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Sample records for renal transplantation role

  1. Clinical role of the renal transplant biopsy

    PubMed Central

    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

  2. Recruitment of renal transplant patients into patrolling police roles using orthotic shields

    PubMed Central

    Levene, Sara; Levene, Charlotte Amy; Makanjuola, David; Rajakariar, Ravi

    2014-01-01

    Renal allografts are transplanted to an anatomically unnatural site where they are exposed to trauma, and may fail if damaged. Individuals with renal allografts have been excluded from patrolling police roles as these often necessitate confrontation. We describe two patients with renal allografts who have been recruited by the Metropolitan Police Service, using bespoke orthotic shields to protect the grafts. PMID:24879727

  3. Malignancy after renal transplantation.

    PubMed

    Zeier, Martin; Hartschuh, Wolfgang; Wiesel, Manfred; Lehnert, Thomas; Ritz, Eberhard

    2002-01-01

    Malignancy following renal transplantation is an important medical problem during the long-term follow-up. The overall incidence of malignancy at this time is 3 to 5 times higher than in the general population. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). The type of malignancy is different in various countries and dependent on genetic and environmental factors. Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse are additional risk factors. Malignancy may even be transplanted by the graft. Previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and postmalignancy screening. Finally, every dialysis patient on the waiting list should undergo a regular screening program before and after renal transplantation to detect a potentially malignant tumor in an early stage. In addition to specific oncological treatment, managing a malignancy after renal transplantation should include modification of immunosuppression. PMID:11774131

  4. Tofacitinab in Renal Transplantation

    PubMed Central

    Zand, Martin S.

    2013-01-01

    Tofacitinib (tositinib, CP-690,550) is a small molecule inhibitor of Janus associated kinases, primarily JAK3 and JAK2, which inhibits cytokine signaling through the IL-2Rγ chain. In this article, we review the mechanism of action of tofacitinib, and pre-clinical and clinical data regarding its use in solid organ transplantation thus far. It is hoped that tofacitinib may form the basis for calcineurin-free immunosuppression, improving renal function while eliminating calcineurin inhibitor renal toxicity. Current studies suggest that tofacitinib is an effective immunosuppressive agent for renal transplantation, but it's use in current protocols carries an increased risk of CMV, BK, and EBV viral infection, anemia and leukopenia, and post-transplant lymphoproliferative disorder. PMID:23849222

  5. [Immune tolerance after renal transplantation].

    PubMed

    Krajewska, Magdalena; Weyde, Wacław; Klinger, Marian

    2006-01-01

    Progress in immunosuppressive therapy has improved short-term survival of renal allografts by decreasing the frequency of acute rejections. However, the long-term survival of renal grafts has not improved. Transplanted kidneys are lost in the late period after transplantation as a result of vasculopathy and chronic rejection. Immunological tolerance means the lack of immunological activity towards certain antigens while the response towards others remains correct. The induction of immunological tolerance of donor antigens (transplant tolerance) is examined intensively to work out treatment methods which will allow prevention of chronic allograft rejection. The paper includes an overview of current knowledge on allograft tolerance. Immune response to alloantigens is described and the mechanisms of immunological tolerance induction (including clonal deletion, anergy connected with the microchimerism phenomenon, and active suppression caused by regulatory lymphocytes) are characterized. The role of dendritic cells in the process of inducing and maintaining tolerance is highlighted. Tolerance-inducing strategies in renal transplant recipients and clinically applied evaluation methods are presented. At present, optimizing recipient matching is used to decrease the risk of graft rejection. Hopefully, gene therapy will be possible in the near future. However, before introducing such a procedure into clinical studies, optimal therapy conditions and risk evaluation must be defined in tests on animals. PMID:16552396

  6. Current status of renal transplantation.

    PubMed Central

    Suranyi, M. G.; Hall, B. M.

    1990-01-01

    The success rate of renal transplantation has improved considerably during the past decade, with substantial improvements in both graft and patient survival. The quality of graft function, however, and not graft survival alone is increasingly determining the standards by which transplantation outcome is being judged. As the demand for kidney transplants continues to rise and transplants are being offered to an ever-increasing number of patients, organs are being sought from new supply pools and efforts are being made to use current resources more efficiently. Improvements in clinical management have allowed short-term complications such as infection and rejection to be better prevented or better diagnosed and treated. Fundamental advances in the understanding of the immunologic processes underlying both allograft rejection and acceptance and the introduction of new immunosuppressive agents have allowed a better use of drug therapy and have moved the goal of acquired transplant tolerance closer to attainment. With improved initial transplant success rates, the long-term transplantation outcome is becoming more important. The role of tissue matching in preventing chronic rejection is becoming more appreciated, and the long-term risks of malignancy, arteriosclerosis, and chronic rejection are being better recognized and managed. PMID:2191502

  7. [Renal transplantation: ethical issues].

    PubMed

    Mamzer-Bruneel, Marie-France; Laforêt, Emmanuelle Grand; Kreis, Henri; Thervet, Éric; Martinez, Frank; Snanoudj, Renaud; Hervé, Christian; Legendre, Christophe

    2012-12-01

    One of the most significant advances in medicine during the last 50 years is the development of organ transplantation. In the context of chronic kidney diseases, renal transplantation offers patients a better clinical outcome than other treatment options. However, the benefits of organ transplantation have not been maximized due to an inadequate supply of organs for transplantation. Despite the establishment of elaborate legal rules for organs procurement, both on deceased and living donors in numerous countries, ethical concerns remain. Most of them are consequences of the strategies implemented or proposed to address the so-called organ shortage. The involvement of society in these complex problems is crucial as numerous questions emerge: could actual state of organ procurement change? Is it possible and/or realistic to increase the number of organs, with respects to living donors or deceased persons? Is the shortage an indicator to limit the use of kidney transplantation? How do we maintain efficiency and justice, in this context. PMID:23168353

  8. Renal transplantation in infants.

    PubMed

    Jalanko, Hannu; Mattila, Ilkka; Holmberg, Christer

    2016-05-01

    Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively. PMID:26115617

  9. The role of the ERA-EDTA in organizing continuing medical education in Europe for nephrology, dialysis and renal transplantation.

    PubMed

    Coppo, Rosanna

    2006-01-01

    Continuing medical education (CME) is a process not to be ignored by the medical profession of nephrology. Each country has already organized or is going to organize a national CME system providing individual modalities of credit distribution and control. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) has considered the need to work together with the European Union of Medical Specialists (UEMS) to study and to promote a unified CME system in Europe with the aim of defending the quality of a comparably high level of specialist care given to patients in the EU. To this aim, the ERA-EDTA has created a European Accreditation Council for CME in nephrology, dialysis and renal transplantation (ERA-EDTA EACCME). It acts not on-ly by accrediting European meetings providing great educational value, but aims to expand the commitment of the ERA-EDTA in educational activities everywhere in Europe. Continuous medical education activity started in 2004 with a series of residential courses. Finally, the ERA-EDTA entered the newly formed Board of Nephrology for CME, which will work to homogenize the training level of nephrologists in Europe aimed at CME, as well as continuing professional education (CPE) for nephrologists. The new ERA-EDTA activities for CME in nephrology, dialysis and renal transplantation will renew the role of this scientific society for all European nephrologists (www.era-edta.org/era-courses.asp). PMID:16736408

  10. Future challenges in renal transplantation.

    PubMed

    Whalen, H; Clancy, M; Jardine, A

    2012-02-01

    There is a worldwide increase in the incidence of end-stage renal disease. Renal transplantation has been shown to be cost effective, prolong survival and provide a better quality of life in comparison to dialysis. Consequently, there has been a steady increase in demand for organs leading to a shortage of available kidneys, and an increase in transplant waiting lists. Renal transplantation is therefore an expanding field with a number of unique future challenges to address. This article outlines strategies that may be employed to expand organ supply in order to meet increased demand. The ethical issues surrounding this are also summarized. Furthermore, we highlight techniques with the potential to minimize peri-transplant injury to the kidney on its journey from donor to recipient. Current and potential future management strategies to optimize graft and patient survival are also discussed. PMID:22361673

  11. Fungal infections in renal transplant patients.

    PubMed

    Khan, Asif; El-Charabaty, Elie; El-Sayegh, Suzanne

    2015-06-01

    Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of

  12. Fungal Infections in Renal Transplant Patients

    PubMed Central

    Khan, Asif; El-Charabaty, Elie; El-Sayegh, Suzanne

    2015-01-01

    Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of

  13. A renal transplantation model for developing countries.

    PubMed

    Rizvi, S A H; Naqvi, S A A; Zafar, M N; Hussain, Z; Hashmi, A; Hussain, M; Akhtar, S F; Ahmed, E; Aziz, T; Sultan, G; Sultan, S; Mehdi, S H; Lal, M; Ali, B; Mubarak, M; Faiq, S M

    2011-11-01

    The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man. PMID:21883911

  14. Serum lipid pattern unifies following renal transplantation in children.

    PubMed

    Müller, Thomas; Koeppe, Silvie; Arbeiter, Klaus; Luckner, Doris; Salzer, Urike; Balzar, Egon; Aufricht, Christoph

    2003-09-01

    Hyperlipidemia is a common problem in solid organ transplant recipients. In this study we evaluated the role of pre-transplant renal replacement therapy on early and late changes of serum lipid levels in children following renal transplantation. In 46 children with chronic renal failure (median age 10.3 years) and 12 children with heart failure (median age 5.0 years), cholesterol and triglycerides were measured before and during follow-up after transplantation. Children with renal failure had significantly higher serum lipids than controls ( n=34, median age 9.2 years) and patients with heart failure. Pre transplantation, cholesterol and triglycerides were significantly lower in the hemodialysis than in the peritoneal dialysis population, whereas conservatively treated children had intermediate levels. After transplantation, serum cholesterol converged towards a mean level of 208 mg/dl and triglyceride levels converged towards a uniform level of 195 mg/dl at 9 months post transplant. The ratio of cholesterol/high-density lipoprotein significantly decreased from 4.7 to 3.8. The pattern of "post-transplant hyperlipidemia" was similar in both renal and cardiac allograft recipients. Hence, the early post-transplant changes of serum lipid pattern are markedly dependent on the mode of pre-transplant renal replacement therapy. Later, serum lipid levels were no longer influenced by prior renal replacement therapy and showed a new pattern of "post-transplant hyperlipidemia" in all children. PMID:12883978

  15. Recurrence of light chain deposit disease after renal allograft transplantation: potential role of rituximab?

    PubMed

    Kuypers, Dirk R J; Lerut, Evelyne; Claes, Kathleen; Evenepoel, Pieter; Vanrenterghem, Yves

    2007-04-01

    Light chain deposit disease (LCDD) is a monoclonal plasma cell disorder characterized by tissue deposition of nonamyloid immunoglobulin light chains, predominantly kappa chains, causing renal insufficiency. LCDD reoccurs almost invariably after renal grafting, leading to early graft loss, usually within a time span of months to years. We describe a female patient with LCDD who lost her first living donor graft after 1 year due to extensive recurrence of kappa chain deposition. Rituximab was administered on the seventh day after her second transplantation with a graft from a deceased donor, in order to prevent early recurrence of LCDD. The 2-year protocol biopsy - similarly to the completely normal 1-year protocol biopsy - revealed persistent absence of light chain deposition on light microscopy but immunohistochemical staining and electron microscopy showed very mild recurrence of light chain deposits. A second 4-week course of rituximab was repeated because of these electron microscopic findings. Subsequently, free kappa light chain concentration decreased from 693 to 74 mg/l and remained low 4 months after completion of therapy. Rituximab could be considered for delaying early LCDD recurrence in patients in whom treatment of the underlying bone marrow disorder failed or is contraindicated, but maintenance therapy is apparently necessary to consolidate this response. PMID:17326779

  16. Treatment of Autonomous Hyperparathyroidism in Post Renal Transplant Recipients

    ClinicalTrials.gov

    2015-12-23

    Chronic Allograft Nephropathy; Chronic Kidney Disease; Chronic Renal Failure; Disordered Mineral Metabolism; End Stage Renal Disease; Hyperparathyroidism; Hypophosphatemia; Kidney Disease; Kidney Transplantation; Post Renal Transplantation

  17. [Great moments in renal transplantation].

    PubMed

    Ghossain, Antoine

    2015-01-01

    A selective review of some great moments in renal transplantation experienced or witnessed with some of the great architects of this epic. The path was strewn with hazards, sometimes halts or changes of attitude that harmed or helped some patients. PMID:26591188

  18. Renal dysfunction associated with liver transplantation.

    PubMed Central

    Jindal, R. M.; Popescu, I.

    1995-01-01

    It has been known for some time that a variety of liver diseases affect kidney function, but renal dysfunction associated with orthotopic liver transplantation has received scant attention. Although the mechanisms mediating these abnormalities are incompletely defined, advances in the understanding of renal pathophysiology after liver transplantation have made it possible to develop new treatment strategies. Aggressive and early intervention to diagnose and treat renal complications associated with liver transplantation should be the goal for transplant centres. PMID:7479462

  19. PREGNANCY AND RENAL TRANSPLANTATION.

    PubMed

    Atallah, David; El Kassis, Nadine; Salameh, Charbel; Safi, Joelle; Bejjani, Lina; Lutfallah, Fouad; Ghaname, Wadih; Moukarzel, Maroun

    2015-01-01

    Pregnancy is common nowadays in kidney transplant female patients because of medical and surgical advances. However, pregnancy is a high risk one in these patients. Fertility is rapidly restored after the transplantation; thus, contraception is a good option in the first year. Adding to that, pregnancy can endanger the allograft function in the presence of hypertension, a moderate to severe kidney disease and proteinuria. Medical complications are more prevalent in kidney transplant population, such as infections, gestational hypertension and diabetes and anemia. Low birth weight infants and premature delivery are two other major concerns in this population. Acute rejection of the allograft is another major complication that can be avoided with close monitoring of the graft and convenient immunosuppression. Immunosuppressive drugs must be continued during pregnancy except for mycophenolic acid and sirolimus that can be teratogen. Delivery of kidney transplant patients should be vaginal and spontaneous. Cesarean section should be reserved for obstetrical indications. Prophylactic antibiotics should be administered for every invasive procedure. Patients treated with corticosteroids can breastfeed their babies. Kidney donating women can have a safe pregnancy but with a slight risk of gestational diabetes and hypertension. In summary, a multidisciplinary medical team should follow pregnant kidney transplant patients in a tertiary center. International and national registries are a must to collect data concerning this particular high-risk population in order to solve unanswered questions. PMID:26591192

  20. Renal transplantation across ABO barrier

    PubMed Central

    Gupta, P. N.; Pokhariyal, S.; Bansal, S.; Jain, S.; Saxena, V.; Sharma, R.; Jain, M.; Jha, P.; Sethi, S. K.; Ghosh, P.; Tewari, A.; Ahlawat, R.; Kher, V.

    2013-01-01

    In India, patients without a compatible blood group donor are usually excluded from renal transplantation. For young patients, it is a difficult therapeutic choice to stay on long-term dialysis. We describe the case of a 19-year-old male patient who had blood group O +ve and had no compatible donor in the family. His mother was B +ve and was willing to donate. The patient had an initial anti-B antibody titer of 1:512 and underwent antibody depletion with plasmapheresis (11 sessions) and intravenous immunoglobulin (IVIG) 100 mg/kg after every plasmapheresis. He also received rituximab 500 mg for 3 days prior to transplant and was induced with basiliximab. At the time of transplant, his anti-B titers were <1:8. Post-operatively, he required four sessions of plasmapheresis and IVIG as his titers rebounded to 1:64. The titers then spontaneously subsided to <1:16 and have stayed at the same level for 6 months post-transplant. The patient continues to have normal renal function with a creatinine of 1.4 mg/dl% and has had no episodes of rejection. PMID:23814422

  1. Cognitive and emotional effects of renal transplantation

    PubMed Central

    Pawar, A.A.; Rathod, J.; Chaudhury, S.; Saxena, S.K.; Saldanha, D.; Ryali, V.S.S.R.; Srivastava, K.

    2006-01-01

    Background: Recent studies have shown a high prevalence of depression and cognitive changes in patients with end-stage renal disease (ERSD) and renal transplant recipients. There are few data available on the cognitive and emotional changes in patients undergoing renal transplantation in India. Aim: To evaluate the changes in cognitive profile and depression in renal transplant recipients. Methods: Thirty consecutive patients undergoing renal transplantation were evaluated 1 month before and 3 months after successful renal transplant with Beck Depression Inventory (BDI), Weschler Adult Performance Intelligence Scale (WAPIS), Luria Nebraska Neuropsychological battery (LNNB) and Life satisfaction scale. Results: Our study revealed an 86.7% prevalence of depression in ESRD patients as compared to 56.7% in post renal transplant patients. Analysis of neurocognitive functions on LNNB did not reveal any significant impairment. Furthermore, analysis of the Life satisfaction scale revealed most of the patients scored high satisfaction levels despite the stress of their disease. Results on WAPIS brought out significant improvement in intelligence quotient (IQ) after renal transplantation. Conclusion: Successful renal transplant is associated with improvement in depression, IQ and life satisfaction. PMID:20703410

  2. Challenges in pediatric renal transplantation

    PubMed Central

    Peruzzi, Licia; Amore, Alessandro; Coppo, Rosanna

    2014-01-01

    Transplantation in children is the best option to treat renal failure. Over the last 25 years the improvements in therapy have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Tolerance of the graft and minimization of side effects are the challenges for improving the outcome of children with a grafted kidney. Notwithstanding the difficulties in settling in children large multicenter trials to derive statistically useful data, many important contributions in the last years brought important modifications in the immunosuppressive therapy, including minimization protocols of steroids and calcineurin inhibitors and new induction drugs. New methods for diagnosis of anti HLA antibodies and some new protocols to improve both chance and outcome of transplantation in immunized subjects represent area of ongoing research of extreme interest for children. PMID:25540732

  3. Neurocognitive functions in pediatric renal transplant patients.

    PubMed

    Gulleroglu, K; Baskin, E; Bayrakci, U S; Aydogan, M; Alehan, F; Kantar, A; Karakayali, F; Moray, G; Haberal, M

    2013-01-01

    Neurocognitive dysfunction is one of the major complications of chronic renal failure (CRF). Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. The aim of our study was to determine the state of neurocognitive function in pediatric renal transplant recipients. We prospectively performed a neurological examination and neuropsychological test battery (Bender-Gestalt Test, Cancellation Test, and Visual and Auditory Number Assay Test) in 20 pediatric renal transplant recipients between 6 and 16 years of age. Twenty healthy children and 20 children with CRF were included in the study as the control groups. Mean age of the renal transplant recipients was 13.50 ± 3.40 years old. Mean evaluation time after transplantation was 2.0 ± 0.5 years. Bender-Gestalt Test result was abnormal in 40% of patients. The results of the Cancellation Test and the Visual and Auditory Number Assay Test showed significant decline in pediatric renal transplant patients when compared with the control. We found that neurocognitive dysfunction was frequent in pediatric renal transplantation patients. Awareness of this potential problem may be helpful for early recognition and treatment. Our findings suggest that periodic neurocognitive assessments may be indicated in transplant recipients. PMID:24314945

  4. Renal transplantation in Mapuche people.

    PubMed

    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 < .05), and the proportion receiving organs with > or = 3 compatibilities was significantly higher (Mapuche 38% versus non-Mapuche 22%; P < .05). Kaplan-Meier survival curves showed nonsignificant differences in kidney survival: 86% at 5 years and 68% at 10 years in 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. PMID:18454999

  5. Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

    PubMed Central

    McGregor, Tom; Bjazevic, Jennifer; Patel, Premal; Koulack, Joshua

    2016-01-01

    Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. PMID:26858788

  6. Growth in pediatric renal transplant recipients.

    PubMed

    Vasudevan, A; Phadke, K

    2007-04-01

    One of the fundamental challenges in managing pediatric renal transplant recipient is to ensure normal growth and development. The goal of renal transplant is not just to prolong life but to optimize quality of life. Short stature during childhood may be associated with academic underachievement and development of comorbidities such as attention deficit hyperactivity disorder, learning disability, and mood disorders. The most important factors affecting growth are use of corticosteroids, allograft function, and age and height deficit at the time of transplant. Aggressive conservative management of chronic renal failure and early use of growth hormone therapy will help in optimizing height at time of transplant. Early transplant, steroid minimization or withdrawal, and growth hormone therapy will help in achieving normal adult height in a majority of renal post transplant population. Steroid avoidance to achieve good growth still needs to be validated. PMID:17445590

  7. Is there a Role for Gallium-67 Citrate SPECT/CT, in Patients with Renal Impairment or Who are Renal Transplant Recipients, in Identifying and Localizing Suspected Infection?

