. The overall SMR was 2.3 (female 3.4 and male 1.7) and the highest SMR was NHL. The patterns of PTM differ among countries. Increases in cancer incidence can now translate into similar increases in cancer mortality. NHL is important in our kidney transplant recipients. Strategies in cancer screening in selected patient groups are needed to improve transplant outcomes.

  2. Ethical and legal issues in renal transplantation in Nigeria

    Directory of Open Access Journals (Sweden)

    S O Ajayi

    2016-01-01

    Full Text Available With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.

  3. Post-transplant Lymphoproliferative Disorder Arising from Renal Allograft Parenchyma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan; Kim, Chan Kyo; Kwon, Ghee Young [Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

    2010-06-15

    Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious complication that occurs in patients undergoing kidney transplantation. PTLD usually manifests as a renal hilar mass comprised of histologically B-lymphocytes. We report our experience of managing a patient with PTLD arising from renal parenchyma. Ultrasonographic and MR imaging features of this unusual PTLD suggested differentiated renal cell carcinoma arising from the renal allograft

  4. Colchicine-induced myoneuropathy in a cyclosporine-treated renal transplant recipient

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    Kyungmin Huh

    2013-06-01

    Full Text Available Colchicine is a relatively safe medication that is widely used for both prevention and treatment of gout attack. However, serious adverse events, including myoneuropathy and multiorgan failure, have been reported. We report a case of colchicine-induced myoneuropathy in a female kidney transplant recipient who had been taking cyclosporine. She developed gastrointestinal discomfort and paresthesia 5 days after the initiation of colchicine. She showed signs of myoneuropathy, and hepatic and renal injury. Colchicine toxicity was suspected, and colchicine was discontinued. Her symptoms and laboratory findings improved gradually. Literature was reviewed for previous reports of colchicine-induced myoneuropathy in solid organ transplant recipients.

  5. RELATIONSHIP BETWEEN CYTOMEGALOVIRUS INFECTION AND THE PRODUCTION OF AN TICARDIOLIPIN ANTIBODY IN RENAL TRANSPLANT RECIPIENTS

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the relationship bet wee n cytomegalovirus (CMV) infection and the production of anticardiolipin antibody (ACA) in renal transplant recipients.Methods Polymerase c hain reaction (PCR) was used qualitat ively for detection of CMV-DNA in 146 renal transplant recipients.Meanwhile,enz yme-linked immunosorbent assay (ELISA) was used for detection of ACA-IgG in bl ood serum samples from these recipients and 32 healthy individuals. Results The ACA positive rate was 17.1% among the 146 ren al transplant recipients,and that of the control group was 6.3%.There was no sig nificant difference.However,the ACA positive rate of the renal transplant recipi ents infected with CMV was 31.2%.It was clearly higher than that of those with n o infection of CMV and that of the control group (P<0.005). Con clusion The production of ACA was closely related to CMV infection.It m ight be one of the factors of chronic angiopathy of the transpl anted kidney due to CMV infection.

  6. Analysis on BK virus associated nephropathy related risk factors in renal transplant recipients%肾移植受者BK病毒相关性肾病的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    黄刚; 王长希; 罗小菁; 黄燕纯; 费继光; 邓素雄; 李军; 陈国栋; 付茜

    2015-01-01

    Objective To analyze the risk factors affecting BK virus associated nephropathy (BKVAN) after kidney transplantation.Methods Three screening methods for BKVAN including quantitative PCR assay for BK virus(BKV) DNA load in urine and plasma and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 615 patients from January 2006 to December 2014 were used.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry and classified into three categories of BKVAN.Potential variables were analyzed by Logistic regression model multivariate analysis to assess and rank BKVAN related risk factors.Results The positive rate of urine decoy cell,BKV viruria and viremia in 615 renal recipients were 13.7% (84/615),29.3% (180/615),and 8.8% (54/615),respectively.BKVAN were diagnosed in 49 recipients.The incidence and the median level of the number of the decoy cell,BK viral load in urine and plasma were higher in the BKVAN group than those in non-BKVAN group (all P < 0.05).Tacrolimus (Tac) combined with mycopbenolic acid (MPA) protocol (OR =12.4,P =0.001) and severe pneumonia post-transplant (OR =3.7,P =0.001) were the independent risk factors impacting on BKVAN in renal recipients.Conclusions The renal recipients with high level of BKV replication,whose immunosuppressant protocol include Tac and MPA,should be suspected the diagnosis of BKVAN.%目的 探讨影响肾移植受者BK病毒相关性肾病(BKVAN)的危险因素.方法 选取2006年1月至2014年12月于中山大学附属第一医院行移植肾穿刺活检的615例肾移植受者,肾穿刺同时收集血、尿标本,进行尿沉渣Decoy细胞计数,尿、血标本中BK病毒(BKV)DNA含量的检测.并且运用普通病理染色、免疫组织化学染色的方法检查移植肾组织确定BKVAN的诊断并进行病理分期.应用Logistic回归法分析筛选BKVAN的危险因素.结果 615例肾移

  7. Cutaneous and bone marrow histoplasmosis after 18 years of renal allograft transplant.

    Science.gov (United States)

    Ibrahim, K Y; Carvalho, N B; Mimicos, E V; Yeh-Li, H; Sotto, M N; França, F O S

    2014-10-01

    The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12-18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.

  8. Prognosis of renal transplant function by renography with radioactive hippuran

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, G.; Fill, H.; Hilty, E.; Leidlmair, K.

    1986-01-01

    The relation of the functional prognosis of a kidney graft to the results of renography with radioactive hippuran (OIH-RG) was assessed in 96 patients after renal allograft transplantation in 1982. By October 1, 1984 26 of these kidneys had lost their function. The curves obtained from the gamma-camera OIH-RG are classified into six different curve patterns (curve types 1 to 6) as published earlier. For the evaluation of the long-term prognosis, the survival times of the kidneys were related to the curve types. The distribution of the curve types obtained in patients with a kidney survival longer than 144 weeks differs significantly from the curve type distribution when the kidney survival is shorter than 144 weeks. The individual survival times in the collective 26 lost kidneys show a relation to the different curve types. All kidneys with curve type 4 in the last examination before hospital discharge are lost within the first 20 weeks while curve types 1 and 2 promise a functional survival up to 144 weeks. Serum creatinine time courses and their relation to the OIH-RG curve patterns are analyzed by analyses of variance and covariance with repeated measurement. These statistical analyses reveal significant differences between the creatinine courses in the single curve types and, in addition, a significant interaction of the curve types with the creatinine courses. In curve type 1, a rapid normalization of an elevated creatinine level can be predicted, while in curve type 4 no improvement of the creatinine level and thus of kidney function can be expected at least within the five days following discharge.

  9. Changes at the glomerulo-tubular junction in renal transplants.

    Science.gov (United States)

    Lee, S J; Howie, A J

    1988-12-01

    We studied by microscopy 377 biopsies, nephrectomies, and necropsy kidneys from 123 human renal transplants. We discovered two common abnormalities of the renal corpuscle, both affecting the glomerulo-tubular junction. Adhesion of the tip of the glomerular tuft to the origin of the tubule, as reported in various non-transplant glomerulopathies, was seen in 197 specimens (52 per cent). This change was common in material showing acute or chronic vascular rejection and glomerulopathy, and was almost universal in transplants that had been in place for over 1 year. Another change at the glomerulo-tubular junction, not previously highlighted, consisted of an infiltrate of lymphocytes or neutrophil polymorphs into the epithelium at the tubular origin. This change was seen in 145 specimens (38 per cent) and was associated with cellular rejection and ascending infection. These changes are of importance because they show two responses of the kidney to injury that involve the glomerulo-tubular junction and thus suggest that this part of the kidney has some specific properties that have been largely neglected up to now.

  10. Deceased donor renal transplantation: A single center experience

    Science.gov (United States)

    Gopalakrishnan, N.; Dineshkumar, T.; Dhanapriya, J.; Sakthirajan, R.; Balasubramaniyan, T.; Srinivasa Prasad, N. D.; Thirumalvalavan, K.; Murugananth, S.; Kawaskar, K.

    2017-01-01

    Deceased donor renal transplantation (DDRT) constitutes less than 5% of all kidney transplantats in India. A retrospective analysis of 173 deceased donor renal transplants performed in a public funded government hospital was done. Mean age of the recipients was 36 years (male:female ratio 2.4:1), and that of the donors was 32.3 years (male:female ratio 6:1). The cold ischemic time was 340 ± 170 minutes. Mean follow-up period was 36 months. Forty one patients died, 75% of them in the first post – transplant year. Sepsis and cardiovascular disease were the most common causes of death. Twenty two percent had acute rejection. There was no significant difference in the incidence in the rate of acute rejection, bacterial, fungal infections and death rate between the cohorts of induction and non induction immunosuppression. The patient and death censored graft survival at 1 year were 80 and 82.6% and at 5 years were 76 and 80% respectively. PMID:28182043

  11. Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation.

    Science.gov (United States)

    Trompeter, Richard; Filler, Guido; Webb, Nicholas J A; Watson, Alan R; Milford, David V; Tyden, Gunnar; Grenda, Ryszard; Janda, Jan; Hughes, David; Ehrich, Jochen H H; Klare, Bernd; Zacchello, Graziella; Bjorn Brekke, Inge; McGraw, Mary; Perner, Ferenc; Ghio, Lucian; Balzar, Egon; Friman, Styrbjörn; Gusmano, Rosanna; Stolpe, Jochen

    2002-03-01

    This study was undertaken to compare the efficacy and safety of tacrolimus (Tac) with the microemulsion formulation of cyclosporin (CyA) in children undergoing renal transplantation. A 6-month, randomized, prospective, open, parallel group study with an open extension phase was conducted in 18 centers from nine European countries. In total, 196 pediatric patients (diarrhea (13.6% vs. 3.2%), hypertrichosis (0.0% vs. 7.5%), flu syndrome (0.0% vs. 5.4%), and gum hyperplasia (0.0% vs. 5.4%). In previously non-diabetic children, the incidence of long-term (>30 days) insulin use was 3.0% (Tac) and 2.2% (CyA). Post-transplant lymphoproliferative disease was observed in 1 patient in the Tac group and 2 patients in the CyA group. In conclusion, Tac was significantly more effective than CyA microemulsion in preventing acute rejection after renal transplantation in a pediatric population. The overall safety profiles of the two regimens were comparable.

  12. Treatment of tuberculosis with rifabutin in a renal transplant recipient.

    Science.gov (United States)

    López-Montes, Aurora; Gallego, Eduardo; López, Esperanza; Pérez, Juan; Lorenzo, Inmaculada; Llamas, Francisco; Serrano, Ana; Andrés, Elena; Illescas, Luisa; Gómez, Carmen

    2004-10-01

    Development of tuberculosis infection in a renal transplant patient is infrequent in Spain, although the prevalence is higher than in the general population. These patients usually receive calcineurin inhibitors as the main component of their immunosuppressive treatment. The metabolism of these drugs, whether cyclosporine or tacrolimus, involves cytochrome P-450 3A. Rifampin, a widely used agent in the treatment of tuberculosis, is also an important inducer of cytochrome P-450 3A metabolism and has the capacity to decrease serum levels of the calcineurin inhibitors. This metabolic interaction makes pharmacologic management of tuberculosis-infected transplant patients more complex and can result in a higher risk of acute rejection caused by decreased levels of the immunosuppressant in the blood. The authors present a case of a renal transplant patient with a soft tissue infection caused by Mycobacterium tuberculosis who was treated with rifabutin instead of rifampin, with excellent results in terms of graft survival and overall survival. The use of rifabutin allowed the authors to achieve better control of circulating immunosuppressant levels and a lower probability of acute graft rejection.

  13. Diagnosis and management of ureteral complications following renal transplantation

    Directory of Open Access Journals (Sweden)

    Brian D. Duty

    2015-10-01

    Full Text Available When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic, urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter. Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

  14. Total peripheral vascular resistance in pediatric renal transplant patients.

    Science.gov (United States)

    Matteucci, Maria Chiara; Giordano, Ugo; Calzolari, Armando; Rizzoni, Gianfranco

    2002-11-01

    Abnormal cardiovascular reactivity at rest and during physical exercise may be a risk factor for left ventricular hypertrophy (LVH) in pediatric renal transplanted (Tx) patients. Data on total peripheral vascular resistance (TPR) are not available. Eleven renal Tx patients treated with cyclosporine (7 females and 4 males; mean age 14.6 +/- 3.3 years; mean time since transplantation 43 +/- 35 months) were evaluated for 24-hour blood pressure (BP), TPR and echocardiographic left ventricular mass (LVM). TPR values of patients were compared with data of a group of 11 healthy controls matched for sex and age. Twenty-four-hour ambulatory blood pressure monitoring showed that all but one patient had normal daytime BP values and six patients showed a reduced or inverse nocturnal dip. LVH was found in 72% of the patients. In comparison with healthy controls, patients showed significantly elevated TPR at rest and during exercise suggesting an increased vascular tone. The degree of LVH in these patients is severe and appears disproportionate to the BP values. The high incidence of LVH can reflect an augmented cardiovascular reactivity associated with a disturbed circadian pattern. The increase in TPR and the reduction of the nocturnal fall of BP also might contribute to the development of LVH in young renal Tx patients.

  15. Pregnancy after renal transplantation: Effects on mother, child, and renal graft function

    OpenAIRE

    Siham El Houssni; Siham Sabri; Loubna Benamar; Naima Ouzeddoun; Rabia Bayahia; Hakima Rhou

    2016-01-01

    The aim of this study was to report our experience of pregnancy in renal transplant (RT) patients and its medium and long-term effects on the renal graft as well as the maternal fetal complications. We studied 21 pregnancies in 12 RT patients with mean age of 29.9 ± 5.3 years. The mean duration of RT to 1 st pregnancy was 42 (21-68.5) months and the median follow-up period was 112.5 (138-165) months. The pregnancy was planned in 28.6% of the cases. At the time of the diagnosis of the pregnanc...

  16. Major influence of renal function on hyperlipidemia after living donor liver transplantation

    Science.gov (United States)

    Ling, Qi; Wang, Kai; Lu, Di; Guo, Hai-Jun; Jiang, Wen-Shi; He, Xiang-Xiang; Xu, Xiao; Zheng, Shu-Sen

    2012-01-01

    AIM: To investigate the impact of renal and graft function on post-transplant hyperlipidemia (PTHL) in living donor liver transplantation (LDLT). METHODS: A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled. Data were collected and analyzed by the China Liver Transplant Registry retrospectively. PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT. Early renal dysfunction (ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week. RESULTS: In 115 eligible patients, the incidence of PTHL was 24.3%. Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL (17.9% vs 4.6%, P = 0.037). Serum creatinine showed significant positive correlations with total serum triglycerides, both at post-transplant month 1 and 3 (P transplant serum creatinine levels (P transplant renal insufficiency (P transplant serum creatinine, graft-to-recipient weight ratio, graft volume/standard liver volume ratio, body mass index (BMI) and ERD were identified as risk factors for PTHL by univariate analysis. Furthermore, ERD [odds ratio (OR) = 9.593, P transplant renal dysfunction, which mainly results from pre-transplant renal insufficiency, contributes to PTHL. PMID:23323005

  17. EPIDEMIOLOGY AND ETIOLOGICAL FACTORS OF ERECTILE DYSFUNCTION IN PATIENTS ON DIALYSIS AND AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    E. A. Efremov

    2011-01-01

    Full Text Available Today the problem of better life quality of patients with end stage renal disease and after renal transplantation and their sexual adaptation is considered to be more impotent. The clinical part of the investigation is the obser- vation of 205 patients – men with terminal stage renal disease. Erectile dysfunction is represented in 91,4% (64 of patients getting haemodialysis, 92,3% (24 of patients getting peritoneal dialysis, 61,5% (67 of patients after renal transplantation. According to International Index of Erectile Function the mean score of erectile function is 16,7 ± 5,2 in haemodialysis patients, 19,46 ± 3,6 in peritoneal dialysis patients, 21,9 ± 5,6 in patients after renal transplantation. The analysis revealed great prevalence of erectile dysfunction and interest in improvement among the patients with end stage renal disease and after renal transplantation

  18. Induction treatment of previously undiagnosed ANCA-associated vasculitis in a renal transplant patient with Rituximab

    Science.gov (United States)

    Graham-Brown, M. P. M.; Aljayyousi, R.; Baines, R. J.; Burton, J. O.; Brunskill, N. J.; Furness, P.; Topham, P.

    2016-01-01

    We report the case of a 40-year-old female transplant patient with undiagnosed ANCA-associated vasculitis (AAV) and renal allograft dysfunction who achieved disease remission with restoration of transplant function following induction therapy with rituximab. There are currently no trial data looking at the use of rituximab for induction of remission of renal transplant patients with AAV. Although recurrence of AAV following renal transplantation is rare, such patients have invariably had multiple previous exposures to induction and maintenance immunosuppressive regimens, often limiting treatment options post-transplantation. In this case, rituximab was well tolerated with no side effects, and was successful in salvaging transplant function. Optimal treatment regimens for relapsed AAV in the transplant population are not known, and clinical trials are needed to evaluate the efficacy and safety of rituximab at inducing and maintaining disease remission in relapsed AAV following transplantation. PMID:27699052

  19. Recurrence of hemolytic uremic syndrome after renal transplantation.

    Science.gov (United States)

    Seitz, B; Albano, L; Vocila, F; Mzoughi, S; Aoudia, R; Guitard, J; Ribes, D; Vachet-Copponat, H; Mourad, G; Bienaimé, F; Dahan, P; Frémeaux-Bacchi, V; Cassuto, E

    2007-10-01

    Non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) is a rare disease. The clinical outcome is often unfavorable: 50% of patients progress to end-stage renal failure. Several mutations in complement regulatory genes predispose to non-Stx-HUS. Transplantation outcomes are poor among patients with either mutation in the genes encoding complement H or I factors, with 80% graft loss due to HUS recurrence. In contrast, patients with mutation in the gene encoding MCP have no disease relapse after transplantation. There are no treatment guidelines for non-Stx-HUS recurrence. Herein we have presented 8 patients with non-Stx-HUS recurrence after transplantation during the last 10 years in the South of France. HUS recurrence, which occurred early after transplantation in all but 1 patient, was treated by plasma exchange (PE) with substitution by fresh frozen plasma (FFP). Three patients still treated with long-term plasma therapy have no recurrence at 15, 19, or 24 months. An international registry would help to define new guidelines.

  20. [Pseudotumor cerebri associated with cyclosporin use following renal transplantation].

    Science.gov (United States)

    Costa, Kellen Micheline A H; Almeida, José Bruno de; Félix, Ricardo Humberto de M; Silva Júnior, Maurício Ferreira da

    2010-03-01

    Pseudotumor cerebri (PC) is a syndrome characterized by the presence of intracranial hypertension (ICH) and no alteration in the ventricular system. Renal transplanted patients seem more susceptible to develop it due to immunosuppressive therapy. Cyclosporin (CsA) is a rare cause of PC, scarcely reported in the literature, and should be considered in the differential diagnosis of ICH and papilledema in those patients. We report the case of a 10-year-old boy, with a renal allograft for three years, on chronic use of mycophenolate mophetil (MMF), CsA, and low doses of prednisone. The patient presented with headache, vomiting, diplopia, and photophobia. Funduscopy showed bilateral papilledema. Cerebrospinal fluid analysis and imaging tests were normal. After excluding secondary causes, PC was diagnosed based on the chronic use of CsA, which was then replaced by sirolimus. After that, the patient progressively improved, and the papilledema resolved in three months.

  1. Diagnostic radiology of early complications after renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Looser, C.M.; Terrier, F.; Scheidegger, J.R.; Frey, F.J.; Gertsch, P.; Lerut, J.; Revel, D.

    1988-12-01

    Postoperative complications after renal transplantation, such as hematomas, abscesses, urinomas and lymphoceles and obstruction of the ureter, can be diagnosed by means of ultra sonography. Early vascular complications, such as venous thrombosis and arterial occlusion or stenosis, can be recognized by duplex ultrasonography and accurately depicted by angiography to allow planning of surgical intervention. Stenosis of the renal artery is amenable to treatment by percutaneous angioplasty. Parenchymatous complications (acute tubular necrosis, acute rejection, cyclosporin-Atoxicity) can cause changes in the intrarenal flow patterns at duplex ultra sonography, but this examination does not allow accurate diagnosis and differentiation of these changes. Magnetic resonance imaging is a very promising method for the differential diagnosis of parenchymatous complications. (orig.) .

  2. Prognosis of HTLV-1 positive renal transplant recipients in Iran

    Directory of Open Access Journals (Sweden)

    Orode Naghibi

    2011-01-01

    Full Text Available The human T lymphocyte virus-1 (HTLV-1 is the responsible pathogen for diseases such as HTLV-1 associated myelopathy (HAM and adult T-cell leukemia (ATL. Mashhad, in northeast Iran, with high instances of this infection, has a noticeable number of infected renal failure patients. Since immunosuppressive drugs might decrease the latency period of HTLV-1 or increase its complications, the question arises whether HTLV-1 positive renal failure patients are suitable candidates for kidney transplants. To answer this, HTLV-1 positive recipients were evaluated in our study. Patients were divided into two groups. First group consisted of patients at the Imam Reza Hospital dialysis center. Second group had 20 kidney transplantation recipients consisting of ten infected and ten uninfected recipients as control from Imam Reza. Medical history of these patients was recorded and evaluated. The follow-up periods were between one and six years. Among them, 3.8% of patients undergoing dialysis were infected. The most important fact resulting from this study is that none of the infected recipients suffered from HAM or ATL during the follow-up period. In addition, it did not show any significant difference in the incidence of post-transplant complications between the infected and non-infected groups. Our study indicates that HTLV-1 positive patients may undergo kidney transplant without fear of increased incidence of side effects than those found in uninfected recipients. Because of short-term follow-up, probable long latency period of the virus, and the limited number of infected recipients, further work on this issue would be prudent.

  3. PERFORMANCE EVALUATION OF ENDOVASCULAR MYOCARDIUM REVASCULARIZATION IN RENAL TRANSPLANT RECIPIENTS

    Directory of Open Access Journals (Sweden)

    I. G. Ryadovoy

    2012-01-01

    Full Text Available Coronary artery stenting was performed at 75 renal transplant recipients. Diffuse multiple and expressed calcified coronary artery disease took place that created many difficulties during the procedures. In result of endovascular treatments positive dynamics of clinical condition in the nearest postoperative period was marked, tolerance to physical exercise was increased and according to this the functional class of angina was reduced. Cardiac and general mortality after treatment in comparison to the data of foreign authors was lower and comparable with demographic death rate of the population for persons of the same sex and age. 

  4. Idiopathic giant oesophageal ulcer and leucopoenia after renal transplantation.

    Science.gov (United States)

    van Boekel, G A J; Volbeda, M; van den Hoogen, M W F; Hilbrands, L B; Berden, J H M

    2012-10-01

    A 45-year-old male recipient of a renal allograft was admitted because of a giant oesophageal ulcer coinciding with leucopoenia. An extensive workup revealed no explanation for the ulcer and leucopoenia. Our final diagnosis by exclusion was an idiopathic giant oesophageal ulcer and late-onset neutropenia as consequences of rituximab induction therapy given during the transplant procedure. The patient fully recovered after treatment with prednisone. However, after four months, the ulcer and leucopoenia recurred and again successfully responded to treatment with prednisone.

  5. Identification of donor melanoma in a renal transplant recipient.

    Science.gov (United States)

    Wilson, L J; Horvat, R T; Tilzer, L; Meis, A M; Montag, L; Huntrakoon, M

    1992-12-01

    A patient with chronic renal failure received a closely matched cadaveric kidney. Approximately 3 months after transplantation, the patient developed a metastatic malignant melanoma. A large retroperitoneal mass consisting of large pleomorphic polygonal neoplastic cells was found close to the donated kidney. This tumor was diagnosed as a malignant melanoma. DNA analysis of this tumor, the donated kidney, and the recipient indicated that the melanoma originated from the donor. Although this is not the first report of a donated melanoma, it is the first report of definitive DNA analysis of the origin of the malignant cells.

  6. Disseminated mucormycosis with myocardial involvement in a renal transplant recipient.

    Science.gov (United States)

    Nam, Y; Jung, J; Park, S S; Kim, S J; Shin, S J; Choi, J H; Kim, M; Yoon, H E

    2015-12-01

    We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri-allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection.

  7. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Directory of Open Access Journals (Sweden)

    Talwalkar N

    1994-01-01

    Full Text Available Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

  8. THE PURE RED BLOOD CELL APLASIA IN RENAL TRANSPLANT RECIPIENT

    Directory of Open Access Journals (Sweden)

    B. T. Dzumabaeva

    2011-01-01

    Full Text Available The pure red blood cell aplasia of renal transplant recipients caused by parvovirus B19 (PB19 is characterized by persistent anemia which resistant to erythropoietin therapy, lack of reticulocytes, bone marrow hypoplasia, and clinically accompanied by severe recurrent bacterial, fungal and viral infection. In case of reactivation PB19 it is necessarv, first of all, eliminate the causes activation of this virus and to cancel or reduce the dose of drugs which depressed the normal hematopoiesis germs, thus to reduce the pancytopenia associating complications in this population. 

  9. Renal graft function and low-dose cyclosporine affect mycophenolic acid pharmacokinetics in kidney transplantation.

    Science.gov (United States)

    Cortinovis, Monica; Gotti, Eliana; Pradini, Silvia; Gaspari, Flavio; Perico, Norberto

    2011-09-15

    In kidney transplantation, the pharmacokinetics of mycophenolic acid (MPA), the active compound of mycophenolate mofetil (MMF), is influenced by concomitant immunosuppressive therapy, including cyclosporine (CsA). However, whether in the setting of immunosuppressive therapy minimization CsA still affects MPA pharmacokinetics, particularly in relation to varying degree of renal graft function deterioration, remains ill defined. One hundred thirty-five complete MPA profiles were sequentially collected from 56 kidney transplant recipients given MMF and low-dose CsA as part of their immunosuppressive therapy. MPA pharmacokinetic parameters were correlated with blood CsA area under the curve (AUC0-12) and graft function as measured glomerular filtration rate (GFR). The relative contribution of CsA exposure and GFR to MPA kinetics in relation to other clinical parameters was determined by multivariate analysis. Dose-adjusted MPA AUC0-12 negatively correlated with CsA AUC0-12. MPA exposure significantly increased when CsA AUC0-12 was below 2000 ng hr/mL. Stratification of MPA profiles according to stages of renal dysfunction showed that dose-adjusted MPA AUC0-12 was higher (Prenal insufficiency. At multivariate analysis GFR, serum albumin and hemoglobin levels, use of gastroprotective medications, and time posttransplant were identified as independent determinants of MPA AUC0-12. In stable renal transplant recipients given MMF, tapering CsA dose and deterioration of renal graft function contribute to increased MPA exposure. Thus, monitoring plasma MPA pharmacokinetics should be advised, especially in patients on minimized CsA therapy with severe renal insufficiency.

  10. Designing and evaluating a self-management support system for renal transplant patients : The first step

    NARCIS (Netherlands)

    Wang, W.; Rövekamp, T.J.M.; Brinkman, W.P.; Alpay, L.; Boog, P. van der; Neerincx, M.A.

    2012-01-01

    Motivation - Thanks to the mobile measurement and telecare technology, it becomes possible to build selfmanagement support systems for renal transplant patients. This project aims to provide (1) a trusted and accepted selfmanagement support systems for renal transplant patients, (2) guidelines for b

  11. Abdominal obesity and smoking are important determinants of C-reactive protein in renal transplant recipients

    NARCIS (Netherlands)

    van Ree, RM; de Vries, APJ; Oterdoom, LH; The, TH; Gansevoort, RT; van der Heide, JJH; van Son, WJ; Ploeg, RJ; de Jong, PE; Gans, ROB; Bakker, SJL

    2005-01-01

    Background. C-reactive protein (CRP) is a predictor of coronary heart disease, total mortality and chronic allograft nephropathy in renal transplant recipients. The determinants of CRP have been investigated in the general population, but not in renal transplant recipients. CRP might reflect metabol

  12. The impact of hemoglobin levels on patient and graft survival in renal transplant recipients.

    LENUS (Irish Health Repository)

    Moore, Jason

    2008-08-27

    It remains unclear whether low hemoglobin levels are associated with increased mortality or graft loss after renal transplantation. This study assessed the relationship of hemoglobin levels with patient and graft survival in 3859 patients with functioning renal transplants more than 6-months posttransplantation.

  13. Growth hormone treatment in growth-retarded adolescents after renal transplant

    NARCIS (Netherlands)

    A.C.S. Hokken-Koelega (Anita); Th. Stijnen (Theo); M.A.J. de Ridder (Maria); S.M.P.F. de Muinck Keizer-Schrama (Sabine); E.D. Wolff (Eric); M. de Jong (Marion); R.A. Donckerwolcke (R.); J. Groothoff (Jaap); W.F. Blum (Werner); S.L.S. Drop (Stenvert)

    1994-01-01

    textabstractGrowth failure is a psychosocial problem for many patients who have undergone renal transplantation. 18 adolescents (mean age 15 6, range 11·3-19 5) with severe growth retardation after renal transplantation were treated with biosynthetic growth hormone (GH) for 2 years. All received pre

  14. Pregnancy after renal transplantation: Effects on mother, child, and renal graft function

    Directory of Open Access Journals (Sweden)

    Siham El Houssni

    2016-01-01

    Full Text Available The aim of this study was to report our experience of pregnancy in renal transplant (RT patients and its medium and long-term effects on the renal graft as well as the maternal fetal complications. We studied 21 pregnancies in 12 RT patients with mean age of 29.9 ± 5.3 years. The mean duration of RT to 1 st pregnancy was 42 (21-68.5 months and the median follow-up period was 112.5 (138-165 months. The pregnancy was planned in 28.6% of the cases. At the time of the diagnosis of the pregnancy, all the patients were maintained on corticosteroids and cyclosporine, 14.3% of the patients were on mycophenolate mofetil, and 71.4% of the patients were on azathioprine. The high blood pressure was present before the pregnancy in 33.3% of the patients. During pregnancy, proteinuria appeared in 20% of the cases, urinary tract infection in 33.3%, and preeclampsia in 5%. Anemia was present in all the patients during pregnancy. The doses of cyclosporine were increased during pregnancy. The mean term of delivery was 37 ± 2 weeks. Premature delivery was observed in 19% of the cases, fetal death in utero in 10%, and abortion in 15%. The number of living children was 16, with a mean birth weight of 3014 ± 515 g; the weight was lower than 2500 g in three (15% cases. In the long-term follow-up, we noticed two cases of acute rejection related to patients′ noncompliance, and four cases of chronic allograft nephropathy, without a switch to dialysis. We conclude that pregnancy in RT patients requires multidisciplinary care because of the increased risks of maternal and fetal complications. Each pregnancy needs to be planned; all parameters have to be studied and evaluated in order to allow for optimization of outcome and minimization of complications.