    PubMed Central

    Nowosinska, Ewa; Navalkissoor, Shaunak; Quigley, Ann Marie; Buscombe, John R.

    2015-01-01

    To assess the added value of single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with end-stage renal failure (ESRF) or renal transplant recipients in whom focal infection was suspected. Gallium-67 (Ga-67) citrate scintigrams of 18 patients (10 in ESRF and eight with renal transplants) were reviewed. Sites of abnormal uptake seen on the whole body and SPECT were noted. A SPECT/CT was also reviewed to see if additional information could be obtained. Imaging results were compared with the final diagnosis. Overall, 14 out of 18 (78%) patients had a proven cause to explain symptoms while four patients did not have a final cause identified. Infection was proven in the final diagnosis in 12 out of 14 (86%) patients. Of the 10 patients with ESRF, six had confirmed infection with the Ga-67 citrate study correctly identifying five out of six (83%) patients, and SPECT/CT providing additional information in four out of five (80%) patients. In the eight renal transplant recipients, six had a confirmed source of infection (all identified by the Ga-67 citrate study). SPECT/CT provided additional information in two out of six (33%) patients. Ga-67 citrate imaging had an overall sensitivity of 13/14 (93%), with one false negative. SPECT/CT provided an additional contribution in eight out of 18 (44%) patients by better defining the location/extent of infection and differentiating the physiological from the pathological uptake. PMID:26420989

  8. Renal transplantation in developing countries.

    PubMed

    Rizvi, S Adibul Hasan; Naqvi, S A Anwar; Hussain, Zafar; Hashmi, Altaf; Akhtar, Fazal; Hussain, Manzoor; Ahmed, Ejaz; Zafar, M Naqi; Hafiz, Saleem; Muzaffar, Rana; Jawad, Fatema

    2003-02-01

    Healthcare in developing countries less funded than developed nations (0.8 to 4% vs. 10 to 15%, respectively), and must contend against approximately 1/3 of the population living below the poverty line ($1US/day), poor literacy (58% males/29% females), and less access to potable water and basic sanitation. Cultural and societal constraints combine with these economic obstacles to translate into poor transplantation activity. Donor shortage is a universal problem. Paid donation comprises 50% of all transplants in Pakistan. Post-transplant infections are a major problem in developing countries, with 15% developing tuberculosis, 30% cytomegalovirus, and nearly 50% bacterial infections. The solutions to these problems may seem simplistic: alleviate poverty, educate the general population, and expand the transplant programs in public sector hospitals where commerce is less likely to play a major role. The SIUT model of funding in a community-government partnership has increased the number of transplantations and patient and organ survival substantially. Over the last 15 years, it has operated by complete financial transparency, public audit and accountability. The scheme has proven effective and currently 110 transplants/year are performed, with free after care and immunosuppressive drugs. Confidence has been built in the community, with strong donations of money, equipment and medicines. We believe this model could be sustained in other developing nations. PMID:12864884

  9. Demodicosis in Renal Transplant Recipients.

    PubMed

    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. PMID:26431451

  10. The renal scan in pregnant renal transplant patients

    SciTech Connect

    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.

  11. Colchicine myoneuropathy in a renal transplant patient.

    PubMed

    Dupont, Peter; Hunt, Ian; Goldberg, Lawrence; Warrens, Anthony

    2002-07-01

    Colchicine is widely employed for the treatment of gout in renal transplant patients where NSAIDs are contra-indicated and allopurinol prophylaxis is often avoided due to concomitant azathioprine immunosuppression. We report here a case of colchicine-induced myoneuropathy in a renal transplant recipient. Our patient had myalgia, muscle weakness, elevated creatine kinase levels, myopathic changes on electromyography and peripheral neuropathy. Withdrawal of colchicine resulted in recovery within 4 weeks. Renal transplant recipients are likely to be at greater risk of colchicine-induced myoneuropathy due to the unique concurrence of risk factors predisposing to toxicity in such patients. These risk factors include the high incidence of gout in this population, widespread use of colchicine as first-line therapy, impaired renal function and concomitant cyclosporin treatment. The diagnosis should be considered in any renal transplant recipient receiving the drug who develops myopathy. Prompt withdrawal of colchicine therapy should result in rapid clinical and biochemical improvement. PMID:12122515

  12. The Iranian model of living renal transplantation.

    PubMed

    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'. PMID:22673884

  13. Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

    PubMed Central

    Jiménez-Alvaro, Sara; Fernández-Rodríguez, Ana; Rivera-Gorrín, Maite; Sánchez, Juan; Chinchilla, Antonio; Marcén, Roberto

    2016-01-01

    Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal. PMID:27579209

  14. Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis.

    PubMed

    Pampa-Saico, Saúl; Jiménez-Alvaro, Sara; Caravaca-Fontán, Fernando; Fernández-Rodríguez, Ana; Rivera-Gorrín, Maite; Sánchez, Juan; Chinchilla, Antonio; Marcén, Roberto

    2016-01-01

    Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal. PMID:27579209

  15. Blood disorders typically associated with renal transplantation

    PubMed Central

    Yang, Yu; Yu, Bo; Chen, Yun

    2015-01-01

    Renal transplantation has become one of the most common surgical procedures performed to replace a diseased kidney with a healthy kidney from a donor. It can help patients with kidney failure live decades longer. However, renal transplantation also faces a risk of developing various blood disorders. The blood disorders typically associated with renal transplantation can be divided into two main categories: (1) Common disorders including post-transplant anemia (PTA), post-transplant lymphoproliferative disorder (PTLD), post-transplant erythrocytosis (PTE), and post-transplant cytopenias (PTC, leukopenia/neutropenia, thrombocytopenia, and pancytopenia); and (2) Uncommon but serious disorders including hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA), therapy-related myelodysplasia (t-MDS), and therapy-related acute myeloid leukemia (t-AML). Although many etiological factors involve the development of post-transplant blood disorders, immunosuppressive agents, and viral infections could be the two major contributors to most blood disorders and cause hematological abnormalities and immunodeficiency by suppressing hematopoietic function of bone marrow. Hematological abnormalities and immunodeficiency will result in severe clinical outcomes in renal transplant recipients. Understanding how blood disorders develop will help cure these life-threatening complications. A potential therapeutic strategy against post-transplant blood disorders should focus on tapering immunosuppression or replacing myelotoxic immunosuppressive drugs with lower toxic alternatives, recognizing and treating promptly the etiological virus, bacteria, or protozoan, restoring both hematopoietic function of bone marrow and normal blood counts, and improving kidney graft survival. PMID:25853131

  16. Blood disorders typically associated with renal transplantation.

    PubMed

    Yang, Yu; Yu, Bo; Chen, Yun

    2015-01-01

    Renal transplantation has become one of the most common surgical procedures performed to replace a diseased kidney with a healthy kidney from a donor. It can help patients with kidney failure live decades longer. However, renal transplantation also faces a risk of developing various blood disorders. The blood disorders typically associated with renal transplantation can be divided into two main categories: (1) Common disorders including post-transplant anemia (PTA), post-transplant lymphoproliferative disorder (PTLD), post-transplant erythrocytosis (PTE), and post-transplant cytopenias (PTC, leukopenia/neutropenia, thrombocytopenia, and pancytopenia); and (2) Uncommon but serious disorders including hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA), therapy-related myelodysplasia (t-MDS), and therapy-related acute myeloid leukemia (t-AML). Although many etiological factors involve the development of post-transplant blood disorders, immunosuppressive agents, and viral infections could be the two major contributors to most blood disorders and cause hematological abnormalities and immunodeficiency by suppressing hematopoietic function of bone marrow. Hematological abnormalities and immunodeficiency will result in severe clinical outcomes in renal transplant recipients. Understanding how blood disorders develop will help cure these life-threatening complications. A potential therapeutic strategy against post-transplant blood disorders should focus on tapering immunosuppression or replacing myelotoxic immunosuppressive drugs with lower toxic alternatives, recognizing and treating promptly the etiological virus, bacteria, or protozoan, restoring both hematopoietic function of bone marrow and normal blood counts, and improving kidney graft survival. PMID:25853131

  17. Presurgical Pulmonary Evaluation in Renal Transplant Patients

    PubMed Central

    Sahni, Sonu; Molmenti, Ernesto; Bhaskaran, Madhu C.; Ali, Nicole; Basu, Amit; Talwar, Arunabh

    2014-01-01

    Patients with chronic renal failure (CRF) due to various mechanisms are prone to significant pulmonary comorbidities. With the improvements in renal replacement therapy (RRT), patients with CRF are now expected to live longer, and thus may develop complications in the lung from these processes. The preferred treatment of CRF is kidney transplantation and patients who are selected to undergo transplant must have a thorough preoperative pulmonary evaluation to assess pulmonary status and to determine risk of postoperative pulmonary complications. A MEDLINE®/PubMed® search was performed to identify all articles outlining the course of pre-surgical pulmonary evaluation with an emphasis on patients with CRF who have been selected for renal transplant. Literature review concluded that in addition to generic pre-surgical evaluation, renal transplant patients must also undergo a full cardiopulmonary and sleep evaluation to investigate possible existing pulmonary pathologies. Presence of any risk factor should then be aggressively managed or treated prior to surgery. PMID:25599047

  18. Asymptomatic hyperuricemia following renal transplantation

    PubMed Central

    Bellomo, Gianni

    2015-01-01

    Evidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear. In this short review evidence from epidemiological as well as intervention studies is summarized and discussed, with some practical considerations presented at the end. PMID:26167455

  19. Asymptomatic hyperuricemia following renal transplantation.

    PubMed

    Bellomo, Gianni

    2015-07-01

    Evidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear. In this short review evidence from epidemiological as well as intervention studies is summarized and discussed, with some practical considerations presented at the end. PMID:26167455

  20. Cortical necrosis in a renal transplant

    SciTech Connect

    Blumhardt, R.; Growcock, G.; Lasher, J.C.

    1983-07-01

    The /sup 99m/Tc-DTPA renogram is a well extabished noninvasive method for evaluating and following transplanted kidneys. The examination is useful in distinguishing rejection from acute tubular necrosis as well as demonstrating several less common complications such as vascular occlusion, urinary extravasation, obstruction, and lymphocele. A previously unreported condition involving a transplant kidney (i.e., renal cortical necrosis) is described which was diagnosed with renal scintigraphy in combination with sonography.

  1. Psychosocial aspects of dialysis and renal transplant.

    PubMed

    Haq, I; Zainulabdin, F; Naqvi, A; Rizvi, A H; Ahmed, S H

    1991-05-01

    Keeping in view our socio cultural millieu, the psychological aspects of twenty renal transplants recipients and equal number of patients on dialysis were studied. Socio psychiatric profile in the dialysis and transplanted patients revealed that the frequency of anxiety, depression and hypochondriasis was significantly less (P less than 0.01) in the transplanted group. On Bender Gestalt Scale the transplanted group achieved normal status in significantly higher (P less than 0.05) number compared to the dialysis patients. It was concluded that transplanted patients showed marked improvement in social functioning, psychological symptoms and enduring personality traits compared to patients on maintenance dialysis. PMID:1861361

  2. Successful renal transplantation in primary hyperoxaluria.

    PubMed Central

    O'Regan, P.; Constable, A. R.; Joekes, A. M.; Kasidas, G. P.; Rose, G. A.

    1980-01-01

    A successful live related renal transplant in a 29-year-old male patient with Type 1 primary hyperoxaluria, who remains well 32 months postoperatively, is described. The plasma oxalate and exchangeable oxalate pool before transplantation were 160 mumol/1 and 4429 mumol respectively. Since the transplant these have been greatly reduced although they remain elevated above the normal by a factor of 2. Pyridoxine therapy and the avoidance of oxalate-rich foods have been effective in maintaining these reduced levels and the 24-hr urinary oxalate excretion has also been maintained close to normal levels on this regime. After review of the previously reported transplants in patients with well documented primary hyperoxaluria and from the experience with this patient, the following guidelines for successful renal transplantation in primary hyperoxaluria are suggested: transplants should only be carried out in those who have shown a response to adequate pyrodoxine therapy; frequent haemodialysis pre-operatively and during periods of oliguria postoperatively is necessary; oxalate-rich foods should be avoided and a high fluid intake should be maintained after transplantation. If these guidelines are followed there is no contra-indicatin to live related renal transplants in primary hyperoxaluric patients. Images Fig. 1 Fig. 2 PMID:7001421

  3. Dental management of people with renal disease and renal transplants.

    PubMed

    Ferguson, C A; Whyman, R A

    1998-09-01

    Chronic renal failure is the result of progressive loss of functioning nephrons leading to loss of renal function and accumulation of excretory products. Loss of the regulatory and excretory functions of the kidneys causes oral manifestations and multiple complications which have implications for dental care. Dental management of patients with renal failure and renal transplants involves consideration of specific haematological and cardiovascular effects, and implications for the prescribing and use of pharmaceuticals. It also requires the dentist to appreciate the potential for involvement of multiple organ systems in the disease process and the implications this has for dental care. The orofacial manifestations of chronic renal failure are secondary to systemic manifestations and are not specific to the diagnosis of end-stage renal disease. PMID:9775650

  4. Management of children after renal transplantation: highlights for general pediatricians

    PubMed Central

    Giglia, Lucy; Chan, Howard; Chan, Anthony K.

    2012-01-01

    The number of children undergoing successful renal transplantations has been increasing steadily and as a result; general pediatricians are now more likely to encounter children with a kidney allograft in their practice. Although the medical care immediately after transplantation is mostly provided by transplant teams, more and more outpatient care will eventually be performed at the patient’s local community. Medical care from general pediatricians is particularly important, especially for children who are residing far from transplant centers. As these children require prolong immunosuppressive therapies and are susceptible to various specific clinical problems, it is imperative for their primary care providers and pediatricians to be knowledgeable about their specific needs and be competent in providing care. This article highlights the roles and common practice related issues that pertain to general pediatricians in the care of pediatric renal allograft recipients. PMID:26835261

  5. Challenges in renal transplantation in Yemen.

    PubMed

    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

    2015-01-01

    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. PMID:25683097

  6. Invasive Fungal Infections after Renal Transplantation

    PubMed Central

    Ezzatzadegan, S.; Chen, S.; Chapman, J. R.

    2012-01-01

    Background: Invasive fungal infection (IFI) is a leading cause of infection-related mortality among kidney allograft recipients.  Objective: To estimate the incidence and etiology of systemic fungal infection in renal allograft recipients in Sydney transplant facility. Methods: 471 kidney recipients, transplanted between 2000 and 2010 at the Westmead Hospital renal transplantation center, Sydney, Australia, were retrospectively surveyed. Results: IFI developed in 10 (2.1%) of 471 patients. With a mean±SD new kidney transplants per year of 42.9±13, the mean±SD incidence of IFI was 0.9±0.6 for each year of transplantation. 4 patients had received kidneys from living donors and 7 from cadavers with a mean±SD age of 50.5±14 years. The mean time to IFI was 33 months after transplantation with majority within the first 2 years. Cryptococcus neoformans was responsible for 50% of episodes (n=5) followed by Aspergillus fumigatus (n=3), and Pseudallescheria boydii (n=3); there was a single case of mucurmycosis. Lungs (n=5) followed by meninges (n=4) and skin (n=3) were the most commonly involved sites. Conclusion: IFI remains a major concern in renal transplantation. A high index of suspicion is required for early diagnosis and treatment to reduce the mortality. In this regard, appropriate diagnostic tests are necessary, particularly for C. neoformans. PMID:25013619

  7. FSGS Recurrence in Adults after Renal Transplantation

    PubMed Central

    Rudnicki, Michael

    2016-01-01

    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. PMID:27144163

  8. Renal scans in pregnant transplant patients

    SciTech Connect

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

    1988-08-01

    This study demonstrates the normal technetium-99m diethylenetriaminepentaacetic acid ((/sup 99m/Tc)DTPA) renal scan in pregnant patients with transplanted kidneys. Five pregnant renal transplant patients had seven (/sup 99m/Tc)DTPA renal studies to assess allograft perfusion and function. All scans showed the uteroplacental complex. The bladder was always compressed and distorted. The transplanted kidney was frequently rotated to a more vertical position. In all patients allograft flow and function were maintained. There was calyceal retention on all studies and ureteral retention activity in three of five patients. Using the MIRD formalism, the total radiation absorbed dose to the fetus was calculated to be 271 mrad. This radiation exposure is well within NRCP limits for the fetus of radiation workers and an acceptable low risk in the management of these high risk obstetric patients.

  9. Simultaneous pancreatic-renal transplant scintigraphy

    SciTech Connect

    Shulkin, B.L.; Dafoe, D.C.; Wahl, R.L.

    1986-12-01

    99mTc-DTPA scintigraphy was evaluated in seven patients as a technique to assess perfusion of the transplanted pancreas and kidney. Such scans provide high-quality images of both organs in both the flow phase and later phases. The radionuclide is readily available and its brief effective half-life allows repeated evaluations at short intervals. /sup 131/I-hippuran, the major radiopharmaceutical for renal transplant scintigraphy, does not allow visualization of the transplanted pancreas or evaluation of its blood supply. Although the blood glucose is a gross indicator of the function of the pancreatic allograft, pancreatic scintigraphy with 99mTc-DTPA in one case was capable of detecting graft dysfunction before elevation of the blood glucose occurred. While additional studies will be necessary to determine the predictive value of this test, 99mTc-DTPA is valuable for pancreatic-renal transplant evaluation.

  10. Pediatric renal transplantation: a single center experience.

    PubMed

    Kavaz, A; Özçakar, Z B; Bulum, B; Tüzüner, A; Keven, K; Şengül, Ş; Ekim, M; Yalçınkaya, F

    2013-04-01

    Renal transplantation is the treatment of choice for children with end-stage renal disease. The aim of this study was to evaluate retrospectively of our 37 pediatric renal allograft recipients, including 20 boys and 17 girls from July 2007 to August 2012. The overall mean age at transplantation was 12.16 ± 4.25 years. Three patients (8.1%) were transplanted preemptively; two were ABO-incompatible transplantations. The majority of recipients received living donor grafts (81%). The mean duration of follow-up was 25.10 ± 14.95 months. Seven acute rejection episodes were observed in 6 patients (16.2%). Eleven recipients developed serious viral infections: cytomegalovirus (n = 8), parvovirus (n = 2), BK virus (polyoma hominis 1) (n = 2), or Ebstein-Barr virus (n = 1). Three patients died; one from posttransplant lymphoproliferative disease, one from primary disease recurrence with infection, and one from sepsis. In conclusion, kidney transplantation is the treatment of choice for end-stage renal disease. Infection was the major concern after this procedure. PMID:23622586

  11. PARACOCCIDIOIDOMYCOSIS IN A RENAL TRANSPLANT RECIPIENT

    PubMed Central

    GÓES, Heliana Freitas de Oliveira; DURÃES, Sandra Maria Barbosa; LIMA, Caren dos Santos; de SOUZA, Mariana Boechat; VILAR, Enoi Aparecida Guedes; DALSTON, Marcos Olivier

    2016-01-01

    Paracoccidioidomycosis (PCM) is the most common endemic mycosis in Latin America. The etiological agents, which comprise two species, Paracoccidioides brasiliensis and P. lutzii, are thermodimorphic fungi that usually affect previously healthy adults. They primarily involve the lungs and then disseminate to other organs. Such mycosis is rare in organ transplant recipients; there have been only three cases reported in literature, until now. We report a case of PCM in a renal transplant recipient with an unusual dermatological presentation. PMID:26910451

  12. Adipocytokines in renal transplant recipients

    PubMed Central

    Nagy, Kristof; Nagaraju, Shankar Prasad; Rhee, Connie M.; Mathe, Zoltan; Molnar, Miklos Z.