  15. Pregnancy after renal transplantation: Effects on mother, child, and renal graft function.

    Science.gov (United States)

    El Houssni, Siham; Sabri, Siham; Benamar, Loubna; Ouzeddoun, Naima; Bayahia, Rabia; Rhou, Hakima

    2016-03-01

    The aim of this study was to report our experience of pregnancy in renal transplant (RT) patients and its medium and long-term effects on the renal graft as well as the maternal fetal complications. We studied 21 pregnancies in 12 RT patients with mean age of 29.9 ± 5.3 years. The mean duration of RT to 1 st pregnancy was 42 (21-68.5) months and the median follow-up period was 112.5 (138-165) months. The pregnancy was planned in 28.6% of the cases. At the time of the diagnosis of the pregnancy, all the patients were maintained on corticosteroids and cyclosporine, 14.3% of the patients were on mycophenolate mofetil, and 71.4% of the patients were on azathioprine. The high blood pressure was present before the pregnancy in 33.3% of the patients. During pregnancy, proteinuria appeared in 20% of the cases, urinary tract infection in 33.3%, and preeclampsia in 5%. Anemia was present in all the patients during pregnancy. The doses of cyclosporine were increased during pregnancy. The mean term of delivery was 37 ± 2 weeks. Premature delivery was observed in 19% of the cases, fetal death in utero in 10%, and abortion in 15%. The number of living children was 16, with a mean birth weight of 3014 ± 515 g; the weight was lower than 2500 g in three (15%) cases. In the long-term follow-up, we noticed two cases of acute rejection related to patients' noncompliance, and four cases of chronic allograft nephropathy, without a switch to dialysis. We conclude that pregnancy in RT patients requires multidisciplinary care because of the increased risks of maternal and fetal complications. Each pregnancy needs to be planned; all parameters have to be studied and evaluated in order to allow for optimization of outcome and minimization of complications.

  16. Systemic and Nonrenal Adverse Effects Occurring in Renal Transplant Patients Treated with mTOR Inhibitors

    Directory of Open Access Journals (Sweden)

    Gianluigi Zaza

    2013-01-01

    Full Text Available The mammalian target of rapamycin inhibitors (mTOR-I, sirolimus and everolimus, are immunosuppressive drugs largely used in renal transplantation. The main mechanism of action of these drugs is the inhibition of the mammalian target of rapamycin (mTOR, a regulatory protein kinase involved in lymphocyte proliferation. Additionally, the inhibition of the crosstalk among mTORC1, mTORC2, and PI3K confers the antineoplastic activities of these drugs. Because of their specific pharmacological characteristics and their relative lack of nephrotoxicity, these inhibitors are valid option to calcineurine inhibitors (CNIs for maintenance immunosuppression in renal transplant recipients with chronic allograft nephropathy. However, as other immunosuppressive drugs, mTOR-I may induce the development of several adverse effects that need to be early recognized and treated to avoid severe illness in renal transplant patients. In particular, mTOR-I may induce systemic nonnephrological side effects including pulmonary toxicity, hematological disorders, dysmetabolism, lymphedema, stomatitis, cutaneous adverse effects, and fertility/gonadic toxicity. Although most of the adverse effects are dose related, it is extremely important for clinicians to early recognize them in order to reduce dosage or discontinue mTOR-I treatment avoiding the onset and development of severe clinical complications.

  17. A simple and accurate grading system for orthoiodohippurate renal scans in the assessment of post-transplant renal function

    Energy Technology Data Exchange (ETDEWEB)

    Zaki, S.K.; Bretan, P.N.; Go, R.T.; Rehm, P.K.; Streem, S.B.; Novick, A.C. (Cleveland Clinic Foundation, OH (USA))

    1990-06-01

    Orthoiodohippurate renal scanning has proved to be a reliable, noninvasive method for the evaluation and followup of renal allograft function. However, a standardized system for grading renal function with this test is not available. We propose a simple grading system to distinguish the different functional phases of hippurate scanning in renal transplant recipients. This grading system was studied in 138 patients who were evaluated 1 week after renal transplantation. There was a significant correlation between the isotope renographic functional grade and clinical correlates of allograft function such as the serum creatinine level (p = 0.0001), blood urea nitrogen level (p = 0.0001), urine output (p = 0.005) and need for hemodialysis (p = 0.007). We recommend this grading system as a simple and accurate method to interpret orthoiodohippurate renal scans in the evaluation and followup of renal allograft recipients.

  18. 'It's a regional thing': financial impact of renal transplantation on live donors.

    Science.gov (United States)

    McGrath, Pam; Holewa, Hamish

    2012-01-01

    There has been no research exploring the financial impact on the live renal donor in terms of testing, hospitalisation and surgery for kidney removal (known as nephrectomy). The only mention of financial issues in relation to live renal transplantation is the recipients' concerns in relation to monetary payment for the gift of a kidney and the recipients' desire to pay for the costs associated with the nephrectomy. The discussion in this article posits a new direction in live renal donor research; that of understanding the financial impact of live renal donation on the donor to inform health policy and supportive care service delivery. The findings have specific relevance for live renal donors living in rural and remote locations of Australia. The findings are presented from the first interview (time 1: T1) of a set of four times (time 1 to time 4: T1-T4) from a longitudinal study that explored the experience of live renal donors who were undergoing kidney removal (nephrectomy) at the Renal Transplantation Unit at the Princess Alexandra Hospital, Brisbane, Australia. A qualitative methodological approach was used that involved semi-structured interviews with prospective living kidney donors (n=20). The resulting data were analysed using the qualitative research methods of coding and thematic analysis. The findings indicate that live renal donors in non-metropolitan areas report significant financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. These include the fact that bulk billing (no cost to the patient for practitioner's service) is not always available, that individuals have to pay up-front and that free testing at local public hospitals is not available in some areas. In addition, non-metropolitan donors have to fund the extra cost of travel and accommodation when relocating for the nephrectomy to the specialist metropolitan hospital. Live renal transplantation is an important new direction in medical care that has excellent

  19. Alcohol consumption, new onset of diabetes after transplantation, and all-cause mortality in renal transplant recipients

    NARCIS (Netherlands)

    Zelle, Dorien M.; Agarwal, Pramod K.; Ramirez, Jessica L. Pinto; van der Heide, Jaap J. Homan; Corpeleijn, Eva; Gans, Reinold O. B.; Navis, Gerjan; Bakker, Stephan J. L.

    2011-01-01

    Background. Renal transplant recipients (RTR) are often advised to refrain from alcohol because of possible interaction with their immunosuppressive medication. Although moderate alcohol consumption is associated with reduced risk of diabetes and mortality in the general population, this is unknown

  20. Robot Assisted Renal Auto Transplantation: A Case Based Discussion of Unique Anaesthetic Considerations

    Directory of Open Access Journals (Sweden)

    Praveen Gupta

    2015-02-01

    Full Text Available Laparoscopic renal autotransplantation has serious perturbations on the body's homeostasis due to its non physiological positioning, use of pneumoperitoneum, changing fluid strategy at different points of time and on-going steps to maintain optimal environment for the transplanted kidney. Generally speaking, the anaesthetic management of renal auto-transplantation by open technique is not very complex and the perioperative management can be categorized in the intermediate level of clinical skill requirement. Adding to the comfort of the anaesthesiologist is the fact that these patients are not in end stage renal disease state and does not manifest the comorbidities, multisystem involvement and technical complexities of long term renal dysfunction and renal replacement therapy. In our case report surgeons used the da Vinci surgical robotic system for laparoscopic transplantation of the kidney at a new site. In this article we discuss the anaesthetic challenges of robot assisted laparoscopic renal auto-transplantation along with a description of our index case.

  1. Combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia.

    Science.gov (United States)

    Grekas, D; Kassimatis, E; Makedou, A; Bacharaki, D; Bamichas, G; Tourkantonis, A

    2001-08-01

    The most common cause of post-transplant dyslipidemia is the use of corticosteroids and cyclosporin-A (CyA). The HMG-CoA reductase inhibitors have emerged as the agents of first choice in the treatment of post-transplant hyperlipidemia in combination with low fat diet. The objective of this study was to evaluate the efficacy of combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia. Twenty-four renal transplant patients, 15 men and 9 women aged from 30 to 60 years with stable renal function were included in this study. All patients were transplanted from living related donors and were given a stable triple immunosuppressive therapy, with methylprednisolone, azathioprine and CyA. All patients were also given a standard diet containing 1 g/kg BW protein, reducing the daily fat to less than 30%, and maintaining at least a 1:1 ratio of saturated to polyunsaturated (or monounsaturated) fats. A dosage of 20 mg pravastatin (pravachol) and 1 g of fish oil (prolipid) were added to the diet after dinner, according to our protocol. Blood samples were taken after each study period for total cholesterol, LDL-cholesterol, triglycerides, Apo A(1), Apo B, Lp(a), creatinine, CPK and fibrinogen determination. At the end of the therapeutic protocol with pravastatin a significant reduction (p < 0.02) of total and LDL-cholesterol was observed, but no significant change in triglycerides, HDL, Lp(a), Apo A(1), Apo B and fibrinogen was shown. At the end of the therapeutic protocol with pravastatin and fish oil supplement significant changes were seen in TC (p < 0.02), TG (p < 0.03), LDL-C (p < 0.03), Apo A(1) (p < 0.04) and Apo B (p < 0.05) concentrations. There were no significant changes in HDL-C and Lp(a) concentrations. Renal function and cyclosporine levels were not changed during and after the study. CPK was increased only in one case. It is suggested that if the response to the diet is inadequate, the use of combined treatment with low

  2. Comparison between valganciclovir and aciclovir/valaciclovir for CMV prophylaxis in pediatric renal transplantation

    Directory of Open Access Journals (Sweden)

    M Fila

    2015-01-01

    Full Text Available Prophylaxis has dramatically decreased the occurrence of cytomegalovirus (CMV infection after renal transplantation. Optimal regimens of treatment remain controversial, especially in pediatric recipients. The aim of this study was to evaluate the effectiveness of valganciclovir (VGC versus aciclovir/valaciclovir (ACV in a pediatric renal transplant population. Data from 101 renal transplantations were retrospectively analyzed. Except those with R-/Dstatus, all patients received prophylaxis either with ACV, n = 39 or VGC, n = 38. Incidences of positive CMV antigenemia and disease, as well as the delay in relation to the prophylaxis, were collected during at least 12 months after the end of treatment. Positive CMV antigenemia was reported in 34 patients (ACV: 16, VGC: 16, no prophylaxis: 2. CMV disease occurred in 15 patients (ACV: 5; VGC: 8 (ns. For the majority of patients under VGC, positive CMV antigenemia occurred within the year following the withdrawal of prophylaxis (VGC: 14; ACV: 5, P <0.05, whereas it occurred during prophylaxis in 11 patients under ACV versus two under VGC (P <0.05. The over-all incidence of positive CMV antigenemia was similar between ACV and VGC prophylaxis. However, VGC was more efficient to prevent early CMV infection while patients treated with ACV had less CMV infection or disease after the end of the prophylaxis.

  3. Comparison between valganciclovir and aciclovir/valaciclovir for CMV prophylaxis in pediatric renal transplantation.

    Science.gov (United States)

    Fila, M; Dechartes, A; Maisin, A; Dossier, C; Zhao, W; Deschênes, G; Baudouin, V

    2015-01-01

    Prophylaxis has dramatically decreased the occurrence of cytomegalovirus (CMV) infection after renal transplantation. Optimal regimens of treatment remain controversial, especially in pediatric recipients. The aim of this study was to evaluate the effectiveness of valganciclovir (VGC) versus aciclovir/valaciclovir (ACV) in a pediatric renal transplant population. Data from 101 renal transplantations were retrospectively analyzed. Except those with R-/Dstatus, all patients received prophylaxis either with ACV, n = 39 or VGC, n = 38. Incidences of positive CMV antigenemia and disease, as well as the delay in relation to the prophylaxis, were collected during at least 12 months after the end of treatment. Positive CMV antigenemia was reported in 34 patients (ACV: 16, VGC: 16, no prophylaxis: 2). CMV disease occurred in 15 patients (ACV: 5; VGC: 8) (ns). For the majority of patients under VGC, positive CMV antigenemia occurred within the year following the withdrawal of prophylaxis (VGC: 14; ACV: 5, P ACV versus two under VGC (P ACV and VGC prophylaxis. However, VGC was more efficient to prevent early CMV infection while patients treated with ACV had less CMV infection or disease after the end of the prophylaxis.

  4. Latin American Dialysis and Transplant Registry: Experience and contributions to end-stage renal disease epidemiology.

    Science.gov (United States)

    Cusumano, Ana Maria; Rosa-Diez, Guillermo Javier; Gonzalez-Bedat, Maria Carlota

    2016-09-01

    In 2015, 634387 million people (9% of the world's population) resided in Latin America (LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy (RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were (in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice (90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.

  5. Re-establishment of erythropoietin responsiveness in end-stage renal failure following renal transplantation.

    Science.gov (United States)

    Jeffrey, R F; Kendall, R G; Prabhu, P; Norfolk, D R; Will, E J; Davison, A M

    1995-10-01

    Re-establishment of erythropoietin (EPO) secretion following renal transplantation is poorly understood. The development of sensitive EPO radioimmunoassay has enabled further study of this phenomenon. Forty-one adult patients were studied during the first 16 weeks following renal transplantation. Twenty six received cyclosporin monotherapy and 15 also received prednisolone and azathioprine. Serum creatinine, haemoglobin (Hb), ferritin and EPO were assayed pre-operatively, daily for 1 week, weekly for 1 month, and fortnightly to 16 weeks. An expected EPO value, for any Hb level, was derived by linear regression analysis in 144 patients with iron deficiency anemia. An observed to expected ratio (O/E) was calculated, a value of 1.0 implying appropriate responsiveness. Hb increased from 8.6 +/- 2.0 (SD) to 12.3 +/- 2.1 g/dl (p weeks, an increase unaffected by ferritin status. Mean EPO concentration increased during the first week with a peak at day 4 (22.1 +/- 13.3 to 44.6 +/- 40.0 mu/ml, p week 16 (r = -0.404, p weeks (p weeks when mean serum creatinine was 142 +/- 48 mumol/l. Patients with poor ongoing renal function (9 cases, serum creatinine > 250 mumol/l at 16 weeks) had impaired Hb recovery (10.1 +/- 1.6 vs 12.7 +/- 2.0 g/dl at 16 weeks, p < 0.05). EPO values were not different in those patients but median O/E ratios were significantly depressed (p < 0.05) throughout, the maximum O/E ratio being 0.75. Recovery of renal function is accompanied by a beneficial Hb response driven by EPO synthesis in the transplant. The O/E ratio provides a useful index to assess EPO responsiveness. Appropriate secretion was achieved during the first 4 months and optimized by immediate and satisfactory graft function.

  6. Biopsy Induced Arteriovenous Fistula and Venous Stenosis in a Renal Transplant

    Directory of Open Access Journals (Sweden)

    Sridhar R. Allam

    2015-01-01

    Full Text Available Renal transplant vein stenosis is a rare cause of allograft dysfunction. Percutaneous stenting appears to be safe and effective treatment for this condition. A 56-year-old Caucasian female with end stage renal disease received a deceased donor renal transplant. After transplant, her serum creatinine improved to a nadir of 1.2 mg/dL. During the third posttransplant month, her serum creatinine increased to 2.2 mg/dL. Renal transplant biopsy showed BK nephropathy. Mycophenolate was discontinued. Over the next 2 months, her serum creatinine crept up to 6.2 mg/dL. BK viremia improved from 36464 copies/mL to 15398 copies/mL. A renal transplant ultrasound showed lower pole arteriovenous fistula and abnormal waveforms in the renal vein. Carbon dioxide (CO2 angiography demonstrated severe stenosis of the transplant renal vein. Successful coil occlusion of fistula was performed along with angioplasty and deployment of stent in the renal transplant vein. Serum creatinine improved to 1.5 mg/dL after.