    2016-01-01

    In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs. PMID:27274819

  13. Adipocytokines in renal transplant recipients.

    PubMed

    Nagy, Kristof; Nagaraju, Shankar Prasad; Rhee, Connie M; Mathe, Zoltan; Molnar, Miklos Z

    2016-06-01

    In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs. PMID:27274819

  14. Abdominal aortic aneurysmectomy in renal transplant patients.

    PubMed Central

    Lacombe, M

    1986-01-01

    Five patients who had undergone renal transplantation 3 months to 23 years ago were operated on successfully for an abdominal aortic aneurysm. In the first case, dating from 1973, the kidney was protected by general hypothermia. In the remaining patients, no measure was used to protect the kidney. Only one patient showed a moderate increase of blood creatinine in the postoperative period; renal function returned to normal in 15 days. All five patients have normal renal function 6 months to 11 years after aortic repair. Results obtained in this series show that protection of the transplant during aortic surgery is not necessary, provided adequate surgical technique is used. Such a technique is described in detail. Its use simplifies surgical treatment of such lesions and avoids the complex procedures employed in the seven previously published cases. Images FIGS. 1A and B. FIGS. 2A and B. FIGS. 3A and B. FIGS. 4A and B. FIGS. 5A and B. PMID:3510592

  15. Anemia in pediatric renal transplant recipients.

    PubMed

    Kausman, Joshua Yehuda; Powell, Harley Robert; Jones, Colin Lindsay

    2004-05-01

    The aim of this study was to establish the prevalence of anemia in stable pediatric renal transplant recipients and to examine the association of anemia with renal function, immunosuppressants, angiotensin converting enzyme inhibitors, and growth, as well as iron, vitamin B(12), and folate stores. This is a cross-sectional study of the 50 renal transplant recipients currently followed at our center. Patient data were collected regarding hematological parameters, growth, medications, renal function, underlying renal disease, delayed graft function, episodes of rejection, and iron or erythropoietin therapy post transplantation. The mean hemoglobin level (Hb) was 110 g/l and the overall prevalence of anemia was 60%, including 30% who were severely anemic (Hb<100 g/l). There was a high rate of iron deficiency (34%) and serum iron was the parameter of iron metabolism most closely associated with anemia. Hb in patients with low serum iron was 90.7 g/l versus 114.4 g/l in those with normal serum iron ( P<0.01). Both univariate and multiple linear regression determined tacrolimus dose and creatinine clearance to be significant factors associated with anemia. Tacrolimus dose correlated with a 10 g/l reduction in Hb for every increase of tacrolimus dose of 0.054 mg/kg per day ( P=0.001). The dose of mycophenolate was positively correlated with Hb, but this was likely to be confounded by our practice of dose reduction in the setting of anemia. Angiotensin converting enzyme inhibitor use was not associated with anemia. Severely anemic patients tended to be shorter, with a mean Z-score for height of -1.8 compared with -0.9 for those with normal Hb ( P=0.02). Anemia is a significant and common problem in pediatric renal transplant patients. Deteriorating renal function is an important cause, but other factors like iron deficiency and immunosuppression are involved. Definition of iron deficiency is difficult and serum iron may be a valuable indicator. Medication doses

  16. Renal cancer in kidney transplanted patients.

    PubMed

    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. PMID:26202137

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

    PubMed Central

    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. PMID:26440255

  18. Cold Storage Exacerbates Renal and Mitochondrial Dysfunction Following Transplantation

    PubMed Central

    Shrum, S; MacMillan-Crow, LA; Parajuli, N

    2016-01-01

    Long-term renal function is compromised in patients receiving deceased donor kidneys which require cold storage exposure prior to transplantation. It is well established that extended cold storage induces renal damage and several labs, including our own, have demonstrated renal mitochondrial damage after cold storage alone. However, to our knowledge, few studies have assessed renal and mitochondrial function after transplantation of rat kidneys exposed to short-term (4 hr) cold storage compared to transplant without cold storage (autotransplantation). Our data reveal that cold storage plus transplantation exacerbated renal and mitochondrial dysfunction when compared to autotransplantation alone. PMID:27066594

  19. Transmission of toxoplasmosis by renal transplant.

    PubMed

    Mejia, G; Leiderman, E; Builes, M; Henao, J; Arbelaez, M; Arango, J L; Borrero, J

    1983-05-01

    Two renal allograft recipients who had received their organs from the same cadaver donor developed acute toxoplasmosis shortly after transplantation. Neither of the recipients had serologic evidence of previous exposure to Toxoplasma gondii at the time of surgery, but the donor had a positive indirect fluorescent antibody test. One of the recipients died during the fourth week, and multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite could be found in the transplanted kidney. In the second recipient the disease was suspected, serologically demonstrated, and successfully treated. We concluded that toxoplasmosis was transmitted by the donor's kidneys, although this mode of transmission was not completely proven. PMID:6342373

  20. Urinary tract infections in renal transplant recipients.

    PubMed

    Alangaden, George

    2007-11-01

    Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. Although Escherichia coli remains the most common cause of UTI, Enterococcus spp and drug-resistant Enterobacteriaceae have emerged as important uropathogens in these patients. As a result, symptomatic UTIs warrant pathogen-specific antibiotic therapy guided by culture and susceptibility data. In the early transplant period, prophylaxis of UTI with trimethoprim-sulfamethoxazole is generally effective. Until the natural history and optimal management of asymptomatic bacteruria are better defined, therapy of asymptomatic bacteruria is generally unnecessary. PMID:17999883

  1. Neurologic complications following pediatric renal transplantation.

    PubMed

    Ghosh, Partha S; Kwon, Charles; Klein, Melanie; Corder, Julie; Ghosh, Debabrata

    2014-06-01

    We reviewed neurologic complications after renal transplantation in children over a 20-year period. Neurologic complications were classified as early (within 3 months) and delayed (beyond 3 months). Of 115 children, 10 (8.7%) had complications. Early complications were found in 4.35% of patients: seizures in 4 (posterior reversible leukoencephalopathy syndrome due to immunosuppressant toxicity, sepsis/presumed meningitis, and indeterminate) and headaches in 1. One patient with seizures received levetiracetam for 6 months and 1 with headaches received amitriptyline prophylaxis. Late complications were noted in 4.35% of patients: seizures in 3 (posterior reversible leukoencephalopathy syndrome due to hypertension, hypertensive encephalopathy), headaches in 2, and tremors in 1. Two patients with seizures were treated with anti-epilepsy medications; 1 with migraine received cyproheptadine prophylaxis. Neurologic complications develop in children after renal transplantation. Seizures due to posterior reversible leukoencephalopathy syndrome were the commonest complication. Early detection and appropriate management of these complications is important. PMID:23752071

  2. Parasitic infection in renal transplant recipients.

    PubMed

    Valar, C; Keitel, E; Dal Prá, R L; Gnatta, D; Santos, A F; Bianco, P D; Sukiennik, T C T; Pegas, K L; Bittar, A E; Oliveira, K T; Garcia, V D

    2007-03-01

    The purpose of this study was to evaluate the prevalence of symptomatic parasitic infections in adult renal transplant recipients. We retrospectively analyzed a sample of 657 adult renal transplant recipients performed from January 2001 to December 2005 for immunosuppression protocol, clinical manifestations, parasite diagnosis, treatments, and outcomes. The prevalence of symptomatic parasitosis infections was 2.4% (16/657). None of the infected patients received cyclosporine in their immunosuppression protocol. Most of the infections were caused by Strongyloids stercoralis (n = 11), followed by Giardia lamblia (n = 3), Toxoplasma gondii (n = 1), and Trypanosoma cruzi: (n = 1). Strongyloides stercoralis was the most frequent agent, causing three cases of hyperinfection including one fatal case. With the new immunosuppressive regimes there must be a suspicion of parasitic infection to avoid the diagnostic delay that can be fatal. Strategies, including empiric treatment for S. stercoralis, must be considered. PMID:17362759

  3. Whooping cough in a renal transplant recipient.

    PubMed

    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. PMID:26808962

  4. Pyelo-ureteral necrosis after renal transplantation.

    PubMed

    Spasovski, Goce B; Masin-Spasovska, Jelka; Stavridis, Sotir; Saiti, Skender; Lekovski, Ljupco

    2008-01-01

    Because of the limited chance of receiving a kidney transplant (for several well-known reasons), a lot of desperate dialysis patients procure an unrelated donor kidney transplant against all medical advice. This type of renal paid transplantation is associated with many surgical complications and invasive opportunistic infections that increase the morbidity and mortality in this group of transplant recipients. In this report, we describe a case of a 22-year-old girl with a segmental infarction of the graft lower pole and a complete pyelo-ureteral necrosis as a consequence of some vascular damage, complicated by a pathohistological finding of an invasive candidiasis. Despite the successful surgical pyelovesical anastomosis and the good recovery of the patient and the kidney, long-term prognosis remains poor. The lack of information from the transplanting center regarding both donor and recipient and the associated, unacceptable risks on the graft and patient survival in unrelated, paid transplant recipients reinforce the standpoint that this practice should be abandoned. PMID:18204913

  5. Cardiovascular disease in renal transplant recipients.

    PubMed

    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. PMID:20586909

  6. Changes in leucocyte migration after renal transplantation

    PubMed Central

    Smith, M. G. M.; Eddleston, A. L. W. F.; Dominguez, J. A.; Evans, D. B.; Bewick, M.; Williams, Roger

    1969-01-01

    The leucocyte migration test, an in-vitro measure of cellular immunity, has been used to follow the changes in cell-mediated hypersensitivity to kidney and histocompatibility antigens in three patients after renal transplantation. Inhibition of leucocyte migration, indicating strong sensitization to the antigens used, occurred in each patient, starting five to seven days after transplantation. Satisfactory renal function had not been established in any of the patients at this time. In one case inhibition of leucocyte migration persisted almost continuously until the 24th day and was associated with poor renal function proved histologically to be due to rejection. Treatment with increased dosage of prednisone was associated with a rapid reversion to normal of the migration index and improvement in renal function. Later, inhibition of migration occurred again, and shortly afterwards the graft ceased to function. In the other two cases the migration index became normal without alteration in immunosuppressive therapy and a satisfactory diuresis followed. It is suggested that this simple test should prove useful in the specific diagnosis of rejection and in control of immunosuppressive therapy. ImagesFig. 3Fig. 4 PMID:4899455

  7. [Cytomegalovirus and BK polyomavirus infection after renal transplantation].

    PubMed

    De Paolis, P; Gervasio, E; Tedesco, M; Favaro', A; Iappelli, M; Di Giulio, S

    2009-01-01

    Cytomegalovirus (CMV) and BK polyomavirus (BKV) infections have been described in a high percentage of renal transplant patients and are known to cause various complications in renal transplantation. They are closely related to immunosuppressive therapy and implicated in the progression of graft failure. This review focuses on the clinical aspects of CMV and BKV infection after renal transplantation, optimal monitoring, and recent preventive measures and interventions to improve graft function and recipient survival. PMID:19382094

  8. Noncompliance in children with renal transplants.

    PubMed

    Korsch, B M; Fine, R N; Negrete, V F

    1978-06-01

    Fourteen patients (13 of them adolescents) interrupted immunosuppressive treatment following renal transplantation. Twelve were girls and two were boys. Six subsequently lost their allografts and eight had impaired renal function. Noncompliance was suspected when diminution in cushingoid features, unexplained weight loss, or changes in renal function occurred. Noncompliance was comfirmed by interview with psychosocial staff. Available psychosocial data from family interview and personality test obtained earlier as part of systematic follow-up study were analyzed to explore the reasons for noncompliance. Non compliant patient families had lower incomes, more fatherless households, and comunication difficulties within the family and with the medical establishment. Using a stepwise discriminant analysis, a discriminant function was derived which selected 13 of 14 noncompliant patients. Noncompliance may be a preventable cause of allograft failure. These data can aid in identifying high-risk patients and planning intervention programs. PMID:353683

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

    PubMed

    Bhatti, Adnan Bashir; Usman, Muhammad

    2015-01-01

    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. PMID:26677426

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

    PubMed Central

    Usman, Muhammad

    2015-01-01

    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. PMID:26677426

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

    PubMed

    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. PMID:26154652

  12. Ambulatory blood pressure monitoring in renal transplantation: should ABPM be routinely performed in renal transplant patients?

    PubMed

    Covic, Adrian; Segall, Liviu; Goldsmith, David J A

    2003-12-15

    In renal transplant recipients, hypertension is common and associated with increased cardiovascular and allograft rejection risks. Ambulatory blood pressure monitoring is required for its accurate diagnosis and adequate treatment, as it clearly offers several advantages over office or casual blood pressure measurements. First, it correlates better with target-organ damage and with cardiovascular mortality. Second, ambulatory blood pressure monitoring can eliminate "white coat" hypertension. Most important is the identification of nocturnal hypertension, an independent cardiovascular risk factor. A circadian nondipping pattern is often found in renal transplant recipients, most probably resulting from cyclosporine A and persistent fluid overload in the early posttransplant phase (approximately 70% prevalence), but reflecting an underlying renal (parenchymal or vascular) allograft disease when persistent (approximately 25% prevalence) beyond the first year posttransplant. PMID:14702541

  13. Robotic renal transplantation: first European case.

    PubMed

    Boggi, Ugo; Vistoli, Fabio; Signori, Stefano; D'Imporzano, Simone; Amorese, Gabriella; Consani, Giovanni; Guarracino, Fabio; Melfi, Franca; Mussi, Alfredo; Mosca, Franco

    2011-02-01

    A kidney from a 56-year-old mother was transplanted to her 37-year-old daughter laparoscopically using the daVinci HDSi surgical system. The kidney was introduced into the abdomen through a 7-cm suprapubic incision used also for the uretero-vescical anastomosis. Vascular anastomoses were carried out through a total of three additional ports. Surgery lasted 154 min, including 51 min of warm ischemia of the graft. Urine production started immediately after graft reperfusion. Renal function remains optimal at the longest follow-up of 3 months. The technique employed in this case is discussed in comparison with the only other two contemporary experiences, both from the USA. Furthermore, possible advantages and disadvantages of robotics in kidney transplantation are discussed extensively. We conclude that the daVinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Further experience is needed, but it is likely that solid organ transplantation will not remain immune to robotics. PMID:21091963

  14. Subclinical Rejection in Renal Transplantation: Reappraised.

    PubMed

    Mehta, Rajil; Sood, Puneet; Hariharan, Sundaram

    2016-08-01

    Short-term outcomes in renal transplantation have improved significantly in the past few years. However, the improvement in long-term outcomes has been modest. The reasons for graft failure beyond the first year of transplantation have been attributed to several different factors. We believe that subclinical rejection (SCR) may be 1 of the factors that contribute to graft loss in the long run. We also believe that there are data to suggest that SCR leads to progressive fibrosis and loss of graft function. This has been demonstrated even in patients who have mild degrees of subclinical inflammation. This review outlines the major studies that have been published on this important topic. It also outlines potential risk factors for the development of SCR. The current approach and diagnostic methods are discussed as well as their pros and cons. Newer noninvasive methods of diagnosis as well as molecular diagnostics and their merits and shortcomings are also discussed in some depth. Thus, the proposed state of the art review on SCR will create a renewed interest at all levels including transplant clinicians, transplant researchers, pharmaceutical industries as well as regulatory organizations. PMID:26985747

  15. Cutaneous alternariosis in a renal transplant recipient.

    PubMed

    Essabbah, Nawel; Gorsane, Imen; Youssef, Monia; Hadhri, Rym; Aloui, Sabra; Gorcii, Mohamed; Ali, Hichem Bel Hadj; Chemli, Zeineb; Babba, Hammouda; El May, Mezri; Zili, Jameleddine; Zakhama, Abdelfatteh; Skhiri, Habib

    2014-05-01

    Alternariosis is a fungal infection that is usually described in immunocompromised patients. We report a case of cutaneous alternariosis in a renal transplant recipient caused by Alternaria tenuissima. The diagnosis was supported by histopathologic (ie, yeastlike cells, filamentous structures) and mycologic findings from a cutaneous biopsy. Cutaneous lesions regressed 1 month following a decrease in the dosage of immunosuppressive therapy. The patient also was treated with intravenous amphotericin B followed by oral fluconazole without improvement. Cryotherapy remarkably accelerated healing of the lesions. PMID:24897135

  16. Gout in pediatric renal transplant recipients.

    PubMed

    Trück, Johannes; Laube, Guido F; von Vigier, Rodo O; Goetschel, Philippe

    2010-12-01

    Clinical gout has rarely been described after pediatric renal transplantation (RTx), although asymptomatic hyperuricemia is common in these patients. We describe three male pediatric patients who presented with gouty arthritis 7-8.5 years following RTx. Since receiving allopurinol, all patients had been free of gouty symptoms. To prevent severe bone marrow depletion, the dosage of azathioprine, an immunosupressant drug, was reduced by 50% to prevent interaction with allopurinol. Because atypical presentation of gout can occur, a high index of suspicion is needed to allow appropriate diagnosis of this disease in patients with skeletal pain after RTx. PMID:20640905

  17. Renal allograft transplant recipient with ruptured hydatid native kidney.

    PubMed

    Bhat, Riyaz Ahmad; Wani, Imtiyaz; Khan, Imran; Wani, Muzaffar

    2014-07-01

    Echinococcosis of the kidneys in a renal transplant recipient is extremely rare and its occurrence being related to immunosuppression is a possibility which needs further characterisation. Ruptured renal hydatid in a renal transplant recipient is not reported so far to our best knowledge. We present a 42-year-old renal allograft receipient who presented one year after transplant with left flank pain, palpable left lumbar mass and gross hydatiduria. Investigations revealed a ruptured native hydatid kidney. Patient was managed with a combination of chemotherapy and left native nephrectomy and discharged in a satisfactory condition. PMID:25125908

  18. Non-invasive cardiac investigations in patients awaiting renal transplantation.

    PubMed Central

    Langford, E J; de Belder, A J; Cairns, H; Hendry, B M; Wainwright, R J

    1997-01-01

    Patients with chronic renal failure undergoing renal transplantation have a high prevalence of cardiovascular disease. Invasive investigation may identify those at risk of cardiac death during or after renal transplantation, but which patients should undergo cardiac catheterization is currently not clear. In 95 patients awaiting renal transplantation we assessed the ability of echocardiography and exercise electrocardiography to identify patients at risk of cardiac death. Echocardiography identified impaired left ventricular (LV) systolic function in 20%, severe in 8%. Of the patients with severe LV dysfunction, 25% died before transplantation. Of those undergoing exercise electrocardiography, 44% did not achieve 85% of maximum predicted heart rate. No coronary artery disease requiring intervention was identified by exercise testing. These findings indicate that echocardiography, but not exercise electrocardiography, should be part of the assessment for renal transplantation. PMID:9135610

  19. Cardiovascular risk factors following renal transplant

    PubMed Central

    Neale, Jill; Smith, Alice C

    2015-01-01

    Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Non-traditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. PMID:26722646

  20. Prednisolone protein binding in renal transplant patients.

    PubMed Central

    Reece, P A; Disney, A P; Stafford, I; Shastry, J C

    1985-01-01

    Prednisolone pharmacokinetics and protein binding characteristics were studied in 10 renal transplant patients with various degrees of renal function (serum creatinine: 80-380 mumol/l) who received their usual oral maintenance dose of prednisolone (0.18 +/- 0.04 mg/kg). Plasma was assayed for prednisolone and hydrocortisone by h.p.l.c. and free prednisolone concentrations were determined in each sample by a rapid ultrafiltration technique. Free prednisolone area under curve (AUCu) ranged from 101 to 436 ng ml-1 h and was 6.3 to 15.0% of total prednisolone AUC. The fraction AUCu/AUC was closely related to serum albumin and creatinine concentrations determined at the time of study (multilinear regression correlation coefficient r2 = 0.830, P less than 0.0001); elevated serum creatinine and low albumin concentrations were associated with a higher % free. These results suggest that much of the variability in prednisolone protein binding could be attributed to inter-patient variability in serum albumin and creatinine concentrations. Total prednisolone concentrations would be potentially misleading in any comparisons made between patient groups with different renal function. PMID:3899153

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

    PubMed

    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. PMID:27018408

  2. Endovascular repair of a transplant renal artery anastomotic pseudoaneurysm using the snorkel technique.

    PubMed

    Che, Haijie; Men, Changping; Yang, Mu; Zhang, Juwen; Chen, Ping; Yong, Jun

    2014-10-01

    Renal artery pseudoaneurysms after renal transplantation are extremely uncommon and are able to cause severe complications such as aneurysm rupture or renal allograft loss. Treatment often leads to transplant nephrectomy. We successfully treated a transplant renal artery pseudoaneurysm with covered stents, which resulted in well-preserved renal function. PMID:23993437

  3. An epidemic of Pneumocystis jiroveci pneumonia in a renal transplantation center: role of T-cell lymphopenia.

    PubMed

    Brunot, V; Pernin, V; Chartier, C; Garrigue, V; Vetromile, F; Szwarc, I; Delmas, S; Portalès, P; Basset, D; Mourad, G

    2012-11-01

    Although only 2 cases of Pneumocystis jiroveci pneumonia were observed in our center between 2004 and 2009, we diagnosed 9 cases in 2010. Each patient had been in contact in the hospital with at least 1 other patient suffering P jiroveci pneumonia. Genotyping of P jiroveci pneumonia strains demonstrates a total homogeneity of the DNA sequences in the 7 patients already analyzed. CD4+ lymphocyte count was significantly lower at M3 in P jiroveci pneumonia patients than in controls. Our clinical and molecular data confirm that interhuman transmission of P jiroveci is possible, particularly to lymphopenic transplant recipients. PMID:23146531

  4. Hyperinfection strongyloidiasis in renal transplant recipients.

    PubMed

    Khuroo, Mehnaaz S

    2014-01-01

    Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We report two cases of hyperinfection strongyloidiasis in renal transplant recipients and document endoscopic and pathological changes in the involved small bowel. One patient presented with features of dehydration and malnutrition while another developed ileal obstruction and strangulation, requiring bowel resection. Oesophagogastroduodenoscopy showed erythematous and thickened duodenal mucosal folds. Histopathological examination of duodenal biopsies revealed S. stercoralis worms, larvae and eggs embedded in mucosa and submucosa. Wet mount stool preparation showed filariform larvae of S. stercoralis in both cases. Patients were managed with anthelmintic therapy (ivermectin/albendazole) and concurrent reduction of immunosuppression. Both patients had uneventful recovery. Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas. PMID:25150235

  5. Hyperinfection strongyloidiasis in renal transplant recipients

    PubMed Central

    Khuroo, Mehnaaz S

    2014-01-01

    Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We report two cases of hyperinfection strongyloidiasis in renal transplant recipients and document endoscopic and pathological changes in the involved small bowel. One patient presented with features of dehydration and malnutrition while another developed ileal obstruction and strangulation, requiring bowel resection. Oesophagogastroduodenoscopy showed erythematous and thickened duodenal mucosal folds. Histopathological examination of duodenal biopsies revealed S. stercoralis worms, larvae and eggs embedded in mucosa and submucosa. Wet mount stool preparation showed filariform larvae of S. stercoralis in both cases. Patients were managed with anthelmintic therapy (ivermectin/albendazole) and concurrent reduction of immunosuppression. Both patients had uneventful recovery. Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas. PMID:25150235

  6. Multi-State Survival Analysis in Renal Transplantation Recipients

    PubMed Central

    MIRZAEE, Moghaddameh; MOHAMMAD, Kazem; MAHMOODI, Mahmood; ZERAATI, Hojjat; EBADZADEH, Mohammad-Reza; ETMINAN, Abbas; FAZELI, Faramarz; DEHGHANI FIROUZABADI, Mohammad Hasan; SATTARY, Hossein; HAGHPARAST, Mahdiyeh; RAHIMI FOROUSHANI, Abbas

    2014-01-01

    Abstract Background Renal transplantation is a therapy for end-stage renal disease. During the study of recipients’ survival after renal transplantation, there are some events as intermediate events that not only affect the recipients’ survival but also events which are affected by various factors. The aim of this study was to handle these intermediate events in order to identify factors that affect recipients’ survival by using multi-state models. Methods This retrospective cohort study included 405 renal transplant patients from Afzalipour Hospital, Kerman, Iran, from 2004 to 2010. The survival time of these recipients was determined after transplantation and the effect of various factors on the death hazard with and without renal allograft failure and hazard of renal allograft failure was studied by using multi-state models. Results During 4.06 years (median) of follow-up; 28 (6.9%) recipients died and allograft failure occurred in 51 (12.6%) recipients. Based on the results of multi-state model, receiving a living kidney transplantation decreased the hazard of renal allograft failure (HR=0.38; 95% CI: 0.17- 0.87), pre-transplant hypertension (HR=2.94; 95% CI: 1.54- 5.63) and serum creatinine levels >1.6 upon discharge from the hospital (HR=7.38; 95% CI: 3.87- 7.08) increased the hazard of renal allograft failure. Receiving living kidney transplantation decreased the hazard of death directly (HR=0.18; 95% CI: 0.04- 0.93). Conclusion It was concluded that the effect of donor type, pre-transplant hypertension and having serum creatinine >1.6 upon discharge from the hospital was significant on hazard of renal allograft failure. The only variable that had a direct significant effect on hazard of death was donor type. PMID:25988091

  7. An association between antibodies specific for endothelial cells and renal transplant failure.

    PubMed

    Perrey, C; Brenchley, P E; Johnson, R W; Martin, S

    1998-06-01

    Human leucocyte antigen (HLA)-specific antibodies, present at the time of transplant, cause renal transplant rejection but cases of rejection of HLA-identical renal transplants indicate that antibodies to non-HLA antigens may also be detrimental. There is increasing evidence that antibodies to antigens present on endothelial cells and monocytes, and on endothelial cells alone, are associated with transplant rejection. We investigated 105 patients with failed renal transplants for the presence of endothelial cell reactive antibodies and compared them with 94 successful transplant patients to determine the role of non-HLA antibodies in transplant failure. Patient sera were tested by enzyme-linked immunoabsorbent assay (ELISA) using as a target fixed cells either from the endothelial/epithelial cell line EAHy.926 or primary cultures of human umbilical vein endothelial cells. Antibody binding was detected using an alkaline phosphatase-conjugated anti-human immunoglobulin G (IgG) antibody. Fourteen of the 105 failed transplant patients had endothelial cell-reactive antibodies as compared with only three of the 94 patients with successful transplants (Fisher's exact test, p = 0.02). Antibody-positive sera were absorbed with the epithelial cell line A549 to remove antibodies directed against the epithelial component of EAHy.926 and with a pool of lymphoblastoid cell line cells to remove HLA-specific antibodies. Absorption did not reduce antibody activity showing the antibodies to be directed against endothelial cell determinants. Antibody-positive sera were also tested by flow cytometry against the monocyte cell line THP-1 and 13 of the 14 patients were negative. In conclusion, we have demonstrated the presence of IgG antibodies directed against endothelial cell determinants in renal transplant recipients in association with renal transplant failure. PMID:9777698

  8. Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula

    SciTech Connect

    Barley, Fay L.; Kessel, David Nicholson, Tony; Robertson, Iain

    2006-12-15

    We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

  9. Integrated dialysis and renal transplantation: small is beautiful.

    PubMed Central

    Nicholls, A J; Catto, G R; Edward, N; Engeset, J; Logie, J R; Macleod, M

    1980-01-01

    Many patients in Britain with chronic renal failure suitable for renal replacement treatment die because not enough treatment facilities are available. Moreover, the number of renal transplants performed is insufficient to meet even present needs, so the number of patients on dialysis is rising. The integrated dialysis and transplant unit in Aberdeen, which has a population base much smaller than the average British unit, meets community needs for dialysis and transplantation. The problem of harvesting cadaver kidneys has been solved; the present supply has not only enabled the number of patients on dialysis to remain stable but has resulted in a net export of kidneys. The Aberdeen unit shows how estimated needs for chronic dialysis and renal transplantation may be met. PMID:6992935

  10. Association of renal adenocarcinoma and BK virus nephropathy post transplantation.

    PubMed

    Kausman, Joshua Yehuda; Somers, Gino Rene; Francis, David Michael; Jones, Colin Lindsay

    2004-04-01

    While most BK virus infections are asymptomatic, immunosuppression has been associated with BK virus reactivation and impaired graft function or ureteric ulceration in renal transplant patients and hemorrhagic cystitis in bone marrow transplant patients. Oncogenicity is also postulated and this is the first report of a child with a carcinoma of the donor renal pelvis following BK virus allograft nephropathy. Removal of the primary tumor and cessation of immunosuppression led to regression of secondary tumors and a return to health. PMID:14986088

  11. Renal Transplantation by Automatic Anastomotic Device in a Porcine Model.

    PubMed

    Lo Monte, Attilio Ignazio; Damiano, Giuseppe; Palumbo, Vincenzo Davide; Spinelli, Gabriele; Buscemi, Giuseppe

    2015-10-01

    Automatic vascular staplers for vascular anastomoses in kidney transplantation may dramatically reduce the operative time and, in particular, warm ischemia time, thus increasing the outcome of transplantation. Ten pigs underwent kidney auto-transplantation by automatic anastomotic device. Kidneys were collected by laparotomy with selective ligations at the renal hilum and perfused with cold storage solution. To overcome the shortage in length of renal hilum, a tract of the internal jugular vein was harvested to increase the length of the vessels. The anastomoses were totally performed by the use of the anastomotic device. On 10 kidney transplants, nine were successful and no complications occurred. Renal resistive indexes showed a slight increase in the immediate postoperative period returning normal at 10 days of follow-up. We demonstrated the possibility to perform renal vascular anastomoses by means of an automatic anastomotic device. This instrument developed for coronary bypass surgery by virtue of the small caliber of the vessels could be adopted on a larger scale for renal transplantation. The reduced warm ischemia time needed for anastomosis may help to achieve a better outcome for the graft and expand the pool of marginal donors in renal transplantation. PMID:25900063

  12. Post-renal Transplantation de novo Renal Cell Carcinoma in a Middle-aged Man

    PubMed Central

    Pandya, V. K.; Sutariya, H. C.

    2016-01-01

    Renal cell carcinoma is usually seen in the native kidney but may be seen in the renal allograft. We report a rare case of renal cell carcinoma in a 56-year-old renal allograft recipient who was transplanted for end-stage renal disease induced by analgesic nephropathy. This complication developed after 13 years of renal transplantation. Patient was investigated for hematuria and abdominal pain with a normal renal function. Computed tomography depicted a mass sized 9.0×7.3×6.8 cm that involved the upper pole of the transplant. There was no metastasis. The patient underwent radical allograft nephrectomy for the carcinoma that had extended up to the renal hilum. Histopathological examination revealed Furhman grade-1, clear cell variant, stage pT2 N0 M0. In the last visit, the patient was on maintenance hemodialysis via arterio-venous fistula and planned for cadaveric renal transplantation. Computed tomography could facilitate early diagnosis and proper management of patients with post-renal allograft renal cell carcinoma. PMID:26889374

  13. Post-renal Transplantation de novo Renal Cell Carcinoma in a Middle-aged Man.

    PubMed

    Pandya, V K; Sutariya, H C

    2016-01-01

    Renal cell carcinoma is usually seen in the native kidney but may be seen in the renal allograft. We report a rare case of renal cell carcinoma in a 56-year-old renal allograft recipient who was transplanted for end-stage renal disease induced by analgesic nephropathy. This complication developed after 13 years of renal transplantation. Patient was investigated for hematuria and abdominal pain with a normal renal function. Computed tomography depicted a mass sized 9.0×7.3×6.8 cm that involved the upper pole of the transplant. There was no metastasis. The patient underwent radical allograft nephrectomy for the carcinoma that had extended up to the renal hilum. Histopathological examination revealed Furhman grade-1, clear cell variant, stage pT2 N0 M0. In the last visit, the patient was on maintenance hemodialysis via arterio-venous fistula and planned for cadaveric renal transplantation. Computed tomography could facilitate early diagnosis and proper management of patients with post-renal allograft renal cell carcinoma. PMID:26889374

  14. Renal cell carcinoma in a transplanted kidney: MR imaging findings.

    PubMed

    Leonardou, Polytimi; Semelka, Richard C; Mastropasqua, Maria; Kanematsu, Masayuki; Woosley, John T

    2003-07-01

    We report the MR findings of a 42-year-old man who developed renal cell carcinoma in an allograft kidney, 10 years after transplantation. The lower pole of the transplant kidney showed a solid lesion which was well shown on the post gadolinium fat suppressed images as a heterogeneously enhancing 2 cm mass lesion. PMID:12915202

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

    SciTech Connect

    Lawton, C.A.; Cohen, E.P.; Barber-Derus, S.W.; Murray, K.J.; Ash, R.C.; Casper, J.T.; Moulder, J.E. )

    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.

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

    PubMed

    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. PMID:16824152

  17. Use of Kidneys with Small Renal Tumors for Transplantation.

    PubMed

    Lugo-Baruqui, Alejandro; Guerra, Giselle; Arocha, Adriana; Burke, George W; Ciancio, Gaetano

    2016-01-01

    Population of patients with end-stage renal disease increases every day. There is a vast difference in the number of patients on the waiting list for a kidney transplant, and the number of donors and the gap increases every year. The use of more marginal organs can increase the donor pool. These organs include the kidneys with small renal cell carcinomas (RCTC). There has been a number of reports in the literature about the use of these grafts for renal transplant after tumor excision and reconstruction. These grafts have been reported to be used with good renal function outcomes without an increased risk for malignancy recurrences. We present the collection of evidence for the use of kidneys with RCC for transplantation, technique used for surgical resection, and reconstruction as well as insights on the recommendations for the use of these grafts. PMID:26695405

  18. Hepatitis C virus related lymphoproliferative disorder in a renal transplant recipient.

    PubMed

    Aravindan, A N; Moger, Venkatesh; Sakhuja, Vinay; Kohli, Harbir S; Varma, Neelam; Jha, Vivekanand

    2006-01-01

    Posttransplant lymphoproliferative disorders (PTLD) are commonly caused by Ebstein-Barr Virus infection. The role of hepatitis C virus (HCV) in the genesis of lymphomas has been recognized recently. We report a HCV infected renal transplant recipient who developed PTLD 11 months after transplantation. Reduction of immunosuppression led to disappearance of viremia and clearance of PTLD. This is the first such report in the world literature. PMID:16868710

  19. Two papillary renal cell carcinomas of different origin following renal transplantation (Case report).

    PubMed

    Gerth, Hans-Ulrich; Pohlen, Michele; Thoennissen, Nils-Heinrich; Suwelack, Barbara; Pavenstädt, Hermann-Josef; Störkel, Stefan; Abbas, Mahmoud; Spieker, Tilmann; Thölking, Gerold

    2012-07-01

    Papillary renal cell carcinoma (PRCC) is a rare malignant tumor entity compared to common clear cell renal carcinoma. In the present study, we report a patient who was diagnosed with PRCC twice and successfully treated each time following renal transplantation. The first PRCC was located in the left native kidney two years following transplantation, and the second PRCC was diagnosed in the allograft 13 years following transplantation. The two tumors were completely removed by surgery in stage I of the disease with sufficient conservation of the allograft function. Notably, the tumors had a different origin as indicated by the microsatellite analysis, which reflects the exceptional course of the case. Risk factors for PRCC were identified in our patient. We concluded that high-risk candidates for malignancies in renal transplant recipients should receive shorter ultrasonic screening intervals, which may facilitate early tumor detection and improve outcome rates. PMID:22807965

  20. Tailoring tacrolimus-based immunotherapy in renal transplantation.

    PubMed

    Yang, Harold C

    2003-05-01

    Tacrolimus is a cornerstone immunosuppressive agent in renal transplantation and compared with cyclosporin, its use is associated with a reduced incidence of acute rejection. Optimizing immunosuppressive management in the early post-transplant period is important for achieving long-term graft function and survival. In attempts to improve the long-term outcomes of renal transplantation further, tacrolimus has been combined with two novel immunosuppressive agents, mycophenolate mofetil (MMF) and sirolimus, with encouraging results in terms of patient and graft survival, acute rejection rates and renal graft function. Tacrolimus in combination with MMF adjunctive therapy showed significantly better graft survival in patients with delayed graft function, fewer episodes of corticosteroid-resistant rejection and better renal function at the 3-year follow-up compared with cyclosporin microemulsion plus MMF immunosuppression. A tacrolimus plus MMF regimen was also effective for renal transplant recipients at our centre in Pennsylvania, resulting in excellent survival and rejection rates at 1 year post-transplantation. The 3-month results of a US multicentre study comparing tacrolimus in combination with either MMF or sirolimus showed these two treatment regimens to be equivalent in terms of patient and graft survival, delayed graft function, the incidence of biopsy-confirmed acute rejection and renal graft function, although differences were apparent in terms of acute tubular necrosis and hyperlipidaemia. In conclusion, the development of a new immunosuppressive regimen in renal transplantation should take account of factors that influence graft function, both in the short and long term, as a way of optimizing individual maintenance therapy. PMID:12738759

  1. [Principles of dietotherapy in patients with long-term renal transplantation].

    PubMed

    Sharafetdinov, Kh Kh; Plotnikova, O A; Alekseeva, R I; Zuglova, E A; Kaganov, B S; Kandidova, I E

    2009-01-01

    In this review role of clinical nutrition of the some components of dietotherapy in correction metabolic parameters and in decrease of complication risk (cardiovascular disease, type 2 diabetes, osteoporosis and other) in patients with long-term renal transplantation is discussed. PMID:20387684

  2. Acute venous thrombosis of a renal transplant: early detection with color Doppler sonography.

    PubMed

    Danse, E; Malaise, J; Mourad, M; Cosyns, J P

    2009-01-01

    The observation of a recent case of an acute venous thrombosis of a renal transplant is the opportunity to review and present the role of color Doppler sonography for the early detection of such a severe and uncommon complication. PMID:19534237

  3. Hematopoietic Cell and Renal Transplantation in Plasma Cell Dyscrasia Patients.

    PubMed

    Baraldi, Olga; Grandinetti, Valeria; Donati, Gabriele; Comai, Giorgia; Battaglino, Giuseppe; Cuna, Vania; Capelli, Irene; Sala, Elisa; La Manna, Gaetano

    2016-01-01

    Gammopathies, multiple myeloma, and amyloidosis are plasma dyscrasias characterized by clonal proliferation and immunoglobulin overproduction. Renal impairment is the most common and serious complication with an incidence of 20-30% patients at the diagnosis. Kidney transplant has not been considered feasible in the presence of plasma dyscrasias because the immunosuppressive therapy may increase the risk of neoplasia progression, and paraproteins may affect the graft. However, recent advances in clinical management of multiple myeloma and other gammopathies allow considering kidney transplant as a possible alternative to dialysis. Numerous evidence indicates the direct relationship between hematological remission and renal function restoring. The combination of kidney and hematopoietic cell transplant has been reported as a promising approach to reestablish end-organ function and effectively treat the underlying disease. This review describes current protocols used to perform kidney transplantation in patients with plasma dyscrasias. PMID:26160700

  4. Paediatric obesity and renal transplantation: current challenges and solutions.

    PubMed

    Terrace, John D; Oniscu, Gabriel C

    2016-04-01

    The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with life-style and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation. PMID:26018121

  5. Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients.