  7. Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

    Science.gov (United States)

    Lekkham, Rapeepat; Climaco, Antoinette

    2017-01-01

    Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired. PMID:28316844

  8. Small intestinal involvement by lymphoproliferative disorders post-renal transplantation: A report from the post-transplant lymphoproliferative disorder international survey

    Directory of Open Access Journals (Sweden)

    Hossein Khedmat

    2013-01-01

    Full Text Available In this study, data on post-renal transplant lymphoproliferative disorders (PTLD collected from the existing literature were pooled and analyzed to compare the characteristics, predictors and prognosis of small intestinal PTLDs. We performed a comprehensive search for the available data by Pubmed and Google scholar search engines for reports on this subject. Data from 18 previously published studies, comprising 120 renal allograft recipients, were included in the analysis. Renal transplant recipients with intestinal PTLD were significantly less likely to have Hogkin′s and Hogkin′s-like lesions (P = 0.044 and to be younger at the time of transplan-tation (P = 0.07. Except for Hodgkin′s-like lesions, histopathological evaluations elsewhere were comparable between the group with PTLD in the small intestine and age- and sex-matched renal transplant recipients with PTLD in other sites. The overall mortality was relatively higher in the control group (P = 0.09. When death only due to PTLD was used as the outcome, a trend toward better outcome was seen for the intestinal PTLD group compared with the other localizations (P = 0.1. The 1- and 5-year survival rates for intestinal PTLD patients were 57% and 37%, respectively, compared with 54% and 21%, respectively, for the control group. According to our findings based on analysis of international data, renal transplant patients with small intestinal PTLD are more likely to be of younger age but less frequently represent Hodgkin′s and Hodgkin′s-like lesions. They also have better patient survival compared with transplant recipients with PTLD in other locations. Further multi-center prospective studies are needed to confirm our results.

  9. Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Ruiz Solis, Sebastian; Soriano Castrejon, Angel; Poblete Garcia, Victor Manuel; Talavera Rubio, Maria del Prado; Rodado Marina, Sonia; Cortes Romera, Montserrat [Ciudad Real General Hospital (Spain). Dept. of Nuclear Medicine

    2005-10-15

    Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions. (author)

  10. Ascorbic acid against reperfusion injury in human renal transplantation.

    Science.gov (United States)

    Norio, Karri; Wikström, Mårten; Salmela, Kaija; Kyllönen, Lauri; Lindgren, Leena

    2003-08-01

    The cadaveric renal graft is exposed to ischaemic injury during preservation and to oxidative damage during reperfusion. Both these mechanisms are known to cause cell damage, which may impair graft function. Reperfusion injury (RPI) is mediated by reactive oxygen species (ROS). Ascorbic acid (AA) is a potent physiological extracellular scavenger of ROS. We perfused 31 renal grafts immediately before implantation with a solution of Euro-Collins containing 0.5 mg/ml of AA to diminish RPI. From every donor, the contralateral kidney served as a control. The control grafts were perfused with the same perfusion as those of the AA group, only without the AA substitution. We assessed the effect of AA by recording serum creatinine, creatinine clearance, initial graft function and early rejections. The incidence of delayed graft function (DGF) was 32% in the AA group, and 29% in the control group. Other parameters were also similar in both groups, except for the length of DGF, which showed a trend towards a shorter duration in the AA group. The pre-operative systemic AA concentration was significantly ( P=0.01) lower in the haemodialysis patients than in those on peritoneal dialysis. In conclusion, this clinical study could not demonstrate significant benefits of AA in renal transplantation.

  11. Use of local allograft irradiation following renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Halperin, E.C.; Delmonico, F.L.; Nelson, P.W.; Shipley, W.U.; Cosimi, A.B.

    1984-07-01

    Over a 10 year period, 67 recipients of 71 renal allografts received graft irradiation following the diagnosis of rejection. The majority of kidneys were treated with a total dose of 600 rad, 150 rad per fraction, in 4 daily fractions. Fifty-three kidneys were irradiated following the failure of standard systemic immunosuppression and maximally tolerated antirejection measures to reverse an episode of acute rejection. Twenty-two (42%) of these allografts were noted to have stable (i.e. no deterioration) or improved function 1 month following the treatment with irradiation. Eleven (21%) of these allografts maintained function 1 year following transplantation. Biopsies were obtained of 41 allografts. Of the 24 renal allografts with predominantly cellular rejection, 10 (42%) had the process reversed or stabilized at 1 month following irradiation. Five (21%) of these allografts were functioning at 1 year following irradiation. Rejection was reversed or stabilized in 6 of 17 (35%) allografts at 1 month when the histologic features of renal biopsy suggested predominantly vascular rejection. Local graft irradiation has helped maintain a limited number of allografts in patients whose rejection has failed to respond to systemic immunosuppression. Irradiation may also benefit patients with ongoing rejection in whom further systemic immunosuppression is contra-indicated.

  12. MicroRNA biomarkers in clinical renal disease: from diabetic nephropathy renal transplantation and beyond.

    Science.gov (United States)

    Nassirpour, Rounak; Raj, Dominic; Townsend, Raymond; Argyropoulos, Christos

    2016-12-01

    Chronic Kidney Disease (CKD) is a common health problem affecting 1 in 12 Americans. It is associated with elevated risks of mortality, cardiovascular disease, and high costs for the treatment of renal failure with dialysis or transplantation. Advances in CKD care are impeded by the lack of biomarkers for early diagnosis, assessment of the extent of tissue injury, estimation of disease progression, and evaluation of response to therapy. Such biomarkers should improve the performance of existing measures of renal functional impairment (estimated glomerular filtration rate, eGFR) or kidney damage (proteinuria). MicroRNAs (miRNAs) a class of small, non-coding RNAs that act as post-transcriptional repressors are gaining momentum as biomarkers in a number of disease areas. In this review, we examine the potential utility of miRNAs as promising biomarkers for renal disease. We explore the performance of miRNAs as biomarkers in two clinically important forms of CKD, diabetes and the nephropathy developing in kidney transplant recipients. Finally, we highlight the pitfalls and opportunities of miRNAs and provide a broad perspective for the future clinical development of miRNAs as biomarkers in CKD beyond the current gold standards of eGFR and albuminuria.

  13. P16 and p53 expression in (pre)malignant epidermal tumors of renal transplant recipients and immunocompetent individuals.

    NARCIS (Netherlands)

    Blokx, W.A.M.; Jong, E.M.G.J. de; Wilde, P.C.M. de; Bulten, J.; Link, M.M.G.M.; Ruiter, D.J.; Kerkhof, P.C.M. van de

    2003-01-01

    Ultraviolet (UV) radiation is a prevailing factor implicated in the etiology of keratinocytic intraepidermal neoplasia (KIN) and squamous cell carcinomas (SCCs), as evidenced by the high frequency of UV-related mutations in the p53 and p16 tumor suppressor genes. In renal transplant recipients (RTRs

  14. The tacrolimus metabolism rate influences renal function after kidney transplantation.

    Directory of Open Access Journals (Sweden)

    Gerold Thölking

    Full Text Available The effective calcineurin inhibitor (CNI tacrolimus (Tac is an integral part of the standard immunosuppressive regimen after renal transplantation (RTx. However, as a potent CNI it has nephrotoxic potential leading to impaired renal function in some cases. Therefore, it is of high clinical impact to identify factors which can predict who is endangered to develop CNI toxicity. We hypothesized that the Tac metabolism rate expressed as the blood concentration normalized by the dose (C/D ratio is such a simple predictor. Therefore, we analyzed the impact of the C/D ratio on kidney function after RTx. Renal function was analyzed 1, 2, 3, 6, 12 and 24 months after RTx in 248 patients with an immunosuppressive regimen including basiliximab, tacrolimus, mycophenolate mofetil and prednisolone. According to keep the approach simple, patients were split into three C/D groups: fast, intermediate and slow metabolizers. Notably, compared with slow metabolizers fast metabolizers of Tac showed significantly lower estimated glomerular filtration rate (eGFR values at all the time points analyzed. Moreover, fast metabolizers underwent more indication renal biopsies (p = 0.006 which revealed a higher incidence of CNI nephrotoxicity (p = 0.015 and BK nephropathy (p = 0.024 in this group. We herein identified the C/D ratio as an easy calculable risk factor for the development of CNI nephrotoxicity and BK nephropathy after RTx. We propose that the simple C/D ratio should be taken into account early in patient's risk management strategies.

  15. De Novo Fibrillary Glomerulonephritis (FGN in a Renal Transplant with Chronic Hepatitis C

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    Edward J. Filippone

    2013-01-01

    Full Text Available Chronic hepatitis C viremia (HepC has been associated with numerous renal manifestations both in native kidneys and in the setting of renal transplantation. Glomerulonephritis (GN of the renal allograft in the setting of HepC most commonly manifests as type 1 membranoproliferative GN (MPGN, either representing recurrence of the original disease or arising de novo. Other GNs were reported after transplantation in the patient with HepC including membranous nephropathy and thrombotic microangiopathy, as well as an enhanced susceptibility to transplant glomerulopathy. We describe the first case of de novo fibrillary GN in a renal transplant patient with HepC where the primary renal disease was biopsy proven type 1 MPGN. We discuss this relationship in detail.

  16. Long-Term Health and Work Outcomes of Renal Transplantation and Patterns of Work Status During the End-Stage Renal Disease Trajectory

    NARCIS (Netherlands)

    van der Mei, Sijrike F.; Kuiper, Daphne; Groothoff, Johan W.; van den Heuvel, Wim J. A.; van Son, Willem J.; Brouwer, Sandra

    2011-01-01

    Introduction The aim of this study was to examine the health-and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation

  17. Critical appraisal on the use of everolimus in renal transplantation as an immunosuppressant to prevent organ transplant rejection

    Directory of Open Access Journals (Sweden)

    Fernando Giron

    2010-01-01

    Full Text Available Fernando Giron, Yenny BaezKidney Transplant Service, Colombiana de Trasplantes, Bogota, ColombiaAbstract: Everolimus is a proliferation inhibitor designed to target chronic allograft nephropathy including prevention of acute rejection. Acute renal allograft rejection incidence varies with the therapy used for immunosuppression. Registry data show that 15% to 35% of kidney recipients will undergo treatment for at least one episode of acute rejection within the first post-transplant year. Everolimus has been used as therapy with full- or reduced-dose cyclosporine A without evidence of increasing the acute rejection incidence. This review will summarize the available clinical trial data on the use of everolimus and its role in preventing acute rejection incidence in renal transplantation.Keywords: calcineurin inhibitors, cyclosporine, everolimus, biopsy-proven acute rejection, renal transplantation, acute rejection

  18. Risk factors for long-term renal survival after renal transplantation : A role for angiotensin-converting enzyme (insertion/deletion) polymorphism?

    NARCIS (Netherlands)

    Broekroelofs, J.; Stegeman, Coen; Navis, Ger Jan; Tegzess, Adam; De Jong, P.E.; de Zeeuw, Dick

    1998-01-01

    Chronic progressive renal function loss is a main cause of long-term graft loss after initially successful renal transplantation. Transplanted kidneys share some risk factors for renal function loss, such as hypertension or proteinuria, with diseased native kidneys. Recently, it has been shown that

  19. Rates of renal transplantations in the elderly-data from Europe and the US

    DEFF Research Database (Denmark)

    Sørensen, Søren Schwartz

    2015-01-01

    is to collect and describe available data on rates of transplantation with focus on the elderly patients in both Europe and the US. Data were collected from available sources including activity reports from national and supranational registries on uremia, organ procurement, waiting lists, and transplantations......The demography in most part of the world is changing with an increasing proportion of elderly persons. This is expected to reflect demography of patients accepted for renal replacement therapy both in the form of dialysis and transplantation. Based on this, the intention of the present review...... are 3-4 times higher in the US. In the same period, the rates of renal transplantations in the elderly patient group have increased in both Europe and the US with increased access to the waiting list and to transplantation. Data from the United States Renal Data System on incidence of transplantation...

  20. Renal graft biopsy assists diagnosis and treatment of renal allograft dysfunction after kidney transplantation: a report of 106 cases.

    Science.gov (United States)

    Han, Yong; Guo, Hui; Cai, Ming; Xiao, Li; Wang, Qiang; Xu, Xiaoguang; Huang, Haiyan; Shi, Bingyi

    2015-01-01

    Acute antibody mediated rejection (AMR) is one of the most important complications after kidney transplantation. Renal graft biopsy is safe and reliable without adverse effects on the patients and transplanted kidneys, which was of great instructive significance in diagnosis and treatment of renal allograft dysfunction after renal transplantation. This paper reported a case series of 106 patients underwent renal allograft biopsies. All biopsies were evaluated according to the Banff 2007 schema. 52 examples were obtained within 1 month after transplantation, and there were another 20 examples in one to two months and other 34 examples in two to three months. Appropriate therapy was applied and clinical outcomes were observed. All patients received renal biopsies and anti-inflammatory and hemostasis treatment without complications. There were 2 cases of hyperacute rejection, and 15 cases of acute AMR. All Paraffin-embedded samples were stained by HE, periodic acid-Schiff (PAS), Masson, and immunohistochemistry (C4d, cd20, cd45RO, SV40). All samples were found C4d immunohistochemical staining positive. Patients with acute AMR were managed by steroid intravenous pulse therapy, Rabbit anti-thymocyte globulin intravenous pulse therapy, anti CD20 monoclonal antibody intravenous therapy and so on. Two cases of hyperacute rejection had renal failure, and received kidney excision; 12 cases in 15 cases of AMR recovered, another 2 cases did not recover with high-level creatine, and other 2 cases of renal allograft received excision.

  1. [Early detection, prevention and management of renal failure in liver transplantation].

    Science.gov (United States)

    Castells, Lluís; Baliellas, Carme; Bilbao, Itxarone; Cantarell, Carme; Cruzado, Josep Maria; Esforzado, Núria; García-Valdecasas, Juan Carlos; Lladó, Laura; Rimola, Antoni; Serón, Daniel; Oppenheimer, Federico

    2014-10-01

    Renal failure is a frequent complication in liver transplant recipients and is associated with increased morbidity and mortality. A variety of risk factors for the development of renal failure in the pre- and post-transplantation periods have been described, as well as at the time of surgery. To reduce the negative impact of renal failure in this population, an active approach is required for the identification of those patients with risk factors, the implementation of preventive strategies, and the early detection of progressive deterioration of renal function. Based on published evidence and on clinical experience, this document presents a series of recommendations on monitoring RF in LT recipients, as well as on the prevention and management of acute and chronic renal failure after LT and referral of these patients to the nephrologist. In addition, this document also provides an update of the various immunosuppressive regimens tested in this population for the prevention and control of post-transplantation deterioration of renal function.

  2. QTc interval in children with chronic renal failure and with renal transplants.

    Science.gov (United States)

    Butani, Lavjay; Berg, Gerre; Makker, Sudesh P

    2002-01-01

    Prolongation of the QTc interval, a risk factor for cardiac arrhythmias, has been observed in adult hemodialysis patients; there are few data on the QTc interval in children with chronic renal failure (CRF) and following renal transplantation (Tx). The purpose of our study was to determine the QTc interval in children with CRF and post renal Tx. Twenty children with CRF and 16 children with renal Tx who were followed at the University of California, Davis, underwent prospective EKG monitoring. The mean QTc interval in the CRF and post-Tx cohorts was normal at 407.9 ms and 408.2 ms, respectively. None of the children with CRF had QTc prolongation. Two Tx recipients had QTc prolongation; both had cardiac dilatation on echocardiography (ECHO). There was no correlation between the QTc interval and the creatinine clearance in either group. However, a significant correlation was noted between QTc prolongation and cardiac dilatation on ECHO in the Tx group (P=0.02, Fisher's exact test). In conclusion, QTc prolongation is uncommon in children with CRF and following Tx, in the absence of cardiac dilatation. However, caution is still needed before prescribing medications known to cause QTc prolongation.

  3. Renal dysfunction in a renal transplant patient treated concurrently with cyclosporine and imatinib.

    Science.gov (United States)

    Mulder, Karen E; Egorin, Merrill J; Sawyer, Michael B

    2012-12-01

    Imatinib mesylate has proven activity in treating locally advanced or metastatic gastrointestinal stromal tumors (GIST). Drug interactions are particularly concerning as imatinib is extensively metabolized by the cytochrome P450 enzyme system. We describe the clinical course of a 72 year-old male with a cadaveric renal transplant requiring cyclosporine that presented with a metastatic GIST and was started on imatinib at the standard dose of 400 mg daily. Imatinib initiation resulted in a decline in renal function with the serum creatinine increasing from 123 μmol/L to 196 μmol/L and an elevation in whole blood cyclosporine concentrations from 79 μg/L to 139 μg/L. No other imatinib toxicities were reported. With discontinuation of imatinib, the serum creatinine returned to baseline as did the whole blood cyclosporine levels. Ultimately, decreasing both the cyclosporine and imatinib dosing was associated with stabilized renal function (serum creatinine 150-186 μmol/L) and cyclosporine concentrations (53-97 μg/L). A prolonged partial response to therapy for 19 months was maintained despite low imatinib trough concentrations measured on two separate occasions (127.1 ng/ml and 139 ng/ml). In our patient, imatinib initiation resulted in renal toxicity most likely due to its interaction with cyclosporine resulting in elevation of the whole blood cyclosporine concentration.

  4. Kidney transplantation: the use of living donors with renal artery lesions.

    Science.gov (United States)

    Nahas, W C; Lucon, A M; Mazzucchi, E; Scafuri, A G; Neto, E D; Ianhez, L E; Arap, S

    1998-10-01

    A shortage of organs for transplantation has forced surgeons to optimize the use of marginal organs, such as kidneys with arterial disease. We present a retrospective study of the outcome of donors with renal artery disease and recipients of kidneys from living related and unrelated donors. Kidneys with vascular abnormalities from healthy living donors were grafted into 11 recipients. These kidney transplants comprised 1.8% of those performed at our institution. The vascular abnormalities were aneurysms in 3 cases, atherosclerotic lesions in 4 and fibromuscular dysplasia in 4. After nephrectomy all abnormalities were corrected under hypothermic conditions during bench surgery except in 3 cases of ostial atherosclerotic plaque, which was left in the donors. The renal artery was anastomosed to the external iliac artery in 5 cases and to the internal iliac artery in 6. The ureter was reimplanted using an extravesical technique. All patients had immediate diuresis and no delayed post-transplant graft dysfunction was observed. One patient died of an unrelated cause and 3 had post-transplant graft function loss due to acute vasculopathy in 1, post-diarrhea with acute arterial thrombosis in 1 and recurrence of the hemolytic-uremic syndrome in 1. All remaining patients are well with median serum creatinine of 1.4 mg./dl. (normal 0.4 to 1.4). All donors are well and normotensive with normal renal function. The use of kidneys with arterial disease from living donors with unilateral disease is safe. Complete informed consent regarding the risks and benefits by donor and recipient is mandatory.

  5. Renalase Gene Polymorphism in Patients After Renal Allograft Transplantation

    Directory of Open Access Journals (Sweden)

    Andrzej Pawlik

    2014-06-01

    Full Text Available Background/Aims: Renalase is a recently discovered protein, which is likely involved in regulation of blood pressure in humans and animals. Previous studies suggest that renalase reflects kidney functioning. A common missense polymorphism in the flavin-adenine dinucleotide-binding domain of human renalase (Glu37Asp has been described. In this study we examined the association between (Glu37Asp polymorphism (rs2296545 in renalase gene and kidney allograft function. Methods: The study enrolled 270 Caucasian kidney allograft recipients. SNP within the renalase was genotyped using TaqMan genotyping assays. Results: There were no statistically significant associations between renalase gene rs2296545 polymorphism and delayed graft function, acute rejection, chronic allograft dysfunction as well as creatinine serum concentrations and blood pressure values after transplantation. Conclusions: The results of this study suggest, that renalase gene rs2296545 polymorphism is not important factor determining renal allograft function.

  6. Renal Transplantation Dramatically Reduces IgA Anti-beta-2-glycoprotein I Antibodies in Patients with Endstage Renal Disease

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    Manuel Serrano

    2014-01-01

    Full Text Available IgA anti-beta-2-glycoprotein I (aB2GPI antibodies have been related to vascular pathology in the general population and mainly in hemodialyzed patients (prevalence 33% in whom an elevated incidence of thrombosis and mortality is found. In this paper we have studied the presence of IgA aB2GPI antibodies at pretransplant and their evolution after transplantation with a cross-sectional-based follow-up study of a cohort of 288 endstage renal disease (ESRD patients treated with kidney transplantation. Pretransplant IgA aB2GPI levels were elevated 31.7±4.2 U/mL without differences in age or type of dialysis. Patients with different etiologies of ESRD showed higher levels of IgA aB2GPI than blood donors, except the groups of non-IgA glomerular disease and systemic erythematosus lupus, whose nonsignificant differences were observed. IgA aB2GPI antibodies dropped immediately after transplantation (10.7±1.0 U/mL, P<0.0001, coinciding with a high degree of immunosuppression, and remained significantly lower than that observed in pretransplant status. Prevalence of patients with elevated antibodies was also less in transplanted patients (8.9% versus 30.4%, P<0.0001. Among, positivity for IgA aB2GPI was higher than in patients who had received their first transplant that those were retransplanted. This finding could have important clinical implications and can suggest new therapeutic strategies in patients with IgA aB2GPI antibodies.

  7. No important influence of limited steroid exposure on bone mass during the first year after renal transplantation: a prospective, randomized, multicenter study.

    NARCIS (Netherlands)

    Meulen, C.G. ter; Riemsdijk, I.C. van; Hene, R.J.; Christiaans, M.H.; Borm, G.F.; Corstens, F.H.M.; Gelder, T. van; Hilbrands, L.B.; Weimar, W.; Hoitsma, A.J.

    2004-01-01

    BACKGROUND: Steroid-related bone loss is a recognized complication after renal transplantation. In a prospective, randomized, multicenter study we compared the influence of a steroid-free immunosuppressive regimen with a regimen with limited steroid exposure on the changes in bone mass after renal t

  8. Simultaneous pancreas–kidney transplant for type I diabetes with renal failure: Anaesthetic considerations

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    Lakshmi Kumar

    2016-01-01

    Full Text Available Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation.

  9. Hyperhomocyst(einemia in chronic stable renal transplant patients

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    David José de Barros Machado

    2000-10-01

    Full Text Available PURPOSE: Hyperhomocyst(einaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(einemia in renal transplant recipients. METHODS: Total serum homocysteine (by high performance liquid chromatography, creatinine, lipid profile, folic acid (by radioimmunoassay-RIA and vitamin B12 (by RIA concentrations were measured in 3 groups. Group I patients (n=20 were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9 were under treatment with azathioprine and prednisone; and group III (n=7 were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(einemia. RESULTS: Patient ages were 48.8 ± 15.1 yr (group I, 43.3 ± 11.3 yr (group II; and 46.5 ± 14.8 yr (group III. Mean serum homocyst(eine (tHcy concentrations were 18.07 ± 8.29 mmol/l in renal transplant recipients; 16.55 ± 5.6 mmol/l and 21.44 ± 12.1 mmol/l respectively for group I (with cyclosporine and group II (without cyclosporine (NS. In renal donors, tHcy was significantly lower (9.07 ± 3.06 mmol/l; group I + group II vs. group III, pOBJETIVOS: A hiper-homocisteinemia é um fator de risco importante para aterosclerose e, esta é uma das principais causas de óbito em transplantados renais. O objetivo deste estudo é avaliar a influência da terapêutica imunossupressora na homocisteinemia de receptores de transplante renal. CASUÍSTICA E MÉTODO: Vinte e nove pacientes foram divididos em dois grupos: grupo I (n=20 - pacientes transplantados renais em uso de ciclosporina, azatioprina e prednisona; grupo II (n=9 - pacientes transplantados renais em uso de azatioprina e

  10. Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

    Science.gov (United States)

    de Carvalho, Mônica Andrade; Freitas, Flávio Geraldo Rezende; Silva Junior, Hélio Tedesco; Bafi, Antônio Toneti; Machado, Flávia Ribeiro; Pestana, José Osmar Medina

    2014-01-01

    Introduction The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock. Methods Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality. Results A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51±13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16–23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6–2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7–19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2–2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8–102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0–22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2–9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9–16.6; p = 0.002). Conclusions Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards

  11. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient

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    Copeland, Nathanial K.; Arora, Navin S.; Ferguson, Tomas M.

    2013-01-01

    Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient's skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy. PMID:24369511

  12. Diabetes mellitus after renal transplantation: characteristics, outcome, and risk factors.

    Science.gov (United States)

    Vesco, L; Busson, M; Bedrossian, J; Bitker, M O; Hiesse, C; Lang, P

    1996-05-27

    The incidence and risk factors of posttransplant diabetes mellitus were evaluated in 1325 consecutive renal transplant recipients. Thirty-three (2.5%) patients developed diabetes mellitus requiring insulin therapy. Onset occurred a mean of 5.7 +/- 1.5 months following transplantation. The patients were compared with 33 paired-control kidney recipients. The patients were significantly older than the controls (46.8 +/- 1.9 vs. 40.6 +/- 2.1 years) (Pdiabetes mellitus, the body mass index, ethnic origin, HLA phenotype, and the total doses of steroids and cyclosporine were similar in the two groups. The number of patients with at least one rejection episode was significantly higher among the diabetic patients (21 versus 9) but the number of episodes was similar. Diabetes occurred a mean of 1.1 +/- 0.3 months following rejection treatment. Intravenous pulsed prednisolone was always used for anti-rejection therapy. Insulin was withdrawn in 16 cases after a mean of 4 +/- 1 months, independently of steroid dosage reductions. Actuarial patient and graft survival rates were not significantly different, although 6-year outcome tended to be better in the controls (86% versus 93% for patient survival and 67% versus 93% for graft survival). This study suggests that pulsed steroid therapy might be the critical factor in the onset of posttransplant diabetes and that the risk is increased in older patients with chronic interstitial nephrititis.

  13. Rabbit anti-thymocyte globulin induction in renal transplantation: review of the literature

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    Andress L

    2014-01-01

    Full Text Available Leah Andress,1 Anjali Gupta,2 Nida Siddiqi,3 Kwaku Marfo2,3 1University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, 2Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine Department of Abdominal Organ Transplant Program, Bronx, 3Montefiore Medical Center, Department of Pharmacy, Bronx, NY, USA Abstract: Rabbit anti-thymocyte globulin (rATG has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation. Keywords: anti-thymocyte globulin, renal transplantation, induction therapy

  14. Treated asymptomatic bacteriuria during first year after renal transplantation.

    Science.gov (United States)

    Gołębiewska, J E; Dębska-Ślizień, A; Rutkowski, B

    2014-08-01

    Urinary tract infections (UTIs) are widespread in renal transplant (RTx) recipients with asymptomatic bacteriuria (AB) as the predominant form. It is necessary to determine if AB is a risk factor for symptomatic UTIs. We analyzed clinical data and urine cultures performed within the first 12 months after RTx in 209 consecutive patients undergoing RTx at Gdańsk Transplantation Center between January 2007 and December 2009. We observed 170 AB episodes in 83 patients. This accounted for 53% of all diagnosed UTIs in 111 patients, with more than half of AB episodes occurring during the first month post transplant. The most prevalent uropathogen was Enterococcus faecium (36.8%, n = 32) and, from the second month after RTx, Escherichia coli (54.2%, n = 45). Female gender, use of induction with anti-thymocyte globulin, comorbidity measured by Charlson Comorbidity Index, history of acute rejection, and cytomegalovirus infection were risk factors for developing AB, and no differences in risk factors were seen for developing a symptomatic UTI vs. an AB after RTx. All patients with AB received antibiotic therapy. AB was an independent risk factor for symptomatic UTIs, but only 21 of 152 episodes of symptomatic UTIs were preceded by AB with the same causative agent. AB is a common finding in the RTx population and AB episodes may be considered a risk factor for symptomatic infections. It remains to be determined if the treatment of AB in RTx patients is in fact helpful or harmful in preventing symptomatic infections. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Mining the human urine proteome for monitoring renal transplant injury

    Energy Technology Data Exchange (ETDEWEB)

    Sigdel, Tara K.; Gao, Yuqian; He, Jintang; Wang, Anyou; Nicora, Carrie D.; Fillmore, Thomas L.; Shi, Tujin; Webb-Robertson, Bobbie-Jo; Smith, Richard D.; Qian, Wei-Jun; Salvatierra, Oscar; Camp, David G.; Sarwal, Minnie M.

    2016-06-01

    The human urinary proteome reflects systemic and inherent renal injury perturbations and can be analyzed to harness specific biomarkers for different kidney transplant injury states. 396 unique urine samples were collected contemporaneously with an allograft biopsy from 396 unique kidney transplant recipients. Centralized, blinded histology on the graft was used to classify matched urine samples into categories of acute rejection (AR), chronic allograft nephropathy (CAN), BK virus nephritis (BKVN), and stable graft (STA). Liquid chromatography–mass spectrometry (LC-MS) based proteomics using iTRAQ based discovery (n=108) and global label-free LC-MS analyses of individual samples (n=137) for quantitative proteome assessment were used in the discovery step. Selected reaction monitoring (SRM) was applied to identify and validate minimal urine protein/peptide biomarkers to accurately segregate organ injury causation and pathology on unique urine samples (n=151). A total of 958 proteins were initially quantified by iTRAQ, 87% of which were also identified among 1574 urine proteins detected in LC-MS validation. 103 urine proteins were significantly (p<0.05) perturbed in injury and enriched for humoral immunity, complement activation, and lymphocyte trafficking. A set of 131 peptides corresponding to 78 proteins were assessed by SRM for their significance in an independent sample cohort. A minimal set of 35 peptides mapping to 33 proteins, were modeled to segregate different injury groups (AUC =93% for AR, 99% for CAN, 83% for BKVN). Urinary proteome discovery and targeted validation identified urine protein fingerprints for non-invasive differentiation of kidney transplant injuries, thus opening the door for personalized immune risk assessment and therapy.