    PubMed

    Filler, Guido; Melk, Anette; Marks, Stephen D

    2016-05-01

    The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) . PMID:26917052

  6. Concomitant administration of cyclosporin and ketoconazole in renal transplant recipients.

    PubMed

    First, M R; Schroeder, T J; Weiskittel, P; Myre, S A; Alexander, J W; Pesce, A J

    1989-11-18

    18 renal transplant recipients receiving cyclosporin, prednisone, and azathioprine were given ketoconazole, a potent inhibitor of the cytochrome P-450 enzyme system. Within a month ketoconazole-induced blockade of cyclosporin metabolism allowed a significant reduction (451 vs 106 mg/day; 77%) of the mean dose of cyclosporin without altering cyclosporin whole blood trough levels, although maximum blood levels were almost halved. This dose reduction was maintained in patients followed up for up to 13 months. Renal and hepatic function were unchanged after the addition of ketoconazole. This drug interaction has the potential to reduce dramatically expenditure on cyclosporin in transplant recipients. PMID:2572912

  7. Digital processing of histopathological aspects in renal transplantation

    NASA Astrophysics Data System (ADS)

    de Albuquerque Araujo, Arnaldo; de Andrade, Marcos C.; Bambirra, Eduardo A.; dos Santos, A. M. M.

    1993-07-01

    We describe here our initial experience with the digital image processing of histopathological aspects from multiple renal biopsies of transplanted kidney in a patient treated with Cyclosporine (CsA), a powerful immunosupressor drug whose use has improved the chances of a successful vascularized organ transplantation (Tx). Unfortunately, CsA promotes morphological alterations to the glomerular structure of the kidneys. To characterize this process, glomeruli, tufts, and lumen areas distributions are measured. The results are presented in form of graphics.

  8. The medical management of renal artery stenosis in transplant recipients.

    PubMed

    Jachuck, S J; Wilkinson, R; Uldall, P R; Elliott, R W; Taylor, R M; Hacking, P M

    1979-01-01

    The investigation, management and clinical course of 12 patients developing stenosis of the renal artery following transplantation are described. The possible aetiology of the three arteriographic patterns of stenosis is discussed. Surgical correction of graft arterial stenosis is difficult and may lead to graft loss, whereas the outcome with antihypertensive drug treatment with or without anticoagulants is good. Surgery should only be contemplated if medical treatment is failing or if renal function is deteriorating. PMID:369641

  9. Renal

    MedlinePlus

    ... term "renal" refers to the kidney. For example, renal failure means kidney failure. Related topics: Kidney disease Kidney disease - diet Kidney failure Kidney function tests Renal scan Kidney transplant

  10. Toll-Like Receptor Family Polymorphisms Are Associated with Primary Renal Diseases but Not with Renal Outcomes Following Kidney Transplantation

    PubMed Central

    Damman, Jeffrey; Leuvenink, Henri G. D.; van Goor, Harry; Hillebrands, Jan-Luuk; Hepkema, Bouke G.; Snieder, Harold; van den Born, Jacob; de Borst, Martin H.; Bakker, Stephan J. L.; Navis, Gerjan J.; Ploeg, Rutger J.; Florquin, Sandrine; Seelen, Marc; Leemans, Jaklien C.

    2015-01-01

    Toll-like receptors (TLRs) play a crucial role in innate- and adaptive immunity. The TLR pathways were shown to play key functional roles in experimental acute and chronic kidney injury, including the allo-immune response after experimental renal transplantation. Data about the precise impact of TLRs and their negative regulators on human renal transplant outcomes however are limited and contradictory. We studied twelve non-synonymous single nucleotide polymorphisms (SNPs) of which eleven in TLR1-8 and one in SIGIRR in a final cohort comprising 1116 matching donors and recipients. TLR3 p.Leu412Phe and SIGIRR p.Gln312Arg significantly deviated from Hardy-Weinberg equilibrium and were excluded. The frequency distribution of the minor alleles of the remaining 10 TLR variants were compared between patients with end-stage renal disease (recipients) and controls (kidney donors) in a case-control study. Secondly, the associations between the minor allele frequency of the TLR variants and delayed graft function, biopsy-proven acute rejection and death-censored graft failure after transplantation were investigated with Cox regression. Carrier frequencies of the minor alleles of TLR1 p.His305Leu (OR = 4.79, 95% CI = 2.35–9.75, P = 0.0002), TLR1 p.Asn248Ser (OR = 1.26, 95% CI = 1.07–1.47, P = 0.04) and TLR8 p.Met1Val (OR = 1.37, 95% CI = 1.14–1.64, P = 0.008) were significantly higher in patients with ESRD, with little specificity for the underlying renal disease entity (adjusted for age, gender and donor-recipient relatedness). The minor allele frequency of none of the TLR variants significantly associated with the surrogate and definite outcomes, even when multivariable models were created that could account for TLR gene redundancy. In conclusion, genetic variants in TLR genes were associated with the prevalence of ESRD but not renal transplant outcomes. Therefore, our data suggests that specific TLR signaling routes might play a role in the final common pathway of

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

    PubMed

    Bouhlel, Saoussen

    2014-05-01

    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. PMID:24821159

  12. [Renal transplantation from living donor in Italy and Europe].

    PubMed

    Frascà, Giovanni M; Gaffi, G; Taruscia, D; D'Arezzo, M; Benozzi, L; Sagripanti, S

    2009-01-01

    Renal transplantation from a living donor shows a better graft and patient survival when compared with cadaver donor grafts. Moreover, since surgery can be planned in advance when a living donor is available, the time spent on dialysis while awaiting transplantation can be greatly reduced and dialysis treatment can be completely avoided in some cases. Only few risks for the donor have been reported as a consequence of nephrectomy, both in the short and long term. Nevertheless, despite these advantages, the number of living donor renal transplants carried out in Europe each year varies greatly from country to country and is particularly low in Spain and Italy. Several factors account for these differences, mainly the effectiveness of the organ procurement system, which could make people reluctant to living donation, and doctors' and patients' limited knowledge about living donor transplants. Nephrologists have the responsibility to identify patients eligible for transplant early in the course of the disease, and to inform them and their relatives about living donor transplantation, enabling them to make informed choices among the various treatment options in end-stage renal disease. PMID:19644833

  13. Renal Sinus Lipomatosis in Transplanted Kidneys: An Unusual Clinical Case

    PubMed Central

    Apicella, Luca; Vallone, Gianfranco; Vitale, Sossio; Garofalo, Gianluca; Russo, Luigi; Gallo, Riccardo; Federico, Stefano; Sabbatini, Massimo

    2011-01-01

    Renal sinus lipomatosis (RSL) represents an abnormal proliferation of the adipose tissue surrounding the renal pelvis of uncertain origin, associated with aging, obesity, steroid excess, infections, and calculosis. It represents a rare complication in transplanted kidneys, and, despite the accurate and prolonged radiological followup of transplanted organs, only a few cases of RSL have been described in graft recipients, with no remarkable effects on renal function. The diagnosis relies on ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and, finally, percutaneous biopsy. We describe the case of an extensive RSL in a 38-year-old renal transplant recipient, diagnosed by ultrasonography and computed tomography. The patient underwent a radiologic study because of an acute, asymptomatic renal impairment, that led to the diagnosis of a RSL of unusual dimensions, associated with a discrete hydronephrosis. Paradoxically, after a short course of steroids, the recovery of renal function and the partial resolution of calyceal dilatation were observed. The rarity of this affection, the need of a differential diagnosis with fat-containing tumors, and the possibility of parenchymal inflammation associated with RSL, potentially responsive to steroids, are also discussed. PMID:23213599

  14. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

    PubMed Central

    Sabnis, Ravindra B.; Singh, Abhishek G.; Ganpule, Arvind P.; Chhabra, Jaspreet S.; Tak, Gopal R.; Shah, Jaimin H.

    2016-01-01

    Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques. Materials and Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed. Results: The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients. Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy. PMID:27555675

  15. Hyperaluminemia associated with liver transplantation and acute renal failure.

    PubMed

    Erasmus, R T; Kusnir, J; Stevenson, W C; Lobo, P; Herman, M M; Wills, M R; Savory, J

    1995-08-01

    Iatrogenic aluminium toxicity is reported in a patient who underwent an orthotopic liver transplant and who had concomitant renal failure requiring hemodialysis. Following transplantation the patient developed a metabolic encephalopathy with only mildly elevated blood ammonia concentrations. During the period following transplantation the patient received massive infusions of albumin and was on oral feeding (vivonexten), both of which contained aluminium, as did the dialysis fluid. Hyperaluminemia and profoundly elevated liver tissue aluminium concentrations were observed. Treatment with desferrioxamine, a trivalent ion chelator, decreased the plasma aluminium concentrations with an improvement in the patient's mental status. PMID:7579738

  16. Menstruation. A hazard in radionuclide renal transplant evaluation

    SciTech Connect

    Orzel, J.A.; Jaffers, G.J.

    1986-06-01

    Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle.

  17. Cavitary lung lesion 6 years after renal transplantation

    PubMed Central

    Subbiah, Arun Kumar; Arava, Sudheer; Bagchi, Soumita; Madan, Karan; Das, Chandan J; Agarwal, Sanjay Kumar

    2016-01-01

    The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation. PMID:27358792

  18. Vitamin D Status and Outcomes After Renal Transplantation

    PubMed Central

    Girard, Delphine; Anglicheau, Dany; Canaud, Guillaume; Souberbielle, Jean Claude; Kreis, Henri; Noël, Laure Hélène; Friedlander, Gérard; Elie, Caroline; Legendre, Christophe; Prié, Dominique

    2013-01-01

    Kidney transplant recipients usually have low vitamin D levels, especially in the early posttransplantation period, but the association between vitamin D status with renal outcomes is not well described in this population. Here, we studied a prospective cohort of 634 kidney recipients who underwent transplantation at a single institution between January 2005 and June 2010. In this cohort, low 25-hydroxyvitamin D concentrations 3 months after transplantation did not predict early death or graft loss but were independently associated with lower measured GFR at 12 months (P=0.001) and higher risk for interstitial fibrosis and tubular atrophy (P=0.01). In contrast, levels of calcium, phosphorus, calcitriol, parathyroid hormone, or fibroblast growth factor-23 were not consistently associated with any of the studied outcomes. In conclusion, low 25-hydroxyvitamin D concentration measured 3 months after transplantation is an independent risk factor for interstitial fibrosis progression and is associated with a lower GFR 1 year after transplantation. PMID:23539758

  19. Cavitary lung lesion 6 years after renal transplantation.

    PubMed

    Subbiah, Arun Kumar; Arava, Sudheer; Bagchi, Soumita; Madan, Karan; Das, Chandan J; Agarwal, Sanjay Kumar

    2016-06-24

    The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation. PMID:27358792

  20. Results of cataract surgery in renal transplantation and hemodialysis patients

    PubMed Central

    Luo, Li-Hua; Xiong, Shi-Hong; Wang, Yan-Ling

    2015-01-01

    AIM To compare the effect of cataract surgery in renal transplantation and hemodialysis patients. METHODS We evaluated 51 eyes of 31 renal transplantation patients, 41 eyes of 29 hemodialysis patients and 45 eyes of 32 normal control patients who received phacoemulsification and intraocular lens (IOL) implantation from January, 2000 to August, 2014 in the Beijing Friendship Hospital. Each individual underwent a blood routine and a kidney function examination. Routine ophthalmologic examination included best-corrected visual acuity (BCVA), a slit-lamp examination to detect cataract type, determination of intraocular pressure, a corneal endothelial count, and fundus examination. All patients received phacoemulsification and an IOL implantation. RESULTS For the types of cataract in the three groups, transplantation group was significantly different from normal control group (P=0.04), the most kind is posterior subcapsular cataract (PSC) in transplantation group 33 (64.7%), hemodialysis group had no significantly difference from normal control group (P=0.43), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.02). For postoperative BCVA in the three groups, transplantation group had significantly difference from normal control group (P=0.03), hemodialysis group was significantly different from normal control group (P=0.00), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.00). The multiple linear regression equation is Y=0.007 hemoglobin (Hb)-0.000233 serum creatinine (Cr), R2=0.898. Postoperative fundus examination showed that hemorrhage, exudation, and macular degeneration were greater in the hemodialysis group. CONCLUSION This study showed that the PSC was more in the renal transplantation patients. BCVA was better and fundus lesions were less frequent in the renal transplantation group than in the hemodialysis group after cataract surgery. The

  1. Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  2. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy.

    PubMed

    Chen, Wei; Kayler, Liise K; Zand, Martin S; Muttana, Renu; Chernyak, Victoria; DeBoccardo, Graciela O

    2015-02-01

    Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin-angiotensin-aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash pulmonary edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention. PMID:25713713

  3. Cladophialophora bantiana osteomyelitis in a renal transplant patient.

    PubMed

    Desmet, Stefanie; Smets, Liesbeth; Lagrou, Katrien; Derdelinckx, Inge; Neyt, Jeroen; Maertens, Johan; Sciot, Raf; Demaerel, Philip; Bammens, Bert

    2016-06-01

    Cladophialophora bantiana is a neurotropic dematiaceous fungus which rarely causes disseminated disease. We report a case of proven C. bantiana osteomyelitis in a renal transplant recipient, complicated with probable cerebral disease. Stable disease was reached after combined antifungal therapies, immune enhancement and amputation of the infected lower limb. PMID:27595060

  4. Risk factors for lung diseases after renal transplantation

    PubMed Central

    Pencheva, Ventsislava P.; Petrova, Daniela S.; Genov, Diyan K.; Georgiev, Ognian B.

    2015-01-01

    Background: Lung diseases are one of the major causes of morbidity and mortality after renal transplantation. The aim of the study is to define the risk factors for infectious and noninfectious pulmonary complications in kidney transplant patients. Materials and Methods: We prospectively studied 267 patients after renal transplantation. The kidney recipients were followed-up for the development of pulmonary complications for a period of 7 years. Different noninvasive and invasive diagnostic tests were used in cases suspected of lung disease. Results: The risk factors associated with the development of pulmonary complications were diabetes mellitus (odds ratio [OR] = 4.60; P = 0.001), arterial hypertension (OR = 1.95; P = 0.015), living related donor (OR = 2.69; P = 0.004), therapy for acute graft rejection (OR = 2.06; P = 0.038), immunosuppressive regimens that includes mycophenolate (OR = 2.40; P = 0.011), azathioprine (OR = 2.25; P = 0.023), and tacrolimus (OR = 1.83; P = 0.041). The only factor associated with the lower risk of complications was a positive serology test for Cytomegalovirus of the recipient before transplantation (OR = 0.1412; P = 0.001). Conclusion: The risk factors can be used to identify patients at increased risk for posttransplant lung diseases. Monitoring of higher-risk patients allow timely diagnosis and early adequate treatment and can reduce the morbidity and mortality after renal transplantation. PMID:26958045

  5. Dental management of patients before and after renal transplantation.

    PubMed

    Georgakopoulou, Eleni A; Achtari, Marina D; Afentoulide, Niki

    2011-01-01

    The number of patients who are long-term survivors of renal transplantation increases rapidly, and proportionally increases the demand of quality dental care for this group of patients. All the transplant patients are on potent immunosupressants and also some of them may suffer from other systemic diseases, so their dental management is a challenge for any dentist. This article is an update of the current relevant literature and is aimed to summarize the key points of dental care for renal transplant patients, since no specific guidelines exist. The research for relevant references took place by using Pubmed database, as well as information published by accredited medical societies and health services both in Greece and abroad. PMID:22362336

  6. Genes and beans: pharmacogenomics of renal transplant.

    PubMed

    Murray, Brian; Hawes, Emily; Lee, Ruth-Ann; Watson, Robert; Roederer, Mary W

    2013-05-01

    Advances in the management of patients after solid organ transplantation have led to dramatic decreases in rates of acute rejection, but long-term graft and patient survival have remained unchanged. Individualized therapy after transplant will ideally provide adequate immunosuppression while limiting the adverse effects of drug therapy that significantly impact graft survival. Therapeutic drug monitoring represents the best approximation of individualized drug therapy in transplant at this time; however, obtaining pharmacogenomic data in transplant patients has the potential to enhance our current practice. Polymorphisms of target genes that impact pharmacokinetics have been identified for most immunosuppressants, including tacrolimus, cyclosporine, mycophenolate, azathioprine and sirolimus. In the future, pre-emptive assessment of a patient's genetic profile may inform drug selection and provide information on specific doses that will improve efficacy and limit toxicity. PMID:23651025

  7. The first identical twin renal transplant.

    PubMed

    Ellis, Harold

    2015-03-01

    There is no doubt that it was the work of one man, Alexis Carrel, which laid the foundations of modern organ transplantation. Working first in his native city of Lyons, then in Chicago and finally at the Rockefeller Institute New York, he developed the techniques of successful anastomosis of blood vessels, using extremely fine silk sutures and tiny needles. As early as 1892, he successfully grafted a kidney into the neck of a dog. He was soon able to demonstrate that, although a dog's kidney transplanted into its own neck could survive, even when the opposite kidney was excised, transplant of a kidney to another animal would fail after a few days. Further experiments included transplantation of other organs, including ovary, thyroid, lower limb and heart. In 1914 he wrote to fellow Nobel Prize winning Swiss surgeon, Theodor Kocher about his experiments; "Concerning homoplastic transplantation (from one animal to another) of organs such as the kidney, I have never found positive results to continue after a few months, whereas ir autoplastic transplants the results were always positive. The biological side of the question has to be investigated very much more and we must find out by what means to prevent the reaction of the organism against a new organ" (my italics). This, in fact, was going to occupy the next half century of worldwide research! PMID:26016284

  8. Acoustic Radiation Force Impulse Measurement in Renal Transplantation

    PubMed Central

    Lee, Juhan; Oh, Young Taik; Joo, Dong Jin; Ma, Bo Gyoung; Lee, A-lan; Lee, Jae Geun; Song, Seung Hwan; Kim, Seung Up; Jung, Dae Chul; Chung, Yong Eun; Kim, Yu Seun

    2015-01-01

    Abstract Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = −0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW <3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥3.5 g/kg. No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values. PMID:26426636

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

    PubMed

    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. PMID:26787256

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

    PubMed Central

    Futohi, Farzaneh; Saber, Azadeh; Nemati, Eglim; Einollahi, Behzad; Rostami, Zohre

    2015-01-01

    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. PMID:26866009

  11. Renal artery embolization for managing uncontrolled hypertension in a kidney transplant candidate

    PubMed Central

    Alhamid, Naji; Alterky, Hani; Othman, Mohammad Imad

    2013-01-01

    We report a case of pre-operative bilateral renal artery embolization to control the resistant and malignant hypertension in a patient prepared for kidney transplantation. A 34-year-old man with end-stage renal disease as a result of the focal segmental glomerulosclerosis and uncontrolled hypertension that precluded the transplantation surgery and the patient's post-transplant blood pressure and the renal function remained within normal limits following the transplant for 6 months of follow-up. PMID:23984264

  12. Successful endovascular treatment of transplant intrarenal artery stenosis in renal transplant recipients: Two case reports.