  16. Renal function and histology in children after small bowel transplantation.

    Science.gov (United States)

    Boyer, Olivia; Noto, Cristian; De Serre, Natacha Patey-Mariaud; Gubler, Marie-Claire; Dechaux, Michèle; Goulet, Olivier; Niaudet, Patrick; Lacaille, Florence

    2013-02-01

    CKD is a frequent long-term complication after SBTx. CNIs are a well-known factor, but probably not the only cause. We assessed the incidence, risk factors, and severity of CKD in 27 children with SBTx (15 combined liver/SBTx) and prednisone/TAC-based maintenance immunosuppression. Median follow-up was seven yr (3-21). A renal biopsy was performed in 14 patients, 1-18 yr post-SBTx. A reduced GFR was observed in 17 children (63%) during the follow-up with none requiring dialysis. CNI toxicity was observed in 11/14 biopsies, as early as two yr post-transplant, and could occur with a normal mGFR. The dose of TAC was reduced by 50% in 13 patients with CKD and/or significant kidney histological lesions, and six were also given MMF. This led to a significant improvement in renal function: mGFR normalized in eight patients and improved or stabilized in five. No rejection occurred. At last follow-up, 37% had CKD stage 2 and 15% had CKD stage 3. In conclusion, CKD is frequent in children after SBTx and probably multifactorial. Less nephrotoxic immunosuppressive protocols may improve mGFR and should be further considered. The kidney histology helps in designing personalized immunosuppression strategies for patients.

  17. Metabolic status of 1088 patients after renal transplantation: Assessment of twelve years monitoring in Algiers Mustapha Hospital

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    Lyece Yargui

    2014-01-01

    Full Text Available Since the introduction of monitoring levels of immunosuppressive medications in our service in July 2000, 1088 kidney transplant patients were received for therapeutic drug monitoring and regular follow-up. The aim of this study was to retrospectively analyze the data on these renal graft patients in Algeria and correlate with our 12 years′ experience with calcineurin inhibitor (CNI measurements. In addition, during this period, we also examined other bioche-mical parameters. The analysis was focused on the difference of effect of cyclosporin A (CsA; 623 patients and Tacrolimus (Tac; 465 patients on lipid and glucose metabolism and their side-effects, if any, on the renal function. The mean age at the time of transplantation was 36.1 years. A great majority of the transplanted kidneys had been taken from living related donors (88.6%. Three-quarters of all grafts were transplanted in our country (79.5%. Dyslipidemia and renal dysfunction were the most common adverse effects of CsA and Tac exposure, with a frequency of 21.4% and 10.3%, respectively. Both the CNIs had a similar effect on the lipid levels. The highest incidence occurred at 3-12 months after renal graft. Tac seemed to have more side-effects on glycemia, causing the onset of diabetes mellitus more than two-fold than CsA (6.9% vs. 3.1%. A significant difference was observed during 12-24 months after transplantation. However, Tac was associated with the most favorable effects on renal function estimated with the Modification of Diet in Renal Disease (MDRD formula.

  18. The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients

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    Rashid Awad

    1999-01-01

    Full Text Available Hepatitis C viral infection (HCV is presently a major problem in renal transplant recipients (RTR with a high risk of chronicity resulting in liver cirrhosis. We screened 120 RTR (50 live related, 53 live unrelated, and 17 cadaveric; mean age of 45.2 years and mean post-transplant period of 6.8 years. Positive HCV antibodies using RIBA-2 test were detected in 43 patients (35.8%. Polymerase chain reaction was performed on 37 seropositive patients and confirmed viremia in 100% of hem. Forty-one seropositive patients (95.3% had previous dialysis prior to transplantation; a mean of 4.5 years. Liver disease manifested in only five (11.6% of the seropositive patients and hypertransaminasemia was detected in 14 (32.6%. Twelve seropositive patients with elevated transaminase levels and/or clinical evidence of liver disease, who all had positive PCR, underwent liver biopsy. Inflammation restricted to portal area was noticed in two, persistent hepatitis in three, chronic active hepatitis in four and cirrhosis in three. There was significantly higher incidence (P< 0.03 of acute graft rejection in the seropositive (23.3% compared to the seronegative patients (9.1% . While the difference did not amount to statistical significance for chronic rejection (9.3% and 6.5% respectively. Two patients had acute cellular rejection related to interferon therapy. The leading cause of death was related to liver failure in the seropositive patients and coronary artery disease in he seronegative RTR. In conclusion, there is high incidence of HCV in or renal transplant recipients associated with relatively high morbidity and mortality. At present we are lacking an efficient and well-tolerated antiviral drug.

  19. Hepatic syndecan-1 changes associate with dyslipidemia after renal transplantation

    NARCIS (Netherlands)

    Adepu, S.; Katta, K.; Tietge, U. J. F.; Kwakernaak, A. J.; Dam, W.; van Goor, Harry; Dullaart, R. P. F.; Navis, G. J.; Bakker, S. J. L.; van den Born, J.

    2014-01-01

    Syndecan-1 is a transmembrane heparan sulfate (HS) proteoglycan present on hepatocytes and involved in uptake of triglyceride-rich lipoproteins via its HS polysaccharide side chains. We hypothesized that altered hepatic syndecan-1 metabolism could be involved in dyslipidemia related to renal transpl

  20. Desensitization for renal transplantation: depletion of donor-specific anti-HLA antibodies, preservation of memory antibodies, and clinical risks.

    Science.gov (United States)

    Rogers, Natasha M; Eng, Hooi S; Yu, Raymond; Kireta, Svjetlana; Tsiopelas, Eleni; Bennett, Greg D; Brook, Nicholas R; Gillis, David; Russ, Graeme R; Coates, P Toby

    2011-01-01

    Desensitization protocols reduce donor-specific anti-HLA antibodies (DSA) and enable renal transplantation in patients with a positive complement-dependent cytotoxic cross-match (CDC-CXM). The effect of this treatment on protective antibody and immunoglobulin levels is unknown. Thirteen patients with end-stage renal disease, DSA and positive CDC-CXM underwent desensitization. Sera collected pre- and post-transplantation were analysed for anti-tetanus and anti-pneumococcal antibodies, total immunoglobulin (Ig) levels and IgG subclasses and were compared to healthy controls and contemporaneous renal transplant recipients treated with standard immunosuppression alone. Ten patients developed negative CDC-CXM and enzyme-linked immunosorbent assay (ELISA) and underwent successful transplantation. Eight recipients achieved good graft function without antibody-mediated or late rejection, BK virus or cytomegalovirus infection. One patient had primary non-function due to recurrent oxalosis, and one patient with immediate graft function died from septicaemia. Seven recipients required post-operative transfusion and three developed septicaemia. DSA remained negative by ELISA at 12 months, but were detectable by Luminex(®) . Anti-tetanus and anti-pneumococcal antibodies, total Ig and IgG subclasses were below the normal range but comparable to levels in renal transplant recipients who had not undergone desensitization. Desensitization protocols effectively reduce DSA and allow successful transplantation. Post-operative bleeding and short-term infectious risk is increased. Protective antibody and serum immunoglobulin levels are relatively preserved. © 2010 The Authors. Journal compilation © 2010 European Society for Organ Transplantation.

  1. Effect of exercise on markers of vascular health in renal transplant recipients.

    Science.gov (United States)

    Piťha, J; Králová Lesná, I; Stávek, P; Mahrová, A; Racek, J; Sekerková, A; Teplan, V; Štollová, M

    2015-01-01

    The cornerstone of cardiovascular risk management is lifestyle intervention including exercise which could exert favorable impact also in renal transplant recipients. Nevertheless, reliable assessment of the effect of lifestyle interventions is complicated and the available data in this population are not consistent. The aim of the study was to evaluate the effect of physical activity on selected laboratory markers of vascular health including circulating stem cells, endothelial progenitor cells, microparticles, and plasma asymmetric dimethyl arginine in renal transplant recipients. Nineteen men and 7 women were recruited in 6-month program of standardized and supervised exercise. Control group consisted of 23 men and 13 women of similar age and body mass index not included into the program. One year after the transplantation, the main difference between intervention and control group was found in the change of endothelial progenitor cells (p=0.006). Surprisingly, more favorable change was seen in the control group in which endothelial progenitor cells significantly increased compared to the intervention group. The explanation of this finding might be a chronic activation of reparative mechanisms of vascular system in the population exposed to multiple risk factors which is expressed as relatively increased number of endothelial progenitor cells. Therefore, their decrease induced by exercise might reflect stabilization of these processes.

  2. Paniculite criptocócica em transplantado renal Cryptococcal panniculitis in a renal transplant recipient

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    Beatriz M. Trope

    2008-06-01

    Full Text Available Os autores relatam um caso de paniculite criptocócica em paciente transplantado renal inicialmente tratado como celulite bacteriana. O diagnóstico definitivo só foi possível pela impressão clínica dermatológica confirmada pelo exame micológico. O tratamento foi realizado a princípio com anfotericina B e posteriormente com fluconazol, considerando-se as interações das drogas imunossupressoras utilizadas para evitar rejeição. A regressão clínica foi alcançada no sexto mês de tratamento, que, no entanto, foi mantido por 12 meses. São feitas considerações a respeito dessa forma rara de criptococose cutânea em transplantado de órgão sólido e suas implicações diagnósticas e terapêuticas.The authors report a case of cryptococcal panniculitis in a renal transplant recipient,which was initially mistaken for bacterial cellulitis. Dermatological evaluation and laboratory studies led to the definitive diagnosis. Treatment was started with amphotericin B, followed by oral fluconazol, taking into consideration their interactions with the immunossupressive drugs. Even though clinical improvement was attained after six months, treatment was maintained during a whole year. We discuss this rare presentation of cutaneous cryptococcosis in a solid organ transplant recipient, as well as its diagnosis and therapy.

  3. Does the standard vs piggyback surgical technique affect the development of early acute renal failure after orthotopic liver transplantation?

    Science.gov (United States)

    Cabezuelo, J B; Ramirez, P; Acosta, F; Torres, D; Sansano, T; Pons, J A; Bru, M; Montoya, M; Rios, A; Sánchez Bueno, F; Robles, R; Parrilla, P

    2003-08-01

    The objective of this study was to evaluate the effect of the surgical technique on postoperative renal function during the first week after liver transplantation (OLT). We performed a retrospective study of 184 consecutive OLT. Criteria for acute renal failure were: serum creatinine >1.5 mg/dL, an increase by 50% in the baseline serum creatinine, or oliguria requiring renal replacement therapy. The distribution of patients according to the surgical technique was: standard (n=84), venovenous bypass (n=20), and piggyback (n=80). Other variables analyzed were: intraoperative requirement for blood products, treatment with adrenergic agonists, intraoperative complications, and postreperfusion syndrome. Univariate analysis showed the following parameters to be significantly related to postoperative renal failure: intraoperative fresh frozen plasma and cryoprecipitate requirements, intraoperative complications, postreperfusion syndrome, need for noradrenaline or dobutamine, standard surgical technique versus piggyback (39% vs 18%, P20 U cryoprecipitate requirement (OR=1.04, P=.01). In conclusion, compared with the piggyback technique, the standard surgical technique appears to be an independent risk factor for postoperative acute renal failure. When venovenous bypass is used in patients who do not tolerate trial clamping of inferior vena cava, it does not reduce the incidence of postoperative renal failure. Finally, the piggyback technique significantly reduces the probability of acute renal failure after liver transplantation.

  4. Urinary Metalloproteinases-9 and -2 and Their Inhibitors TIMP-1 and TIMP-2 are Markers of Early and Long-Term Graft Function After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Ewa Kwiatkowska

    2016-05-01

    Full Text Available Background/Aims: Renal ischemia-reperfusion (I-R injury (IRI is an inseparable feature of organ transplantation and may have a negative impact on the graft, its function and survival. Acute tubular necrosis, which is reversible thanks to the regenerative capacity of renal tubular epithelial cells, is the main cause of acute renal failure secondary to IRI. MMP-2 and MMP-9 are proteolytic enzymes involved in digesting proteins that are components of the extracellular matrix (ECM and the basement membrane of the nephrons. This way post-reperfusion MMP activation allows the inflammatory process to spread. Methods: In our studies, we focused on identifying whether the concentrations of MMP-2 and MMP-9 and their natural inhibitors TIMP-1 and TIMP-2 in urine sample at day 1 and day 30 as well as after 12 months following renal transplantation are markers of early and long-term renal function during meanly five-years observation. Moreover, in urine sampled at months 6 and 12 after renal transplantation, we determined the content of TGF-β as a graft fibrosis indicator. Results: MMP-9 concentration in the early post-transplant period is a major marker of early and long-term function of the transplanted kidney. Its increased concentration was correlated with lesions related to tubular atrophy and fibrosis in renal biopsies performed at months 3 and 12 after transplantation. Its concentration is correlated with TGF-β content in a later period. Conclusions: TIMP-1 and-2 are primarily markers of an early function of the transplanted kidney. Early post-transplant concentration of MMP-2 is a marker of proteinuria in early and long-term post-transplant periods.

  5. Differential expression of proteoglycans in tissue remodeling and lymphangiogenesis after experimental renal transplantation in rats.

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    Heleen Rienstra

    Full Text Available BACKGROUND: Chronic transplant dysfunction explains the majority of late renal allograft loss and is accompanied by extensive tissue remodeling leading to transplant vasculopathy, glomerulosclerosis and interstitial fibrosis. Matrix proteoglycans mediate cell-cell and cell-matrix interactions and play key roles in tissue remodeling. The aim of this study was to characterize differential heparan sulfate proteoglycan and chondroitin sulfate proteoglycan expression in transplant vasculopathy, glomerulosclerosis and interstitial fibrosis in renal allografts with chronic transplant dysfunction. METHODS: Renal allografts were transplanted in the Dark Agouti-to-Wistar Furth rat strain combination. Dark Agouti-to-Dark Agouti isografts and non-transplanted Dark Agouti kidneys served as controls. Allograft and isograft recipients were sacrificed 66 and 81 days (mean after transplantation, respectively. Heparan sulfate proteoglycan (collXVIII, perlecan and agrin and chondroitin sulfate proteoglycan (versican expression, as well as CD31 and LYVE-1 (vascular and lymphatic endothelium, respectively expression were (semi- quantitatively analyzed using immunofluorescence. FINDINGS: Arteries with transplant vasculopathy and sclerotic glomeruli in allografts displayed pronounced neo-expression of collXVIII and perlecan. In contrast, in interstitial fibrosis expression of the chondroitin sulfate proteoglycan versican dominated. In the cortical tubular basement membranes in both iso- and allografts, induction of collXVIII was detected. Allografts presented extensive lymphangiogenesis (p<0.01 compared to isografts and non-transplanted controls, which was associated with induced perlecan expression underneath the lymphatic endothelium (p<0.05 and p<0.01 compared to isografts and non-transplanted controls, respectively. Both the magnitude of lymphangiogenesis and perlecan expression correlated with severity of interstitial fibrosis and impaired graft function

  6. Inadequate dietary calcium and vitamin D intakes in renal-transplant recipients in Ireland.

    LENUS (Irish Health Repository)

    Lynch, Irene T

    2012-02-03

    OBJECTIVE: To quantify the dietary calcium and vitamin D intake in adult renal-transplant recipients attending at a large teaching hospital in Ireland for follow-up. SETTING: Outpatient renal-transplant follow-up clinic. SUBJECTS: Fifty-nine adult renal transplant recipients (58% male) with a mean age of 46 years, a median transplant duration of 6 years, and a mean estimated glomerular filtration rate (eGFR) of 50 mL\\/min per 1.73 m2. Fifty-three percent were at National Kidney Foundation stage 3 chronic kidney disease, and 14% had stage 4 chronic kidney disease. INTERVENTION: This cross-sectional, observational study used a tailored food frequency questionnaire specific for calcium and vitamin D intake in Irish adults, which was completed during a face-to-face interview with each subject. MAIN OUTCOME MEASURE: The main outcome measure was the average daily dietary and supplemented calcium and vitamin D intake. RESULTS: The median interquartile range (IQR) dietary calcium intake was 820 mg\\/day (range, 576-1,177 mg\\/day), and was similar in men and women (recommended intake > or = 1,000 mg\\/day in adult men and nonmenopausal adult women, > or = 1,500 mg\\/day in menopausal women). Five participants received calcium supplementation. Overall, 59% of men and 64% of women had total calcium intakes below the recommended amounts. The median IQR estimated dietary vitamin D intake was 5.2 microg\\/day (range, 2.4-6.4 microg\\/day) in women, and 4.6 microg\\/day (range, 2.2-6.6 microg\\/day) in men (recommended intake, > or = 10 microg\\/day). Six subjects received vitamin D supplementation. Total vitamin D intakes were suboptimal in 91% of men and 87% of women. Dietary calcium and vitamin D intakes significantly correlated with each other, but neither was significantly related to eGFR category, and was similarly low in both presumed menopausal women and in the initial year posttransplantation. CONCLUSION: These findings suggest that dietary and total calcium and

  7. What is the impact of immunosuppressive treatment on the post-transplant renal osteopathy?

    Science.gov (United States)

    Blaslov, Kristina; Katalinic, Lea; Kes, Petar; Spasovski, Goce; Smalcelj, Ruzica; Basic-Jukic, Nikolina

    2014-05-01

    Although glucocorticoid therapy is considered to be the main pathogenic factor, a consistent body of evidence suggests that other immunosuppressants might also play an important role in the development of the post-transplant renal osteopathy (PRO) through their pleiotropic pharmacological effects. Glucocorticoids seem to induce osteoclasts' activity suppressing the osteoblasts while data regarding other immunosuppressive drugs are still controversial. Mycophenolate mofetil and azathioprine appear to be neutral regarding the bone metabolism. However, the study analyzing any independent effect of antimetabolites on bone turnover has not been conducted yet. Calcineurin inhibitors (CNIs) induce trabecular bone loss in rodent, with contradictory results in renal transplant recipients. Suppression of vitamin D receptor is probably the underlying mechanism of renal calcium wasting in renal transplant recipients receiving CNI. In spite of an increased 1,25(OH)2 vitamin D level, the kidney is not able to reserve calcium, suggesting a role of vitamin D resistance that may be related to bone loss. More efforts should be invested to determine the role of CNI in PRO. In particular, data regarding the role of mammalian target of rapamycin inhibitors (mTORi), such as sirolimus and everolimus, in the PRO development are still controversial. Rapamycin markedly decreases bone longitudinal growth as well as callus formation in experimental models, but also lowers the rate of bone resorption markers and glomerular filtration in clinical studies. Everolimus potently inhibits primary mouse and human osteoclast activity as well as the osteoclast differentiation. It also prevents the ovariectomy-induced loss of cancellous bone by 60 %, an effect predominantly associated with a decreased osteoclast-mediated bone resorption, resulting in a partial preservation of the cancellous bone. At present, there is no clinical study analyzing the effect of everolimus on bone turnover in renal

  8. Late concentration-controlled calcineurin inhibitor withdrawal with mycophenolate mofetil in renal transplant recipients

    NARCIS (Netherlands)

    Mourer, Jacqueline Sarah

    2014-01-01

    Calcineurin inhibitor (CNI)-based therapy is associated with nephrotoxicity and cardiovascular adverse effects in renal transplant recipients. Early CNI withdrawal with mycophenolate mofetil (MMF) has not become routine practice, due to concerns about acute rejection. Therapeutic drug monitoring (TD

  9. Maintenance immunosuppression with intermittent intravenous IL-2 receptor antibody therapy in renal transplant recipients.

    LENUS (Irish Health Repository)

    Gabardi, Steven

    2011-09-01

    To report what we believe to be the first 2 cases of long-term (>24 months) intermittent intravenous interleukin-2 receptor antibody (IL-2RA) therapy for maintenance immunosuppression following renal transplantation.

  10. Validation of insulin resistance indexes in a stable renal transplant population

    NARCIS (Netherlands)

    Oterdoom, LH; De Vries, APJ; Van Son, WJ; Van Der Heide, JJH; Ploeg, RJ; Gansevoort, RT; De Jong, PE; Gans, ROB; Bakker, SJL

    2005-01-01

    OBJECTIVE - The purpose of this study was to investigate the validity of established insulin resistance indexes, based on fasting blood parameters, in a stable renal transplant population. RESEARCH DESIGN AND METHODS - Fasting insulin, homeostasis model assessment (HOMA), the quantitative insulin

  11. Quantitative Evaluation of Acute Renal Transplant Dysfunction with Low-Dose Three-dimensional MR Renography

    OpenAIRE

    Yamamoto, Akira; Zhang, Jeff L.; Rusinek, Henry; Chandarana, Hersh; Vivier, Pierre-Hugues; Babb, James S.; Diflo, Thomas; John, Devon G.; Benstein, Judith A.; Barisoni, Laura; Stoffel, David R.; Lee, Vivian S.

    2011-01-01

    Our new quantitative analysis method of MR renography, which includes our multicompartmental tracer kinetic renal model, may help to diagnose noninvasively acute rejection or acute tubular necrosis after kidney transplantation.

  12. Incidence of PTLD in pediatric renal transplant recipients receiving basiliximab, calcineurin inhibitor, sirolimus and steroids

    NARCIS (Netherlands)

    McDonald, R. A.; Smith, J. M.; Ho, M.; Lindblad, R.; Ikle, D.; Grimm, P.; Wyatt, R.; Arar, M.; Liereman, D.; Bridges, N.; Harmon, W.

    2008-01-01

    Pediatric renal transplant recipients were enrolled in a multicenter, randomized, double-blind trial of steroid withdrawal. Subjects received basiliximab, calcineurin inhibitor, sirolimus and steroids. Of 274 subjects enrolled, 19 (6.9%) subjects developed posttransplant lymphoproliferative disorder

  13. Patlak plot analysis CT-GFR for the determination of renal function: comparison of normal dogs with autologous kidney transplant dogs.

    Science.gov (United States)

    Alexander, K; Authier, S; del Castillo, J R E; Arora, V; Qi, S; Guillot, M; Beauchamp, G; Troncy, E

    2010-01-01

    Glomerular filtration rate (GFR) can be determined using Patlak plot analysis with single-slice dynamic computed tomography (CT). Acute autologous graft failure has several causes, all of which induce a measurable decrease in glomerular filtration rate. This study demonstrated in an experimental model of canine autologous renal transplant that CT-derived renal plasma clearance was significantly lower (p = 0.002) in dogs having undergone transplant (0.077 +/- 0.058 ml min(-1) ml renal tissue(-1)) compared with control dogs (0.396 +/- 0.139 ml min(-1) ml renal tissue(-1)). A significant negative curvilinear relationship was seen between serum creatinine and total renal plasma clearance (R(2) = 0.84, p = 0.0001). Alterations in renal time attenuation curve shape in dogs having undergone transplant may have been related to increased renal vascular resistance related to tubular necrosis. CT-GFR may be a useful experimental tool in the evaluation of renal dysfunction in transplant models.

  14. Renal artery stenosis in kidney transplants: assessment of the risk factors

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-08-01

    Full Text Available Jalal Etemadi1, Khosro Rahbar2, Ali Nobakht Haghighi2, Nazila Bagheri2, Kianoosh Falaknazi2, Mohammad Reza Ardalan1, Kamyar Ghabili3, Mohammadali M Shoja31Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, 2Department of Nephrology, Shaheed Beheshti University of Medical Sciences, Tehran, 3Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Transplant renal artery stenosis (TRAS is an important cause of hypertension and renal allograft dysfunction occurring in kidney transplant recipients. However, conflicting predisposing risk factors for TRAS have been reported in the literature.Objective: The aim of the present study was to assess the potential correlation between possible risk factors and TRAS in a group of living donor renal transplant recipients 1 year after the renal transplantation.Methods: We evaluated the presence of renal artery stenosis in 16 recipients who presented with refractory hypertension and/or allograft dysfunction 1 year after renal transplantation. Screening for TRAS was made by magnetic resonance angiography and diagnosis was confirmed by conventional renal angiography. Age, gender, history of acute rejection, plasma lipid profile, serum creatinine, blood urea nitrogen, serum uric acid, calcium phosphate (CaPO4 product, alkaline phosphatase, fasting blood sugar, hemoglobin, and albumin were compared between the TRAS and non-TRAS groups.Results: Of 16 kidney transplant recipients, TRAS was diagnosed in three patients (two men and one woman. High levels of calcium, phosphorous, CaPO4 product, and low-density lipoprotein (LDL cholesterol were significantly correlated with the risk of TRAS 1 year after renal transplantation (P < 0.05. Serum level of uric acid tended to have a significant correlation (P = 0.051.Conclusion: Correlation between high CaPO4 product, LDL cholesterol, and perhaps uric acid and TRAS in living

  15. [Urinary protein detection by iTRAQ® associated with renal transplant complications and its modification with therapy].

    Science.gov (United States)

    Escobedo-Villarreal, Miguel Mariano; Mercado-Moreira, Amanda Berenice; Muñoz-Espinosa, Linda Elsa; Gamboa-Esparza, Mariana; Pérez-Rodríguez, Edelmiro; Cordero-Pérez, Paula

    2015-01-01

    After renal transplant, surgical, infection complications, as well as graft rejection may occur; early detection through non-invasive markers is the key to change therapy and avoid biopsy. The aime of the study is to determine urine protein profiles in patients undergoing renal transplant with complications and detect its variation when therapy is modified. Urine samples were collected from patients prior the transplant and various postoperative stages. Urinary protein profiles were obtained by peptide labeling using isobaric isotopes for relative quantification (iTRAQ(®)). A total of 22 patients were included, of whom 12 developed post-transplant complication: 2 with graft rejection (one male and one female) and 10 (6 males and 4 females) in the group of post-transplant infections. Using iTRAQ(®) 15/345 and 28/113 proteins were identified and fulfilled the acceptance criteria, in graft rejection and post-transplant infections group, respectively. Albumin was the only protein found in both groups, the remaining proteins were different. The 5 proteins with higher scores in graft rejection were: alpha-1-microglobulin, 5'-nucleotidase cytosolic III, retinol-binding protein 4, membrane protein palmitoylated 4, and serine carboxypeptidase, while post-transplant infections were: mitochondrial acetyl-coenzyme A synthetase, putative adenosyl homocysteinase 2, zinc finger protein GLIS1, putative protein FAM157B, and zinc finger protein 615. It remains to elucidate the involvement of each of these in patients with renal transplantation. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. Nonmyeloablative Allogeneic Stem-Cell Transplantation for Metastatic Renal Cell Cancer: A Review and Update

    Directory of Open Access Journals (Sweden)

    P. Erotocritou

    2006-01-01

    Full Text Available Metastatic renal cell carcinoma (RCC is resistant to conventional chemotherapy and radiotherapy. However, immunotherapy appears to be effective in 15—20% of cases, with interleukin-2 becoming the standard therapy for this disease. As a consequence of the immune susceptibility of RCC, other avenues of immunotherapy are being explored, such as nonmyeloablative allogeneic stem cell transplantation (NST. A number of trials have shown NST to be effective in varying degrees, causing partial or complete regression. Although nonmyeloablative conditioning is safer than myeloablative conditioning, its role has yet to be clearly proven as many studies have shown variable effect. Alongside this limitation, transplant-related toxicity also forms obstacles. Regardless of the limitation of NST, further refinement of the technique, with appropriate patient selection, may lead to this being an effective therapeutic choice for a significant number of individuals.

  17. Avoiding steroids in pediatric renal transplantation: long-term experience from a single centre

    DEFF Research Database (Denmark)

    Pedersen, Erik Bo; El-Faramawi, Mohamad; Foged, Nils

    2007-01-01

    We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients......). Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long-term graft survival....

  18. Innovative Applications of Robotic Surgery: Renal Allograft and Autologous Transplantation

    OpenAIRE

    Jason Lee; Michael Ordon

    2016-01-01

    Robotic surgery has enabled surgeons to offer more patients a minimally invasive surgical option in the management of their complex diseases. While renal transplantation is associated with significant improvements in quantity and quality of life for most end-stage renal disease (ESRD) patients, it is also not devoid of its surgical risks and potential morbidities. Robotic-assisted kidney transplantation is a recently described, innovative application of the robotic surgery platform, and early...

  19. [Large artery wall properties in dialyse and renal transplant patients with normal blood pressure].

    Science.gov (United States)

    Posadzy-Małaczyńska, Anna; Kosch, Marcus; Hausberg, Martin; Rahn, Karl H; Małaczyński, Paweł; Głuszek, Jerzy; Tykarski, Andrzej

    2004-01-01

    Structural and mechanical properties of the arterial wall are altered in patients with renal failure. Age and hypertension are known to affect the vessel wall structure. Aging process of arterial wall appears to be accelerated in patients with end-stage renal failure. The mechanisms responsible for reduced arterial compliance and distensibility in dialyse patients and renal transplant recipients without hypertension remain to be evaluated. 20 normotensive dialyse patients (D), 20 normotensive renal transplant recipients (T) and 20 healthy volunteers (N) matched for age, sex and blood pressure as controls were enrolled in to the study. Patients with cardiovascular risk factors and diabetes were excluded. The arterial blood pressure of all patients placed below 140/90 mmHg. The dialyse patients and renal transplant recipients were eligible for the study if the serum creatinine level was below 2 mg/dl. In all subjects, fasting concentrations of serum creatinine, total cholesterol, HDL-cholesterol, LDL-cholesterol, hemoglobin and glucose were determined at enrollment to the study. Long-term immunosuppression consisted of cyclosporine and prednisolone. Blood pressure was measured using an automatic sphygmomanometer (Criticon Dinamap model 1846 SX). Pulse wave velocity (PWV) was evaluated using non-invasive automatic Complior device. The vessel wall properties of the left common carotid artery were studied using multigate pulsed Doppler's system (Pie Medical Equipment BV Maastricht, The Netherlands). The frequency of transducer used was 7.5 MHz. With this non-invasive method, the end-diastolic diameter (d) and the systolic increase of vessel diameter (distension delta d) were measured using ECG trigger. From these data relative systolic increase of vessel diameter (delta d/d) and arterial wall distensibility coefficient (DC) were calculated. Simultaneously with the ultrasound measurements at the left common carotid artery carotid pulse waveforms are recorded using

  20. Major influence of renal function on hyperlipidemia after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Qi Ling; Kai Wang; Di Lu; Hai-Jun Guo; Wen-Shi Jiang; Xiang-Xiang He; Xiao Xu

    2012-01-01

    AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia (PTHL) in living donor liver transplantation (LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction (ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL (17.9% vs 4.6%,P=0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3 (P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels (P < 0.001) and longer duration of pre-transplant renal insufficiency (P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index (BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio (OR) =9.593,P < 0.001] and BMI (OR =6.358,P =0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

  1. Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients: A Multicenter Study

    Science.gov (United States)

    Delgado, Patricia; Diaz, Juan Manuel; Silva, Irene; Osorio, José M.; Osuna, Antonio; Bayés, Beatriz; Lauzurica, Ricardo; Arellano, Edgar; Campistol, Jose Maria; Dominguez, Rosa; Gómez-Alamillo, Carlos; Ibernon, Meritxell; Moreso, Francisco; Benitez, Rocio; Lampreave, Ildefonso; Porrini, Esteban; Torres, Armando

    2008-01-01

    Background and objectives: Emerging information indicates that glucose metabolism alterations are common after renal transplantation and are associated with carotid atheromatosis. The aims of this study were to investigate the prevalence of different glucose metabolism alterations in stable recipients as well as the factors related to the condition. Design, setting, participants, & measurements: A multicenter, cross-sectional study was conducted of 374 renal transplant recipients without pre- or posttransplantation diabetes. A standard 75-g oral glucose tolerance test was performed. Results: Glucose metabolism alterations were present in 119 (31.8%) recipients: 92 (24.6%) with an abnormal oral glucose tolerance test and 27 (7.2%) with isolated impaired fasting glucose. The most common disorder was impaired glucose tolerance (17.9%), and an abnormal oral glucose tolerance test was observed for 21.5% of recipients with a normal fasting glucose. By multivariate analysis, age, prednisone dosage, triglyceride/high-density lipoprotein cholesterol ratio, and β blocker use were shown to be factors related to glucose metabolism alterations. Remarkably, triglyceride levels, triglyceride/high-density lipoprotein cholesterol ratio, and the proportion of recipients with impaired fasting glucose were already higher throughout the first posttransplantation year in recipients with a current glucose metabolism alteration as compared with those without the condition. Conclusions: Glucose metabolism alterations are common in stable renal transplant recipients, and an oral glucose tolerance test is required for its detection. They are associated with a worse metabolic profile, which is already present during the first posttransplantation year. These findings may help planning strategies for early detection and intervention. PMID:18322043

  2. Innovative Applications of Robotic Surgery: Renal Allograft and Autologous Transplantation.

    Science.gov (United States)

    Lee, Jason; Ordon, Michael

    2016-01-01

    Robotic surgery has enabled surgeons to offer more patients a minimally invasive surgical option in the management of their complex diseases. While renal transplantation is associated with significant improvements in quantity and quality of life for most end-stage renal disease (ESRD) patients, it is also not devoid of its surgical risks and potential morbidities. Robotic-assisted kidney transplantation is a recently described, innovative application of the robotic surgery platform, and early experiences suggest that it is associated with comparable graft function and lower rates of complications. Urinary tract obstruction, though less common than ESRD, can be a serious threat to renal function. Severe ureteric stricture disease can represent a clinically complex problem requiring major reconstructive surgery. Completely intra-corporeal robotic renal auto-transplantation is another innovative application of the robotic surgery platform and represents a significant advancement in urologic surgery. Initial reports of this procedure demonstrate safety, feasibility, and excellent renal function outcomes.