    PubMed

    Koukoulaki, Maria; Brountzos, Elias; Loukopoulos, Ioannis; Pomoni, Maria; Antypa, Eleni; Vougas, Vasileios; Drakopoulos, Spiros

    2015-06-24

    Transplant renal artery stenosis (TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS. PMID:26131408

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

    PubMed

    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. PMID:20163566

  14. Recurrent Glomerulonephritis after Renal Transplantation: An Unsolved Problem

    PubMed Central

    Golgert, William A.; Appel, Gerald B.; Hariharan, Sundaram

    2008-01-01

    Background and objectives: Despite advances in prevention of acute rejection and improved short- and long-term kidney graft survival, recurrent glomerulonephritis remains problematic and poorly characterized. This study analyzed prevalence and outcome of recurrent glomerulonephritis from various registries. Design, setting, participants, & measurements: Definition, classification, and limitations in evaluating epidemiology of native and recurrent glomerulonephritis are discussed. Epidemiology of native glomerulonephritis as the cause of end-stage renal failure and subsequent recurrence of individual glomerulonephritis was evaluated using data from various registries, and pathogenesis of individual glomerulonephritis is discussed. Results: Analysis of data from transplant registries revealed that glomerulonephritis is an important cause of end-stage renal disease in white and pediatric recipients; however, glomerulonephritis as the cause of end-stage renal disease is not characterized well in black recipients, and many of them are perhaps labeled to have hypertensive nephrosclerosis as the cause of renal disease without renal biopsy. A systematic approach toward urinalysis after transplantation and utility of immunofluorescence and electron microscopic examination of renal biopsy tissues will identify the true prevalence of recurrent glomerulonephritis. Data on recurrent glomerulonephritis should be compiled by either using registry analysis or pooling data from multiple centers. This will provide true data on prevalence and outcome and could potentially initiate translational research studies. Conclusions: The understanding of the pathogenesis of recurrent glomerulonephritis is critical to optimize prevention as well as to treat individual recurrent glomerulonephritis, which can enhance long-term graft survival. PMID:18272827

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

    PubMed

    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 <6 weeks on dialysis. 66% of our patients were 30-60 years old; 98% of the patients had living donors. At 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 <6 weeks on dialysis is the best therapeutic option for end-stage renal failure, especially in developing countries such as Bolivia, where until last year, full public support for renal replacement therapy was unavailable. PMID:27110013

  16. Inflammatory Cutaneous Diseases in Renal Transplant Recipients

    PubMed Central

    Savoia, Paola; Cavaliere, Giovanni; Zavattaro, Elisa; Veronese, Federica; Fava, Paolo

    2016-01-01

    Kidney transplant recipients frequently suffer from skin infections and malignancies, possibly due to the effects of long-term immunosuppressive therapy. While the relationships between immunosuppression and these pathological conditions have been widely investigated, little is known about the relative incidence and characteristics of inflammatory skin diseases in this type of patient. In this study, we analyze the incidence of a number of inflammatory cutaneous diseases in a cohort of patients who underwent kidney transplantation. Although our study shows a relatively low incidence of these pathologies in transplanted patients—in agreement with the general action of immunosuppressant therapies in reducing inflammation—we scored a different efficacy of the various immunosuppressive regimens on inflammatory and autoimmune skin diseases. This information can be key for designing immunosuppressive regimens and devising accurate follow-up protocols. PMID:27548160

  17. Viral Infection in Renal Transplant Recipients

    PubMed Central

    Cukuranovic, Jovana; Ugrenovic, Sladjana; Jovanovic, Ivan; Visnjic, Milan; Stefanovic, Vladisav

    2012-01-01

    Viruses are among the most common causes of opportunistic infection after transplantation. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or posttransplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections. This paper will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens. PMID:22654630

  18. Early diagnosis of acute postoperative renal transplant rejection

    SciTech Connect

    Tisdale, P.L.; Collier, B.D.; Kauffman, H.M.; Adams, M.B.; Isitman, A.T.; Hellman, R.S.; Rao, S.A.; Joestgen, T.; Krohn, L.

    1985-05-01

    A prospective evaluation of In-111 labeled autologous platelet scintigraphy for the early diagnosis of acute postoperative renal transplant rejection was undertaken. To date, 28 consecutive patients between 7 and 14 days post-op have been injected with 500..mu..Ci of In-111 platelets followed by imaging at 24 and 48 hours. Activity within the renal transplant exceeding activity in the adjacent iliac vessels was considered to be evidence of rejection, and both chemical evidence and clinical impression of rejection at 5 days after completion of imaging was accepted as proof of ongoing or incipient rejection at the time of scintigraphy. In addition, to visual inspection, independent quantitative analysis compared the area-normalized activity over the transplant with the adjacent iliac vessels (normal <1.0). For 5 patients, positive In-111 scintigraphy was present before convincing clinical evidence of rejection. In-111 platelet scintigraphy is useful not only to confirm the clinical diagnosis of rejection but also to establish the early, pre-clinical diagnosis of incipient acute postoperative renal transplant rejection.

  19. Improved renal ischemia tolerance in females influences kidney transplantation outcomes

    PubMed Central

    Aufhauser, David D.; Wang, Zhonglin; Murken, Douglas R.; Bhatti, Tricia R.; Wang, Yanfeng; Ge, Guanghui; Redfield, Robert R.; Abt, Peter L.; Wang, Liqing; Reese, Peter P.; Hancock, Wayne W.; Levine, Matthew H.

    2016-01-01

    Experimentally, females show an improved ability to recover from ischemia-reperfusion injury (IRI) compared with males; however, this sex-dependent response is less established in humans. Here, we developed a series of murine renal ischemia and transplant models to investigate sex-specific effects on recovery after IRI. We found that IRI tolerance is profoundly increased in female mice compared with that observed in male mice and discovered an intermediate phenotype after neutering of either sex. Transplantation of adult kidneys from either sex into a recipient of the opposite sex followed by ischemia at a remote time resulted in ischemia recovery that reflected the sex of the recipient, not the donor, revealing that the host sex determines recovery. Likewise, renal IRI was exacerbated in female estrogen receptor α–KO mice, while female mice receiving supplemental estrogen before ischemia were protected. We examined data from the United Network for Organ Sharing (UNOS) to determine whether there is an association between sex and delayed graft function (DGF) in patients who received deceased donor renal transplants. A multivariable logistic regression analysis determined that there was a greater association with DGF in male recipients than in female recipients. Together, our results demonstrate that sex affects renal IRI tolerance in mice and humans and indicate that estrogen administration has potential as a therapeutic intervention to clinically improve ischemia tolerance. PMID:27088798

  20. Survival Benefit of Statins in Hemodialysis Patients Awaiting Renal Transplantation.

    PubMed

    Aftab, Waqas; Gazallo, Juliana; Motabar, Ali; Varadrajan, Padmini; Deedwania, Prakash C; Pai, Ramdas G

    2015-06-01

    End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population. PMID:26060381

  1. Antiviral treatment for chronic hepatitis B in renal transplant patients

    PubMed Central

    Ridruejo, Ezequiel

    2015-01-01

    Chronic hepatitis B infection is frequent in renal transplant patients. It negatively impacts long term outcomes reducing graft and patient survival. Current guidelines clearly define who needs treatment, when to start, what is the first line therapy, how to monitor treatment response, when to stop, and how patients must be controlled for its safety. There is some data showing a favorable safety and efficacy profile of nucleos(t)ide analogue (NUC) treatment in the renal transplant setting. Entecavir, a drug without major signs of nephrotoxicity, appears to be the first option for NUC naïve patients and tenofovir remains the preferred choice for patients with previous resistance to lamivudine or any other NUC. Renal transplant recipients under antiHBV therapy should be monitored for its efficacy against HBV but also for its safety with a close renal monitoring. Studies including a large number of patients with long term treatment and follow up are still needed to better demonstrate the safety and efficacy of newer NUCs in this population. PMID:25729474

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

    PubMed

    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. PMID:7787867

  3. Wait List Death and Survival Benefit of Kidney Transplantation among Non-renal Transplant Recipients

    PubMed Central

    Cassuto, James R.; Reese, Peter P.; Sonnad, Seema; Bloom, Roy D.; Levine, Matthew H.; Naji, Ali; Abt, Peter

    2010-01-01

    The disparity between the number of patients waiting for kidney transplantation and the limited supply of kidney allografts has renewed interest in the benefit from kidney transplantation experienced by different groups. This study evaluated kidney transplant survival benefit in prior non-renal transplant recipients (kidney after liver, KALi; lung, KALu; heart, KAH) compared to primary isolated (KA1) or repeat isolated kidney (KA2) transplant. Multivariable Cox regression models were fit using UNOS data for patients wait listed and transplanted from 1995–2008. Compared to KA1, the risk of death on the wait list was lower for KA2 (p<0.001;HR=0.84;CI=0.81–0.88), but substantially higher for KALu (p<0.001;HR=3.80;CI=3.08–4.69), KAH (p<0.001;HR=1.92;CI=1.66–2.22), and KALi (p<0.001;HR=2.69;CI=2.46–2.95). Following kidney transplant, patient survival was greatest for KA1, similar among KA2, KALi, KAH, and inferior for KALu. Compared to the entire wait list, renal transplantation was associated with a survival benefit among all groups except KALu (p=0.017;HR=1.61;CI=1.09–2.38), where post-transplant survival was inferior to the wait list population. Recipients of KA1 kidney transplantation have the greatest post-transplant survival and compared to the overall kidney wait list, the greatest survival benefit. PMID:20977641

  4. Maintenance pharmacological immunosuppressive strategies in renal transplantation.

    PubMed Central

    Vella, J. P.; Sayegh, M. H.

    1997-01-01

    Current maintenance immunosuppressive regimens for transplantation are based on three classes of drugs: corticosteroids, immunophilin-binding agents (eg, cyclosporin and tacrolimus), and antimetabolites (eg, azathioprine and mycophenolate). Drugs from the various classes inhibit the immune system at different points and are thus synergistic when used in combination. PMID:9338020

  5. Urinary tract infection in renal transplantation

    PubMed Central

    Giessing, Markus

    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. Methods Pubmed/Medline was searched and international guidelines and recommendations for prevention and treatment of UTI after KTX were also assessed. Results Most studies on UTI after KTX have a small sample, and are descriptive and retrospective. Many transplant- and recipient-related risk factors have been identified. While asymptomatic bacteriuria is often treated, even though some studies advise against it, symptomatic UTI should be treated empirically after collecting urine for microbiological analysis, to avoid the development of transplant pyelonephritis with a high chance of urosepsis. The duration of treatment has not been determined in studies and recommendations refer to the treatment of complicated UTI in the non-transplant population. Prophylaxis has not been the focus of studies either. Conclusion UTI after KTX is still largely an under-represented field of study, despite many recipients developing UTI after KTX. Prospective studies on this topic are urgently needed. PMID:26558020

  6. The Cost and Utility of Renal Transplantation in Malaysia

    PubMed Central

    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 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. Results 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. Conclusions Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life. PMID:27500211

  7. Epstein-Barr virus-positive multiple myeloma following an ABO incompatible second renal transplantation

    PubMed Central

    Kirushnan, B.; Subbarao, B.; Prabhu, P.

    2016-01-01

    ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft. PMID:27512301

  8. Epstein-Barr virus-positive multiple myeloma following an ABO incompatible second renal transplantation.

    PubMed

    Kirushnan, B; Subbarao, B; Prabhu, P

    2016-01-01

    ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft. PMID:27512301

  9. Ex vivo reconstruction of the donor renal artery in renal transplantation: a case-control study.

    PubMed

    McLoughlin, Louise C; Davis, Niall F; Dowling, Catherine M; Power, Richard E; Mohan, Ponnusamy; Hickey, David P; Smyth, Gordon P; Eng, Molly M P; Little, Dilly M

    2014-05-01

    Transplantation of renal allografts with anatomic variability or injured vasculature poses a challenge to the transplanting surgeon but can be salvaged for transplantation with ex vivo bench reconstruction of the vasculature. We investigated whether renal allograft function is impaired in these reconstructed allografts; compared to the donor-matched, un-reconstructed allograft. Reconstructed allografts were transplanted into 60 patients at our institution between 1986 and 2012. A control group was selected from the matched pair of the recipient in deceased donor transplantation. We found no significant difference in the overall graft and patient survival rates (P = 1.0, P = 0.178). Serum creatinine levels were not significantly higher in the study group at 1, 3 and 12 months postoperatively. There were two cases of vascular thrombosis in the study group that were not related to the ex vivo reconstruction. A significantly greater proportion of reconstructed patients were investigated with a colour duplex ultrasound postoperatively (0.007). Although we have demonstrated a higher index of suspicion of transplant failure in patients with a reconstructed allograft, this practice has proven to be a safe and useful technique with equivocal outcome when compared to normal grafts; increasing the organ pool available for transplantation. PMID:24851246

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

    PubMed

    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. PMID:27105603

  11. Deceased donor renal transplantation and the disruptive effect of commercial transplants: the experience of Oman.

    PubMed

    Mohsin, N; Al-Busaidy, Q; Al-Marhuby, H; Al-Lawati, J; Daar, A S

    2014-01-01

    The Oman Renal Transplantation Program was established in 1988 as a joint venture between Sultan Qaboos University and the Ministry of Health. It began with both living related donor (LRD) and deceased donor (DD) transplants. Over the next nine years, while the LRD programme progressed relatively well, there were only thirteen DD transplants. Two of the DD kidneys were obtained from overseas via an active collaboration with the Euro-transplant organisation, and one DD kidney was obtained from Saudi Arabia within the Gulf Cooperative Council exchange programme. The rest of the DD kidneys were obtained in Oman. The Omani DD programme, although it was a pioneering effort in the Gulf region at the time, was not entirely sustainable. In this paper we focus on the challenges we encountered. Among the major challenges was the absence of resources to establish a dedicated DD programme and particularly the failure to develop a cadre of dedicated transplant coordinators. PMID:25160966

  12. Cutaneous Alternariasis in a Patient With Renal Transplant

    PubMed Central

    Demirci, Mustafa; Baran, Nurten; Uzum, Atilla; Calli, Aylin Orgen; Gul-Yurtsever, Sureyya; Demirdal, Tuna

    2015-01-01

    Introduction: Alternaria is a common saprophyte, which is usually not pathogenic in humans. Generally, local wounds infections of Alternaria occur with presence of immunosuppression factors such as HIV infection and renal transplant patients. Case Presentation: We reported a case of wound infection induced by Alternaria spp. in a renal transplant patients. The main interest in this case was the rareness of the cutaneous alternariasis, its clinical aspects and good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients. Conclusions: Alternariasis or similar cases may be increased due to the increased number of immunosuppressed patients. From this point of view, skin lesions in these patients must be planned and microbiologically evaluated considering the molds. PMID:26060568

  13. [Severe infectious keratitis in renal transplant patient: a case report].

    PubMed

    Limaiem, Rim; Mnasri, Heni; El Maazi, Abir; Ammari, Hela; Chaabouni, Afif; Mghaieth, Fatma; El Matri, Leila

    2009-07-01

    Keratitis occurring in renal transplant patients are often severe, with difficult management. We describe the case of a renal transplant patient, 44 year-old man, with history of recurrent herpetic keratitis, which developed an impending corneal perforation. Conjunctival smear showed the presence of amoebic cysts. Anti-amoebic treatment was undertaken in addition with oral aciclovir, and a therapeutic penetrating keratoplasty was performed. An ulceration of the graft occurred within five months. Ocular samples showed the presence of Candida albicans. Despite aggressive antifungal therapy, he required a second therapeutic penetrating keratoplasty for graft perforation. One month later, we noted a recurrence of the ulcer with corneal thinning which evolved to perforation. PMID:19345628

  14. Rhodococcal lung abscess in a renal transplant recipient

    PubMed Central

    Wong, Koh-Wei; Thevarajah, Bharathan

    2012-01-01

    Summary Background: Rhodococcus species are relatively rare human pathogens, but are being increasingly recognized as causes of infection especially in immunosuppressed patients. Case Report: We present a case of Rhodococcus lung abscess in a patient 10 months post-cadaveric renal transplant, successfully treated with a combination of antibiotics. She required a prolonged course of oral antibiotics for 6 months. She did not require surgical intervention. Chest X-rays and CT thorax showed complete resolution of the initial lesion. We also review the medical literature related to Rhodococcus infection in patients with renal transplantation. Rhodococcus infection should be considered as in the differential diagnosis of immunosuppressed patients who present with lung abscess/mass. Conclusions: A literature review indicates this is a potentially fatal condition with disseminated sepsis/abscesses. PMID:23569526

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

    PubMed

    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. PMID:22879720

  16. Risk factors and outcome of stroke in renal transplant recipients.

    PubMed

    Findlay, Mark D; Thomson, Peter C; MacIsaac, Rachael; Jardine, Alan G; Patel, Rajan K; Stevens, Kathryn K; Rutherford, Elaine; Clancy, Marc; Geddes, Colin C; Dawson, Jesse; Mark, Patrick B

    2016-08-01

    Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, and imaging and laboratory variables were assessed and case fatality determined. Follow-up was until 05/12/2013. A total of 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation (AF) prevalence was 9.2%, and 38.2% received a transplant during follow-up. A total of 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension, and hemoglobin. Atrial fibrillation was associated with time to stroke (P<0.001). Warfarin did not associate with ischemic stroke risk in those with AF. Fatality was 19.2% at 7, 23.1% at 28, and 42.3% at 365 days after stroke. Patients with a functioning renal transplant have a high stroke incidence and case fatality. Unlike those on hemodialysis, risk factors are similar to the general population. We did not demonstrate benefit from warfarin use in those with AF. PMID:27218240

  17. Slope Estimation of Covariates that Influence Renal Outcome following Renal Transplant Adjusting for Informative Right Censoring

    PubMed Central

    Jaffa, Miran A.; Jaffa, Ayad A; Lipsitz, Stuart R.

    2015-01-01

    A new statistical model is proposed to estimate population and individual slopes that are adjusted for covariates and informative right censoring. Individual slopes are assumed to have a mean that depends on the population slope for the covariates. The number of observations for each individual is modeled as a truncated discrete distribution with mean dependent on the individual subjects' slopes. Our simulation study results indicated that the associated bias and mean squared errors for the proposed model were comparable to those associated with the model that only adjusts for informative right censoring. The proposed model was illustrated using renal transplant dataset to estimate population slopes for covariates that could impact the outcome of renal function following renal transplantation. PMID:25729124

  18. Eligibility for renal transplantation: a Moroccan interregional survey.

    PubMed

    Kabbali, Nadia; Mikou, Souad; El Bardai, Ghita; Najdi, Adil; Ezziani, Meriem; Batta, Fatima Zahra; El Pardiya, Nada Tazi; El Fadil, Chadia; El Hassani, Aniss; Arrayhani, Mohamed; Houssaini, Tarik Sqalli

    2015-01-01

    In the treatment of end-stage renal disease, kidney transplantation (KT) is the best and most cost-effective alternative with regard to both prognosis and quality of life. To identify the proportion and the characteristics of kidney transplant candidates who can be considered eligible, a total of 2066 hemodialysis patients were investigated as part of the ARTEMIS (Attitude toward Renal Transplantation and Eligibility among dialysis patients in a Moroccan Interregional Survey) study. We investigated all patients receiving hemodialysis in the 39 centers of four Moroccan departments. The mean age was 52.9 years and the mean duration of hemodialysis was 55.3 months. Fifty-eight percent of our patients were considered eligible for KT; 18.2% had an absolute contraindication and 23.8% had one or more relative contraindications. When compared with eligible patients (n = 1200) in the univariate analysis, those ineligible were significantly older (61 years vs. 51, P < 0.0001), had no residual diuresis (59.8% vs. 49.1%, P < 0.0001), were more often diabetic (25.1% vs. 11.9%, P < 0.0001) and hypertensive (54.5% vs. 45.8%, P < 0.0001), and their median dialysis duration was longer (61 months vs. 51, P < 0.0001). In the multivariate models, eligibility remained associated with young age, less term of dialysis and residual diuresis. Adequate control of cardiovascular risk factors before dialysis and early referral for transplantation might help to improve eligibility of the renal transplant candidates. PMID:25579741

  19. ACE inhibition in the treatment of children after renal transplantation.

    PubMed

    Arbeiter, Klaus; Pichler, Andrea; Stemberger, Regina; Mueller, Thomas; Ruffingshofer, Dagmar; Vargha, Regina; Balzar, Egon; Aufricht, Christoph

    2004-02-01

    Currently, there are no data available on long-term effects of angiotensin-converting enzyme inhibitors (ACE-I) on graft function in children after renal transplantation. We therefore analyzed all children who were transplanted at our institution between 1989 and 1998 and followed for at least 2 years. Those treated with ACE-I, mainly because of failure of other antihypertensive medications, were compared to those without ACE-I. The ACE-I-treated children ( n=19) showed significantly better blood pressure control during the 1st year of follow-up ( p<0.05). In children with chronic allograft dysfunction ( n=8), treatment with ACE-I stabilized graft function, with improvement in creatinine clearance in 50% ( p<0.01). Serum potassium and hemoglobin levels remained stable. One patient discontinued ACE-I because of renal artery stenosis. Taken together, ACE-I were effective and safe in the treatment of hypertension in children following renal transplantation. Children with chronic allograft dysfunction experienced a stabilizing effect on graft function. PMID:14673630

  20. Recurrence and Treatment after Renal Transplantation in Children with FSGS.

    PubMed

    Kang, Hee Gyung; Ha, Il-Soo; Cheong, Hae Il

    2016-01-01

    Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease and a common pathologic diagnosis of idiopathic nephrotic syndrome (NS), especially in steroid-resistant cases. FSGS is known to recur after kidney transplantation, frequently followed by graft loss. However, not all patients with FSGS suffer from recurrence after kidney transplantation, and genetic and secondary FSGS have a negligible risk of recurrence. Furthermore, many cases of recurrence achieve remission with the current management of recurrence (intensive plasmapheresis/immunosuppression, including rituximab), and other promising agents are being evaluated. Therefore, a pathologic diagnosis of FSGS itself should not cause postponement of allograft kidney transplantation. For patients with a high risk of recurrence who presented with classical symptoms of NS, that is, severe edema, proteinuria, and hypoalbuminemia, close monitoring of proteinuria is necessary, followed by immediate, intensive treatment for recurrence. PMID:27213154

  1. Recurrence and Treatment after Renal Transplantation in Children with FSGS

    PubMed Central

    Ha, Il-Soo

    2016-01-01

    Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease and a common pathologic diagnosis of idiopathic nephrotic syndrome (NS), especially in steroid-resistant cases. FSGS is known to recur after kidney transplantation, frequently followed by graft loss. However, not all patients with FSGS suffer from recurrence after kidney transplantation, and genetic and secondary FSGS have a negligible risk of recurrence. Furthermore, many cases of recurrence achieve remission with the current management of recurrence (intensive plasmapheresis/immunosuppression, including rituximab), and other promising agents are being evaluated. Therefore, a pathologic diagnosis of FSGS itself should not cause postponement of allograft kidney transplantation. For patients with a high risk of recurrence who presented with classical symptoms of NS, that is, severe edema, proteinuria, and hypoalbuminemia, close monitoring of proteinuria is necessary, followed by immediate, intensive treatment for recurrence. PMID:27213154

  2. Thirty-seven years of renal transplantation in Oregon.

    PubMed

    Barry, J M; Lemmers, M J; Conlin, M J; Norman, D J; Bennett, W M; Meyer, M M; DeMattos, A; Wetzsteon, P; Johnson-Tomanka, M; Seely, M

    1996-01-01

    What we accomplish today as a matter of routine was only imagined by a few 4 decades ago. The journey from that first successful kidney transplant in the 1950s to the multidisciplinary, multiorgan transplant program of today has been a fascinating one. Although we attribute our current results to careful recipient selection and preparation, improvements in organ procurement and preservation, refinement of surgical techniques, improvement in histocompatibility techniques and organ sharing, improvements in immunosuppression and infection control, and careful monitoring of recipients, we and our patients have benefited from significant contributions from our colleagues in government and the law. The 4 that come to mind are the provision of near-universal insurance coverage for end stage renal disease patients in 1972 under the Medicare program, the passage of brain death laws in the mid 1970s, the passage of the National Transplant Act in 1984, and the passage of the Oregon required request law in 1985. PMID:9286571

  3. [Cryptosporidium parvum Gastroenteritis in a Patient with Renal Transplantation].

    PubMed

    Çetinkaya, Ülfet; Dursun, İsmail; Kuk, Salih; Şahin, İzzet; Yazar, Süleyman

    2015-09-01

    In this study, a case who starting abundant watery diarrhea on the 14th day of renal transplantation is presented. Stool sample was analyzed for Cryptosporidium spp. by carbol fuchsin staining method, copro-ELISA and nested polimeraze chain reaction (PCR). From sample found positive by Carbol-fuchsin staining method and Copro-ELISA, DNA sequence analysis was performed, gel-purified from amplicon obtained by nested PCR. As a result of DNA sequence analysis was determined to be Cryptosporidium parvum. Although C. parvum is a rare causative agent of gastroenteritis it can be cause serious clinical diarrhea solid organ transplantation patient. As a result, also C.parvum must be considered as a causative agent of diarrhea occurring after organ transplantation. PMID:26470932

  4. Laparoscopic cholecystectomy in a renal transplant recipient.

    PubMed

    Hudson, H M; Hakaim, A G; Birkett, D H

    1992-01-01

    Laparoscopic cholecystectomy is a viable and safe alternative for the treatment of symptomatic gallstones and biliary colic. As surgeons gain more experience with this procedure, contraindications become fewer and indications increase. Well-documented advantages of this approach include less patient discomfort, less surgical scarring, and earlier return to employment. Not previously discussed in the literature, however, are the additional advantages that this procedure holds for a specific subset of patients--namely, those patients that have undergone successful organ transplantation and are receiving immunosuppressive drugs. We report a case of a laparoscopic cholecystectomy in such a patient. PMID:1387737

  5. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation.

    PubMed

    Lafayette, R A; Paré, G; Schmid, C H; King, A J; Rohrer, R J; Nasraway, S A

    1997-09-01

    The postoperative courses of 115 liver transplant recipients were reviewed to monitor for outcomes of acute renal failure and mortality. An analysis of baseline (preoperative) variables with particular attention to baseline renal function was accomplished to establish predictive variables for a complicated postoperative course. Acute renal failure requiring dialysis occurred in 27 cases (23%) and was associated with a prolonged ICU stay, greater infectious complications, greater hospital charges and a high mortality rate (46 +/- 11% vs. 9 +/- 3%) as compared to patients who did not experience acute renal failure. Death occurred in 20 patients (17%) overall prior to discharge. In order to assess the contribution of renal function, the population was divided arbitrarily into two groups based on preoperative serum creatinine. Group 1 (n = 50) had a preoperative serum creatinine < 1.0 mg/dl (mean +/- SD = 2.2 +/- 0.2 mg/dl) and Group 2 (n = 65) had a preoperative serum creatinine < or = 1.0 mg/dl (0.7 +/- 0.1 mg/dl). The groups experienced similar operative courses. Group 1 patients experienced significantly longer ICU stays (18 +/- 3 vs. 10 +/- 2 days), higher rates of acute renal failure requiring dialysis (52 +/- 7 vs. 5 +/- 2%), higher hospital charges (231,454 +/- 17,088 vs. 178,755 +/- 14,744 $, US) and a greatly increased mortality rate (32 +/- 1 vs. 6 +/- 1%), as compared to Group 2 patients. A multifactorial regression analysis demonstrated that of all pretransplant factors analyzed, elevation in the serum creatinine was significantly associated and was the strongest predictor of both outcomes: acute renal failure requiring dialysis (ROC = 0.89) and death (ROC = 0.83). The presence or absence of hepatorenal syndrome did not influence the results of this analysis. This study demonstrates that cirrhotic patients with renal dysfunction, as indicated by an elevated serum creatinine, experience a poor surgical outcome following liver transplantation. These patients

  6. Primary disease recurrence—effects on paediatric renal transplantation outcomes.

    PubMed

    Bacchetta, Justine; Cochat, Pierre

    2015-06-01

    Primary disease recurrence after renal transplantation is mainly diagnosed by examination of biopsy samples, but can also be associated with clinical symptoms. In some patients, recurrence can lead to graft loss (7-8% of all graft losses). Primary disease recurrence is generally associated with a high risk of graft loss in patients with focal segmental glomerulosclerosis, membranous proliferative glomerulonephritis, primary hyperoxaluria or atypical haemolytic uraemic syndrome. By contrast, disease recurrence is associated with a limited risk of graft loss in patients with IgA nephropathy, renal involvement associated with Henoch-Schönlein purpura, antineutrophil cytoplasmic antibody-associated glomerulonephritis or lupus nephritis. The presence of systemic diseases that affect the kidneys, such as sickle cell anaemia and diabetes mellitus, also increases the risk of delayed graft loss. This Review provides an overview of the epidemiology, pathophysiology and management of primary disease recurrence in paediatric renal graft recipients, and describes the overall effect on graft survival of each of the primary diseases listed above. With appropriate management, few paediatric patients should be excluded from renal transplantation programmes because of an increased risk of recurrence. PMID:25917555

  7. ABO incompatible renal transplants: Good or bad?

    PubMed Central

    Muramatsu, Masaki; Gonzalez, Hector Daniel; Cacciola, Roberto; Aikawa, Atsushi; Yaqoob, Magdi M; Puliatti, Carmelo

    2014-01-01

    ABO incompatible kidney transplantation (ABOi-KT) was previously considered to be an absolute contraindication for patients with end-stage kidney disease (ESKD) due to hyperacute rejection related to blood type barrier. Since the first successful series of ABOi-KT was reported, ABOi-KT is performed increasingly all over the world. ABOi-KT has led to an expanded donor pool and reduced the number of patients with ESKD awaiting deceased kidney transplantation (KT). Intensified immunosuppression and immunological understanding has helped to shape current desensitization protocols. Consequently, in recent years, ABOi-KT outcome is comparable to ABO compatible KT (ABOc-KT). However, many questions still remain unanswered. In ABOi-KT, there is an additional residual immunological risk that may lead to allograft damage, despite using current diverse but usually intensified immunosuppressive protocols at the expense of increasing risk of infection and possibly malignancy. Notably, in ABOi-KT, desensitization and antibody reduction therapies have increased the cost of KT. Reassuringly, there has been an evolution in ABOi-KT leading to a simplification of protocols over the last decade. This review provides an overview of the history, outcome, protocol, advantages and disadvantages in ABOi-KT, and focuses on whether ABOi-KT should be recommended as a therapeutic option of KT in the future. PMID:24669364

  8. Endovascular Repair of Renal Artery Anastomotic Pseudoaneurysm Following Living Donor Kidney Transplant.

    PubMed

    Patil, Vivek V; Roytman, Michelle; Ames, Scott; Beckerman, William; Lookstein, Robert A

    2015-12-01

    Renal artery anastomotic pseudoaneurysms, an uncommon complication of transplantation, may result in aneurysm rupture and loss of allograft. We report the case of 50-year-old female with back pain 3 weeks post renal transplantation. CT scan revealed transplant renal artery anastomotic pseudoaneurysm arising from anastomosis of two renal arteries joined together to form a single renal artery that was joined to the aorta. Successful endovascular treatment was achieved with covered stents, resulting in preserved renal function. Follow-up ultrasound at one-day post procedure and CT at 2 months revealed satisfactory renal perfusion with no pseudoaneurysm. Endovascular treatment of transplant renal artery pseudoaneurysms with covered stent and ostial flare balloon technology may be preferred in patients with extensive prior pelvic surgery, as illustrated in this case. PMID:26037091

  9. Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Renal Transplant

    SciTech Connect

    Rao, M.; Arya, N. Lee, B.; Hannon, R.J.; Loan, W.; Soong, C.V.

    2004-09-15

    Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.

  10. Acute Renal Failure - A Serious Complication in Patients After Kidney Transplantation.

    PubMed

    Basta-Jovanovic, G; Bogdanovic, Lj; Radunovic, M; Prostran, M; Naumovic, R; Simic-Ogrizovic, S; Radojevic-Skodric, S

    2016-01-01

    Free radical-mediated injury releases proinflammatory cytokines and activates innate immunity. It has been suggested that the early innate response and the ischemic tissue damage play roles in the development of adaptive responses, which may lead to acute kidney rejection. Various durations of hypothermic kidney storage before transplantation add to ischemic tissue damage. The final stage of ischemic injury occurs during reperfusion that develops hours or days after the initial insult. Repair and regeneration processes occur together with cellular apoptosis, autophagy and necrosis and a favorable outcome is expected if regeneration prevails. Along the entire transplantation time course, there is a great demand for novel immune and nonimmune injury biomarkers. The use of these markers can be of great help in the monitoring of kidney injury in potential kidney donors, where acute kidney damage can be overlooked, in predicting acute transplant dysfunction during the early post-transplant periods, or in predicting chronic changes in long term followup. Numerous investigations have demonstrated that biomarkers that have the highest predictive value in acute kidney injury include NGAL, Cystatin C, KIM-1, IL-18, and L-FABP. Most investigations show that the ideal biomarker to fulfill all the needs in renal transplant has not been identified yet. Although, in many animal models, new biomarkers are emerging for predicting acute and chronic allograft damage, in human allograft analysis they are still not routinely accepted and renal biopsy still remains the gold standard. PMID:27498898

  11. Laparoscopic donor nephrectomy: impact on an established renal transplant program.

    PubMed

    Shafizadeh, S; McEvoy, J R; Murray, C; Baillie, G M; Ashcraft, E; Sill, T; Rogers, J; Baliga, P; Rajagopolan, P R; Chavin, K

    2000-12-01

    The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantation offers significant advantages compared with cadaveric donor transplantation: increased graft and patient survival, diminution in incidence of delayed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants performed in the United States. It has been felt that inherent disincentives to live donation have slowed its growth. These include degree and duration of postoperative pain and convalescence, child care concerns, cosmetic concerns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this study was to compare the results of our first 25 laparoscopic nephrectomies (performed over a 10-month period from September 1998 through July 1999) with the previous 25 standard open donor nephrectomies (ODNs) completed over the past 3 years. We conducted a retrospective review of all donor nephrectomies and recipient pairs performed over the past 3 years. End points included sex, operative time, length of stay, immediate and long-term renal function, and willingness to donate. There were no differences in demographics of the ODN versus the LDN group. The average length of stay was 2.48+/-0.72 days for the LDN versus 4.08+/-0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function and no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 1999. We conclude that LDN is a viable alternative to the standard donor operation. LDN has had a positive impact on the donor pool

  12. Can pre-implantation biopsies predict renal allograft function in pediatric renal transplant recipients?

    PubMed Central

    Kari, Jameela A.; Ma, Alison L.; Dufek, Stephanie; Mohamed, Ismail; Mamode, Nizam; Sebire, Neil J.; Marks, Stephen D.

    2015-01-01

    Objectives: To determine the utility of pre-implantation renal biopsy (PIB) to predict renal allograft outcomes. Methods: This is a retrospective review of all patients that underwent PIB from January 2003 to December 2011 at the Great Ormond Street Hospital for Children in London, United Kingdom. Thirty-two male patients (56%) aged 1.5-16 years (median: 10.2) at the time of transplantation were included in the study and followed-up for 33 (6-78) months. The results were compared with 33 controls. Results: The PIB showed normal histopathological findings in 13 patients (41%), mild chronic vascular changes in 8 (25%), focal tubular atrophy in one, moderate to severe chronic vascular change in 3, mild to moderate acute tubular damage in 6, and tissue was inadequate in one subject. Delayed graft function (DGF) was observed in 3 patients; 2 with vascular changes in PIB, and one with normal histopathological findings. Two subjects with PIB changes lost their grafts. The estimated glomerular filtration rate at 3-, and 6-months post-transplantation was lower in children with abnormal PIB changes compared with those with normal PIB. There was one case of DGF in the control group, and 4 children lost their grafts including the one with DGF. Conclusion: Pre-implantation renal biopsy can provide important baseline information of the graft with implications on subsequent medical treatment for pediatric renal transplant recipients. PMID:26593162

  13. Renal transplantation in Nepal: the first year's experience.

    PubMed

    Chalise, Pawan R; Shah, Dibya S; Sharma, Uttam K; Gyawali, Prem R; Shrestha, Guna K; Joshi, Bhola R; Kafle, Mukunda P; Sigdel, Mahesh; Raut, Kanak B; Francis, David

    2010-05-01

    A successful renal transplantation service was started in Nepal at the Tribhuvan University 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 received 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 postoperative 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, mycophenalate, 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. PMID:20427894

  14. Exogenous Lipocalin 2 Ameliorates Acute Rejection in a Mouse Model of Renal Transplantation

    PubMed Central

    Ashraf, M. I.; Schwelberger, H. G.; Brendel, K. A.; Feurle, J.; Andrassy, J.; Kotsch, K.; Regele, H.; Pratschke, J.; Maier, H. T.

    2016-01-01

    Abstract Lipocalin 2 (Lcn2) is rapidly produced by damaged nephron epithelia and is one of the most promising new markers of renal injury, delayed graft function and acute allograft rejection (AR); however, the functional importance of Lcn2 in renal transplantation is largely unknown. To understand the role of Lcn2 in renal AR, kidneys from Balb/c mice were transplanted into C57Bl/6 mice and vice versa and analyzed for morphological and physiological outcomes of AR at posttransplantation days 3, 5, and 7. The allografts showed a steady increase in intensity of interstitial infiltration, tubulitis and periarterial aggregation of lymphocytes associated with a substantial elevation in serum levels of creatinine, urea and Lcn2. Perioperative administration of recombinant Lcn2:siderophore:Fe complex (rLcn2) to recipients resulted in functional and morphological amelioration of the allograft at day 7 almost as efficiently as daily immunosuppression with cyclosporine A (CsA). No significant differences were observed in various donor–recipient combinations (C57Bl/6 wild‐type and Lcn2−/−, Balb/c donors and recipients). Histochemical analyses of the allografts showed reduced cell death in recipients treated with rLcn2 or CsA. These results demonstrate that Lcn2 plays an important role in reducing the extent of kidney AR and indicate the therapeutic potential of Lcn2 in transplantation. PMID:26595644

  15. Laboratory use of hepcidin in renal transplant recipients

    PubMed Central

    Šimetić, Lucija; Zibar, Lada

    2016-01-01

    Hepcidin is a small peptide with a critical role in cellular iron homeostasis, as it regulates utilization of stored iron and antimicrobial defense in inflammation (bacterial and fungal). Since it was isolated in 2000, and especially in the last decade, numerous studies aimed to evaluate the clinical use of plasma and urine hepcidin as a marker of anemia, especially anemia of chronic disease and post-transplant anemia (PTA). Hepcidin regulation is delicately tuned by two inflammatory pathways activated by interleukin-6 (IL-6) and bone morphogenic proteins (BMPs) and iron regulated pathway sensitive to circulating transferin-iron (TR-Fe) complex. BMP-mediated pathway and TR-Fe sensitive pathway seem to be connected by hemojuveline, a BMP co-factor that interacts with transferine receptor 2 (TRF2) in cases of high TR-Fe circulatory concentration. In addition to these regulatory mechanisms other regulators and signaling pathways are being extensively researched.
Hepcidin has been identified as an important contributor to morbidity and mortality in end stage renal disease (ESRD) but no such association has jet been found in case of PTA. However, there is an association between higher doses of erythropoiesis-stimulating agents (ESA) and mortality in the posttransplant period and the assumption that hepcidin might play a role in ESA resistance in PTA. Thus the review’s main goal was to summarize papers published on the association of hepcidin with PTA, give up-to-date information on hepcidin regulation and on potential therapeutics that optimize hepcidin regulation. We also compared the performances of tests for hepcidin determination and reviewed research on immunosuppressants’ (IS) effect on hepcidin concentration. PMID:26981017

  16. Epidemiology of urinary infections in renal transplant recipients.

    PubMed

    Valera, B; Gentil, M A; Cabello, V; Fijo, J; Cordero, E; Cisneros, J M

    2006-10-01

    Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. We evaluated prospectively all the UTIs in 161 kidney recipients transplanted between July 2003 and July 2005. All patients received prophylaxis with sulfadoxine-pyrimethamine. We excluded asymptomatic bacteriuria. Forty-one patients (25%) suffered at least one UTI episode. Ninety-two episodes of infection were confirmed with an incidence rate of 97 UTI episodes per 100 patient-years. The most common clinical features were uncomplicated acute bacterial cystitis, 71 episodes (77%), and acute pyelonephritis, 21 episodes (23%). Microbiological isolation was confirmed in 58 episodes (63%). Bacterial infections were the most frequent etiologies: gram-negative bacilli in 52 (90%), gram-positive cocci in 4 (7%), fungal in 2 (3%), and one viral BK virus (2%) infection. The causative microorganisms were E. coli as the principal isolated agent in 41 cases (71%), including 10 (24%) that were extended-spectrum betalactamases (ESBLEC). All episodes showed a favorable course. The survival rate of the graft at the end of the study period was 90.7%, and the survival rate of the transplant recipients was 97.5%. The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli (ESBLEC) was the main agent isolated. Uncomplicated UTI, the most frequent post transplantation infection, showed a good prognosis. PMID:17097953