  3. Visceral leishmaniasis in a kidney transplant recipient: parasitic interstitial nephritis, a cause of renal dysfunction.

    Science.gov (United States)

    Dettwiler, S; McKee, T; Hadaya, K; Chappuis, F; van Delden, C; Moll, S

    2010-06-01

    Visceral leishmaniasis (VL) due to Leishmania infantum is an endemic parasitic infection in the Mediterranean area. It most commonly affects immunosuppressed individuals, especially HIV patients and less frequently organ transplant recipients. Renal involvement seems to be frequent and is mostly associated with tubulointerstitial nephritis, as described in autopsy reports. In the 61 cases of renal transplant recipients with VL reported in the literature, renal dysfunction was noted at clinical presentation and was more frequently observed as a complication of antiparasitic therapy. However, no pathological analysis of the allograft lesions was reported. We present the case of a Swiss renal transplant recipient who developed VL after vacations in Spain and Tunisia, complicated by acute parasitic nephritis in the renal allograft 3 months after a well-conducted treatment of liposomal amphotericin B.

  4. Detection of Superior Vena Cava Obstruction on Dynamic 99mTc-DTPA Renal Transplant Scintigraphy

    Directory of Open Access Journals (Sweden)

    Elahe Pirayesh

    2016-02-01

    Full Text Available We present an asymptomatic patient with a history of prolonged hemodialysis through a right internal jugular vein catheter who was diagnosed with superior vena cava (SVC obstruction on 99mTechnetium-diethylenetriaminepentaacetic acid renal transplant scintigraphy. During the angiographic phase, an unusual vascular filling pattern was detected on the anterior view of the abdomen. Angioscintigraphic imaging of the chest wall was suggestive of SVC obstruction. The SVC obstruction in our patient was related to the long-term use of an indwelling catheter in the central venous system, which is a well-known complication of such a procedure. There is also evidence of a hypercoagulable state in dialyzed uremic cases; therefore, our patient may have been more susceptible to an SVC thrombosis. Acquired compensatory dilatation of the azygos vein is rather a rare finding. To the best of our knowledge, this is the first report describing an asymptomatic patient with SVC obstruction who was diagnosed by renal scintigraphy.

  5. Disruption of transitional stages in 24-h blood pressure in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Marcelo E Katz

    2012-03-01

    Full Text Available Patients with kidney replacement exhibit disrupted circadian rhythms. Most studies measuring blood pressure use the dipper/non-dipper classification, which does not consider analysis of transitional stages between low and high blood pressure, confidence intervals nor shifts in the time of peak, while assuming subjective onsets of night and day phases. In order to better understand the nature of daily variation of blood pressure in these patients, we analyzed 24h recordings from 41 renal transplant recipients using the non-symmetrical double-logistic fitting assessment which does not assume abruptness nor symmetry in ascending and descending stages of the blood pressure profile, and a cosine best-fitting regression method (Cosinor. Compared with matched controls, double-logistic fitting showed that the times for most of transitional stages (ascending systolic and descending systolic, diastolic and mean arterial pressure had a wider distribution along the 24 h. The proportion of individuals without daily blood pressure rhythm in the transplanted group was larger only for systolic arterial pressure, and the amplitude showed no significant difference. Furthermore, the transplant recipient group had a less pronounced slope in descending systolic and ascending mean blood pressure. Cosinor analysis confirmed the phase related changes, showing a wider distribution of times of peak (acrophases. We conclude that daily disruptions in renal transplant recipients can be explained not only by absence in diurnal variation, but also in changes in waveform-related parameters of the rhythm, and that distortions in the phase of the rhythm are the most consistent finding for the patients.

  6. Mitigation of Late Renal and Pulmonary Injury After Hematopoietic Stem Cell Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Eric P., E-mail: Eric.Cohen2@va.gov [Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Bedi, Manpreet; Irving, Amy A. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Jacobs, Elizabeth; Tomic, Rade [Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Klein, John [Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Lawton, Colleen A.; Moulder, John E. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States)

    2012-05-01

    Purpose: To update the results of a clinical trial that assessed whether the angiotensin-converting enzyme inhibitor captopril was effective in mitigating chronic renal failure and pulmonary-related mortality in subjects undergoing total body irradiation (TBI) in preparation for hematopoietic stem cell transplantation (HSCT). Methods and Materials: Updated records of the 55 subjects who were enrolled in this randomized controlled trial were analyzed. Twenty-eight patients received captopril, and 27 patients received placebo. Definitions of TBI-HSCT-related chronic renal failure (and relapse) were the same as those in the 2007 analysis. Pulmonary-related mortality was based on clinical or autopsy findings of pulmonary failure or infection as the primary cause of death. Follow-up data for overall and pulmonary-related mortality were supplemented by use of the National Death Index. Results: The risk of TBI-HSCT-related chronic renal failure was lower in the captopril group (11% at 4 years) than in the placebo group (17% at 4 years), but this was not statistically significant (p > 0.2). Analysis of mortality was greatly extended by use of the National Death Index, and no patients were lost to follow-up for reasons other than death prior to 67 months. Patient survival was higher in the captopril group than in the placebo group, but this was not statistically significant (p > 0.2). The improvement in survival was influenced more by a decrease in pulmonary mortality (11% risk at 4 years in the captopril group vs. 26% in the placebo group, p = 0.15) than by a decrease in chronic renal failure. There was no adverse effect on relapse risk (p = 0.4). Conclusions: Captopril therapy produces no detectable adverse effects when given after TBI. Captopril therapy reduces overall and pulmonary-related mortality after radiation-based HSCT, and there is a trend toward mitigation of chronic renal failure.

  7. Acute renal graft-versus-host disease in a murine model of allogeneic bone marrow transplantation.

    Science.gov (United States)

    Schmid, Peter M; Bouazzaoui, Abdellatif; Schmid, Karin; Birner, Christoph; Schach, Christian; Maier, Lars S; Holler, Ernst; Endemann, Dierk H

    2017-03-23

    Acute kidney injury (AKI) is a very common complication after allogeneic bone marrow transplantation (BMT) and associated with poor prognosis. Generally kidneys are assumed to be no direct target of Graft-versus-Host Disease (GvHD), and renal impairment is often attributed to several other factors occurring in the early phase after BMT. Our study aimed to prove the existence of renal GvHD in a fully MHC-mismatched model of BALB/c mice conditioned and transplanted according to two different intensity protocols. Syngeneically transplanted and untreated animals served as controls. 4 weeks after transplantation, allogeneic animals developed acute GvHD that was more pronounced in the high-intensity protocol (HIP) group than in the low-intensity protocol (LIP) group. Urea and creatinine as classic serum markers of renal function could not verify renal impairment 4 weeks after BMT. Creatinine levels were even reduced as a result of catabolic metabolism and loss of muscle mass due to acute GvHD. Proteinuria, albuminuria, and urinary N-acetyl-beta-Dglucosaminidase (NAG) levels were measured as additional renal markers before and after transplantation. Albuminuria and NAG were only significantly increased after allogeneic transplantation, correlating with disease severity between HIP and LIP animals. Histological investigations of the kidneys showed renal infiltration of T-cells and macrophages with endarteriitis, interstitial nephritis, tubulitis, and glomerulitis. T-cells consisted of CD4+, CD8+, and FoxP3+ cells. Renal expression analysis of allogeneic animals showed increases in indoleamine-2,3 dioxygenase (IDO), different cytokines (TNFα, IFN-γ, IL-1α, IL2, IL-6, and IL-10), and adhesion molecules (ICAM-1 and VCAM-1), resembling findings from other tissues in acute GvHD. In summary, our study supports the entity of renal GvHD with histological features suggestive of cell-mediated renal injury. Albuminuria and urinary NAG levels may serve as early markers of renal

  8. Current experience with renal transplantation across the ABO barrier.

    Science.gov (United States)

    Nelson, P W; Helling, T S; Shield, C F; Beck, M; Bryan, C F

    1992-11-01

    Solid organ transplantation has traditionally been governed by the rules of blood group compatibility. Thus, it has been demonstrated that crossing the ABO blood group barrier generally results in hyperacute rejection. However, the A2 subtype of the blood group A is a weaker antigen. Under certain circumstances, organs from donors with blood group A2 can be transplanted across the ABO blood group barrier into recipients of O or B blood type. Since 1986, 33 patients including 24 blood group O and 9 blood group B patients received A2 (30) or A2B (3) donor kidneys. Both cadaver donor (31) and living-related grafts (2) have been undertaken. The mean follow-up since transplantation for the 21 patients with functioning grafts is 36 months, with a 67.2% current graft survival. Immunosuppression for these transplants consisted of azathioprine, prednisone, and cyclosporine, often in combination with prophylactic OKT3 or antilymphocyte globulin as protocol dictated. Special immunosuppressive protocols such as splenectomy or plasmapheresis were not used. The serum of the potential recipient was analyzed for immunoglobulin G (IgG) and immunoglobulin M (IgM) forms of antibody against A1 and A2 red blood cells. There is a strong correlation between a low (less than or equal to 1:8) anti-A1 IgG titer and both early and long-term graft function. Recipients with an IgG titer greater than 1:8 in the pretransplant serum had a much higher incidence of early graft failure. We no longer recommend transplantation of A2 kidneys into O or B recipients with a pretransplant titer of greater than 1:8 but found that recipients with low titers have graft function rates essentially equal to those of ABO-compatible patients. Patients with blood group B have, over time, lower anti-A IgG titers than do blood group O patients. In addition, the graft survival among blood group B patients is 89% compared with 58% among group O recipients. This may be due to the generally low titers found in blood

  9. Ethical aspects of renal transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Berloco, P B

    2007-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantages for the donor other than increased self-esteem, but it at least remains an extremely safe procedure, with a worldwide overall mortality of 0.03%. This theoretical risk for the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be effectively prevented, not only for ethical but also medical reasons. The risks are too high, not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus (HIV) or other infective agents, as well as of inappropriate medical and surgical management of donors and also recipients, who are often discharged too early. Most public or private insurance companies consider kidney donation a safe procedure without long-term impairment and therefore do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our Center does not perform anonymous living organ donation or "cross-over" transplantation.

  10. Clinical evaluation of the endothelial tie-2 crossmatch in ABO compatible and ABO incompatible renal transplants.

    Science.gov (United States)

    Kafetzi, Maria L; Boletis, John N; Melexopoulou, Christine A; Tsakris, Athanassios; Iniotaki, Aliki G; Doxiadis, Ilias I N

    2013-11-01

    The necessity of detection of other than the classical major histocompatibility complex (MHC) and MHC class I-related chain A (MICA) directed antibodies prior to organ transplantation has already been repeatedly reported. A commercial flow cytometric endothelial crossmatch (CM) using isolated peripheral blood tie-2 positive cells provides a tool to detect non-MHC antibodies in addition to antibodies directed to MHC class I and II. The vast majority of circulating tie-2 positive cells expresses HLA-DR but not the A, B blood group antigens. Tie-2 cells are circulating surrogate endothelial cells. In this retrospective study we evaluated the endothelial CM in 51 renal transplantations, 30 with ABO compatible grafts and 21 with ABO incompatible grafts. Fifteen of the ABO compatible recipients (group A) developed unexplained rejection episodes (RE) while the remaining 15 had no RE (group B). Five cases of group A and none of group B had a positive tie-2 CM before transplantation (p=0.042). A positive tie-2 CM was also correlated with graft failure in ABO compatible transplants (p=0.02). No significant correlation was found between a positive pre-transplant tie-2 CM and RE in the ABO incompatible group. This study strongly suggest that a positive tie-2 CM may predict post-transplantation complications in ABO compatible grafts while negative reactions are not predictive. The test is not significantly correlated with RE in ABO incompatible grafts possibly due to applied desensitization. Copyright © 2013 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  11. Pregnancy after kidney transplantation: when is the best time? = Gravidez após transplante renal: qual o momento ideal?

    Directory of Open Access Journals (Sweden)

    Gustavo Falcão Gama

    2012-10-01

    Full Text Available The authors report a case of a patient underwent kidney transplantation that went through an unplanned pregnancy, at 41 years old, as well as the implications for both mother and fetus.Os autores relatam o caso de uma paciente submetida à transplante renal que evoluiu com uma gravidez não planejada, aos 41 anos de idade, bem como suas implicações para o binômio mãe e feto.

  12. Renal Transplantation Using Stone-bearing Deceased Donor Kidneys-Experience of a Transplant Center in China.

    Science.gov (United States)

    Chen, Chuan-Bao; Zhao, Liang; Han, Ming; Wang, Xiao-Ping; Zhou, Jian; Yuan, Xiao-Peng; Wang, Chang-Xi

    2017-09-01

    To evaluate the outcomes of transplantation of deceased donor stone-bearing kidneys. A total of 32 patients who received renal transplantation at our center from July 2011 to June 2016 were included. Eight recipients received kidneys with incidental renal stone(s) (stone group). Twenty-four recipients received kidneys without renal stones (non-stone group). The transplantation outcomes of the 2 groups were compared. There was 1 case of postoperative urinary tract infection in the stone group, and 2 cases in the non-stone group. No ureteral obstruction or hydronephrosis occurred in either group. No significant difference was found in the incidence of complications, serum creatinine level, and estimated glomerular filtration rate between the groups (all, P >.05). No deaths occurred in either group during the follow-up period. One recipient had postoperative calculi recurrence, and 4 recipients had residual calculi before transplantation. However, these patients had no symptomatic nephrolithiasis or obstruction, and their renal functions were normal. Transplantation of deceased donor stone-bearing kidneys can achieve comparable outcomes of deceased donor non-stone-bearing kidneys. Copyright © 2017 Elsevier Inc. All rights reserved.