  17. Ethical and legal issues in renal transplantation in Nigeria.

    PubMed

    Ajayi, S O; Raji, Y; Salako, B L

    2016-01-01

    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. PMID:26787578

  18. Mining the human urine proteome for monitoring renal transplant injury.

    PubMed

    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 provides an assessment of kidney injury with specific biomarkers for different kidney injury phenotypes. In an effort to fully map and decipher changes in the urine proteome and peptidome after kidney transplantation, renal allograft biopsy matched urine samples were collected from 396 kidney transplant recipients. Centralized and blinded histology data from paired graft biopsies was used to classify urine samples into diagnostic categories of acute rejection, chronic allograft nephropathy, BK virus nephritis, and stable graft. A total of 245 urine samples were analyzed by liquid chromatography-mass spectrometry using isobaric Tags for Relative and Absolute Quantitation (iTRAQ) reagents. From a group of over 900 proteins identified in transplant injury, a set of 131 peptides were assessed by selected reaction monitoring for their significance in accurately segregating organ injury causation and pathology in an independent cohort of 151 urine samples. Ultimately, a minimal set of 35 proteins were identified for their ability to segregate the 3 major transplant injury clinical groups, comprising the final panel of 11 urinary peptides for acute rejection (93% area under the curve [AUC]), 12 urinary peptides for chronic allograft nephropathy (99% AUC), and 12 urinary peptides for BK virus nephritis (83% AUC). Thus, urinary proteome discovery and targeted validation can identify urine protein panels for rapid and noninvasive differentiation of different causes of kidney transplant injury, without the requirement of an invasive biopsy. PMID:27165815

  19. The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria.

    PubMed

    Takure, A O; Jinadu, Y O; Adebayo, S A; Shittu, O B; Salako, B L; Kadiri, S

    2016-01-01

    Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation. PMID:27424696

  20. Unrelated renal transplantation: an ethical enigma.

    PubMed

    Aggarwal, Gaurav; Adhikary, Samiran

    2016-01-01

    End-stage renal disease (ESRD) is a condition better discussed than suffered. People suffering from ESRD are at a disadvantage not only financially, but also emotionally and in terms of the quality of their lives. The majority of their productive time is spent in hospital, on dialysis machines, or in the search for a suitable kidney donor, so that they may be able to improve upon the quality of their remaining lifespan. Only a "lucky few" are able to find a suitable matching donor, be it living (related) or a cadaver, whilst the others are left to fend for themselves. As the supply fails to cope with the demand, people go to the extent of exploring the pool of "unrelated donors". Though not legalised yet, this is one domain yet to be explored in its entirety, both on humanitarian as well as ethical grounds. Our current work hopes to highlight this scenario and also provides a few options that may well become "ethically acceptable" in the not-so-far future. PMID:27178491

  1. Management of severe pancreatitis in renal transplant recipients.

    PubMed Central

    Slakey, D P; Johnson, C P; Cziperle, D J; Roza, A M; Wittmann, D H; Gray, D W; Roake, J A; Britton, J; Morris, P J; Adams, M B

    1997-01-01

    OBJECTIVE: The authors determine if any aspects of the treatment of renal transplant patients with pancreatitis were of particular benefit with regard to graft and patient survival. BACKGROUND: The incidence of pancreatitis in renal transplant patients is low (1%-2%), but the mortality of the disease approaches 100%. Although several descriptive reports have been published, there is no consensus-regarding management. METHODS: The authors conduct a retrospective chart review. RESULTS: Twenty-one patients were identified with posttransplant pancreatitis (1.3% incidence). The cause of pancreatitis was presumed to be maintenance immunosuppression in all cases. Patients were classified by dynamic computed tomography (CT) scans having 1) mild/edematous disease (4 patients), 2) localized abscess or pseudocyst (6 patients), or 3) severe disease (11 patients). Patients with mild/edematous pancreatitis did well with medical management. The six patients with localized abscess or pseudocyst were successfully treated with standard operative intervention. Of the 11 patients with severe disease, 6 had several days of intensive medical management before operation, and all died. The other five patients underwent early operative intervention based principally on CT scan findings, and all survived. The latter group had multiple operations and four of five had functioning renal allografts at discharge. CONCLUSION: The severity of pancreatitis in the posttranplant patients may be difficult to assess by clinical criteria. Dynamic CT scanning is, therefore, essential in defining the extent of disease. Early, and perhaps repeated, operations may be lifesaving in those patients having CT scan findings of severe pancreatitis. PMID:9065299

  2. Recurrent and de novo disease after renal transplantation: a report from the Renal Allograft Disease Registry.

    PubMed

    Hariharan, Sundaram; Savin, Virginia J

    2004-08-01

    Recurrent and de novo disease is an increasing problem and is known to negatively impact transplant graft survival. Immunosuppressive medications have not had an impact on the prevalence of recurrent and de novo disease. Renal Allograft Disease Registry (RADR) was established to study the prevalence, impact and risk factors for the development of recurrent and de novo disease. Retrospective and prospective study on recurrent disease is discussed in this manuscript. PMID:15265160

  3. Evaluation of psychiatric issues in renal transplant setting

    PubMed Central

    Naqvi, R.

    2015-01-01

    Chronic illnesses can cause wide range of personality and behavioral disorders and require appropriate evaluation. Poor patient compliance with prescribed medications and other aspects of management can affect the outcome towards undesirable situation. The setting of renal transplantation presents a broad spectrum of problems and consequences. People involved (patients, their families or treating physicians) have lifelong commitment with evaluation and implementation of measures towards resolving the issues. Psychiatric evaluation is part of this scenario, which starts with evaluation of organ recipient along with donor and family as whole, right from time of diagnosis of end organ failure to transplant and then lifelong. This review highlights common issues faced at different stages of this lengthy pathway. PMID:26664203

  4. Evaluation of psychiatric issues in renal transplant setting.

    PubMed

    Naqvi, R

    2015-01-01

    Chronic illnesses can cause wide range of personality and behavioral disorders and require appropriate evaluation. Poor patient compliance with prescribed medications and other aspects of management can affect the outcome towards undesirable situation. The setting of renal transplantation presents a broad spectrum of problems and consequences. People involved (patients, their families or treating physicians) have lifelong commitment with evaluation and implementation of measures towards resolving the issues. Psychiatric evaluation is part of this scenario, which starts with evaluation of organ recipient along with donor and family as whole, right from time of diagnosis of end organ failure to transplant and then lifelong. This review highlights common issues faced at different stages of this lengthy pathway. PMID:26664203

  5. Transition from gastrostomy to oral feeding following renal transplantation.

    PubMed

    Pugh, Pearl; Watson, Alan R

    2006-01-01

    Feeding through a gastrostomy button (GB) provides benefits to the families of children on chronic dialysis. But data on the transition to oral feeding following renal transplantation--especially in children under 2--is scarce. Here, we report our experience of more than 14 years in 22 children who were GB fed at under 5 years of age (median age: 1.66 years; range: 0.25-4.25 years). We excluded 6 children from the analysis of transition following transplantation because of factors precluding early return to oral feeding--specifically, cognitive impairment and a tongue tie. We compared 10 children who commenced GB feeding at less than 2 years (group 1) with those who commenced at 2-5 years (group 2, n = 6). All 16 children made the transition to normal oral feeding by 10 months post transplantation. Median duration of GB feeding post-transplant in group 1 was 0.3 years (range: 0.1-1.0 years) as compared with 0.2 years (range: 0-0.3 years) in group 2 (p = 0.2). Children with normal cognition and no other precluding factors who have a GB inserted at less than 2 years of age can make a successful transition from GB to oral feeding with no significant delay. Family support should be individualized during this period of potential anxiety. PMID:16983960

  6. A simple and accurate grading system for orthoiodohippurate renal scans in the assessment of post-transplant renal function

    SciTech Connect

    Zaki, S.K.; Bretan, P.N.; Go, R.T.; Rehm, P.K.; Streem, S.B.; Novick, A.C. )

    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.

  7. Confusion after starting citalopram in a renal transplant patient

    PubMed Central

    Sran, Hersharan; Phanish, Mysore K

    2013-01-01

    The UK NICE (National Institute for Clinical Excellence) guidelines on management of depression in adults recommends use of selective serotonin re-uptake inhibitor (SSRI) as a first choice agent. Citalopram, an SSRI antidepressant, is a preferred antidepressant in those patients with concomitant chronic physical health problems. Hyponatraemia because of syndrome of inappropriate antiduretic hormone secrection has been reported with SSRI antidepressants but is usually mild and responds to fluid restriction and cessation of the drug. We report a case of severe hyponatraemia because of citalopram in a renal transplant patient who required treatment with hypertonic (3%) saline, with a good outcome avoiding any neurological complications. PMID:23843413

  8. Babesiosis and hemophagocytic syndrome in an asplenic renal transplant recipient.

    PubMed

    Slovut, D P; Benedetti, E; Matas, A J

    1996-08-27

    Babesiosis is a malaria-like illness transmitted by the tick Ixodes dammini. The disease is endemic to the Northeast coastal region and parts of the Midwest. Symptoms-which include fever, anemia, elevated liver function tests, and hemoglobinuria-may be especially severe in asplenic or immunocompromised patients. In rare cases, infection with Babesia may be associated with marked pancytopenia. Bone marrow biopsy may reveal hemophagocytosis and marrow histiocytosis. We report a severe case of babesiosis and hemophagocytic syndrome in an asplenic renal transplant patient. PMID:8781622

  9. Disseminated mucormycosis with myocardial involvement in a renal transplant recipient.

    PubMed

    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. PMID:26538076

  10. Cyclosporin-erythromycin interaction in renal transplant patients.

    PubMed Central

    Gupta, S K; Bakran, A; Johnson, R W; Rowland, M

    1989-01-01

    1. The interaction between cyclosporin (CyA) and erythromycin was studied in renal transplant patients following oral and intravenous administration of CyA. 2. Blood and plasma CyA concentrations and blood concentrations of metabolite 17 were measured by h.p.l.c. 3. Erythromycin produced almost a two-fold increase in bioavailability, from 36% to 60%; with a small (13%) decrease in clearance of CyA. 4. The metabolite 17 data further support the postulate that erythromycin increases the absorption of CyA rather than inhibits its metabolism, as generally believed. PMID:2655690

  11. Scintigraphic assessment of perivesical urinary extravasation following renal transplantation

    SciTech Connect

    Bushnell, D.L.; Wilson, D.G.; Lieberman, L.M.

    1984-02-01

    Radionuclide scintigraphy is a safe and accurate means of detecting postoperative urologic complications in renal transplant recipients. Early identification of urinary leakage coupled with aggressive intervention significantly reduces the associated morbidity and mortality. Perivesical extravasate may be difficult to distinguish from adjacent or nearby bladder activity on scintiscan. Clarification of actual bladder contour and determination of its exact location within the pelvis may resolve such uncertainties. We describe imaging techniques that define the anatomic extent of the bladder and demonstrate our scintigraphic assessment of perivesical extravasation.

  12. Ipsilateral leg swelling after renal transplantation as an alarming sign of Iliac vein stenosis

    PubMed Central

    Kim, Ju Hyeon; Bae, Seong Man; Park, Su-Kil

    2014-01-01

    Iliac vein stenosis is a rare vascular complication of renal transplantation that may compromise allograft function if not recognized and corrected in a timely fashion. Because chronic venous stenosis may remain undiagnosed for several years, a high index of suspicion should be maintained until diagnosing this rare disease. A 56-year-old renal transplant recipient presented with unilateral leg swelling and renal dysfunction 16 years after transplantation. Computed tomography excluded deep vein thrombosis and revealed tight iliac vein stenosis on the side of the renal transplant. Following angiographic confirmation of the stenosis, endovascular treatment was successfully performed with a purposefully designed, self-expanding, venous stent. Ipsilateral leg swelling is an alarming sign for the diagnosis of iliac vein stenosis after renal transplantation. Percutaneous intervention with venous stent placement seems to be a safe and effective treatment of this rare condition. PMID:26885480

  13. Ethical issues relating to renal transplantation from prediabetic living donor

    PubMed Central

    2014-01-01

    Background In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor. Discussion Diabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered. Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols. Summary We argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico

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

    SciTech Connect

    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

  15. Increased intestinal permeability during cytomegalovirus infection in renal transplant recipients.

    PubMed

    de Maar, E F; Kleibeuker, J H; Boersma-van Ek, W; The, T H; van Son, W J

    1996-01-01

    Cytomegalovirus (CMV) infections in renal transplant recipients can affect the gastrointestinal tract, but significant clinical manifestations are seldom seen. We hypothesize that subclinical involvement of the gastrointestinal tract may be quite frequent during CMV infection. In order to study this, we measured intestinal permeability by calculating the urinary lactulose mannitol (LM) excretion ratio after oral administration of lactulose and mannitol (normal < 0.030) in patients with symptomatic and asymptomatic CMV infection. A total of 111 patients were enrolled in the study, 104 of whom were tested on postoperative day (POD) 10. Twenty-nine patients developed CMV infection, 12 of whom could be studied with the permeability test (median POD 40). Another nine patients without CMV infection were also studied at day 40 and served as controls. The LM ratio increased significantly during CMV infection compared to measurements before active infection (median 0.060 vs. 0.030, P < 0.01) and was significantly higher during the infection than in the control group (median 0.007, P < 0.01). No correlation could be found between the LM ratio and viral load, humoral response to the virus, or symptomatology of infection. We conclude that an increased intestinal permeability is found in a substantial number of patients with an active, albeit asymptomatic, CMV infection after renal transplantation. Pathophysiological mechanisms and clinical implications remain speculative but will be subject to further study. PMID:8914238

  16. Changing Role of Heart Transplantation.

    PubMed

    Kittleson, Michelle M

    2016-07-01

    Heart transplantation has become standard of care for end-stage heart failure. Challenges include the limited supply of donor organs and the increased complexity of heart transplant candidates who are at higher risk for poor outcomes. Recent advances may address these challenges, including proposed changes in heart transplant allocation policy, a better understanding of the definition and management of primary graft dysfunction, and advances in the management of sensitized heart transplant candidates. Developments in these areas may result in more equitable distribution and expansion of the donor pool and improved quality of life and survival for heart transplant recipients. PMID:27371517

  17. Conversion to everolimus in liver transplant patients with renal dysfunction.

    PubMed

    Pérez, T; Segovia, R; Castro, L; Roblero, J P; Estela, R

    2011-01-01

    Calcineurin inhibitor (CNI) immunosuppressive therapy post-liver transplantation (OLT) is important to reduce graft rejection episodes. However, these drugs show important side effects, particularly renal dysfunction (RDF). Changing from CNI to a nonnephrotoxic drug, as mammalian target of rapamycin (mTOR) inhibitor may solve the problem. Our objective was to evaluate renal function (RF) among liver transplant patients initially receiving CNI, among whom the patients with RDF were converted completely or partially to an mTOR inhibitor like everolimus (EVE). We performed a prospective study in liver transplant patients from 2000 to 2009. Creatinine levels and creatinine clearances (Cockroft-Gault) expressed as mean values ± standard deviations were measured pre- and postswitch for comparisons using Wilcoxon nonparametric tests. Six patients were converted fully or partially to EVE. Their mean age at the moment of introducing the new therapy was 52.2 ± 13.6 years (range = 28-60). Immunosuppression time prior to switching from CNI to EVE was 23.8 ± 26.6 months (range = 6-70). Postconversion follow-up was 25.8 ± 16.5 months (range = 8-42). All patients showed improvement in RF. The creatinine level improvement was significant (P = .03) namely, from a mean of 2.26 ± 0.49 to 1.21 ± 0.57 mg/dL. Glomerular filtration rate improved from a mean of 40 ± 15.13 to 72.60 ± 17.3 mL/min/m(2) (P = .03). Conversion from CNI to EVE improved creatinine concentrations and creatinine clearances with long-term effects free of graft rejection. PMID:21839260

  18. Medication therapy management and adherence among US renal transplant recipients

    PubMed Central

    Chisholm-Burns, Marie A; Spivey, Christina A; Tolley, Elizabeth A; Kaplan, Erin K

    2016-01-01

    Background Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients’ (RTRs) immunosuppressant therapy (IST) adherence. This study’s purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. Methods Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. Results In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02–1.26, P=0.02). Conclusion The findings provide evidence that access to MTM services increases IST adherence among RTRs. PMID:27175070

  19. Peliosis hepatis complicated by portal hypertension following renal transplantation.

    PubMed

    Yu, Chia-Ying; Chang, Liang-Che; Chen, Li-Wei; Lee, Tsung-Shih; Chien, Rong-Nan; Hsieh, Ming-Fang; Chiang, Kun-Chun

    2014-03-01

    Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH is often associated with underlying conditions, such as chronic infection and tumor malignancies, or with the use of anabolic steroids, immunosuppressive drugs, and oral contraceptives. Most patients with PH are asymptomatic, but some present with abdominal distension and pain. In some cases, PH may induce intraperitoneal hemorrhage and portal hypertension. This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation. The patient experienced progressive abdominal distention and pain in the six months prior to this study. Initially, imaging studies revealed multiple liver tumor-like abnormalities, which were determined to be PH by pathological analysis. Because the hepatic lesions were progressively enlarged, the patient suffered from complications related to portal hypertension, such as intense ascites and esophageal varices bleeding. Although the patient was scheduled to undergo liver transplantation, he suffered hepatic failure and died prior to availability of a donor organ. PMID:24605041

  20. Use of local allograft irradiation following renal transplantation

    SciTech Connect

    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.

  1. Mineral Metabolism in European Children Living with a Renal Transplant: A European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry Study

    PubMed Central

    Bonthuis, Marjolein; Busutti, Marco; Jager, Kitty J.; Baiko, Sergey; Bakkaloğlu, Sevcan; Battelino, Nina; Gaydarova, Maria; Gianoglio, Bruno; Parvex, Paloma; Gomes, Clara; Heaf, James G.; Podracka, Ludmila; Kuzmanovska, Dafina; Molchanova, Maria S.; Pankratenko, Tatiana E.; Papachristou, Fotios; Reusz, György; Sanahuja, Maria José; Shroff, Rukshana; Groothoff, Jaap W.; Schaefer, Franz; Verrina, Enrico

    2015-01-01

    Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric 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 recipients. Design, setting, participants, & measurements This study included 1237 children (0–17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure. Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR. Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction. PMID:25710805

  2. Therapeutic role of sirolimus in non-transplant kidney disease.

    PubMed

    Rangan, Gopala K; Nguyen, Tina; Mainra, Rahul; Succar, Lena; Schwensen, Kristina G; Burgess, Jane S; Ho, Kok On

    2009-08-01

    Sirolimus is a member of a novel class of immunosuppressant drug that potently suppresses T cell proliferation and expansion by inhibition of the Target of Rapamycin Complex 1 (TORC1) protein kinase. Sirolimus also has anti-proliferative effects on intrinsic cells of the kidney, and increasing evidence suggests that it may have a therapeutic role in non-transplant renal diseases. In the normal kidney, sirolimus is considered to be non-nephrotoxic. In the diseased kidney, sirolimus may be beneficial or detrimental, depending on the type of renal injury. In polycystic kidney disease, TORC1 activation mediates renal tubular epithelial cell (TEC) proliferation and cyst growth in animals, and Phase III clinical trials are underway to determine the effect of sirolimus in attenuating disease progression in humans. In contrast, in acute kidney injury, sirolimus transiently impairs proximal TEC regeneration and delays renal recovery. In animal models of lupus nephritis and diabetic kidney disease, sirolimus prevents disease progression. However, the efficacy of sirolimus in human glomerulonephritis as well as in diabetic chronic kidney disease remains unclear, as it paradoxically exacerbates renal dysfunction when the baseline glomerular filtration rate is low (< 40 ml/min/1.73 m(2)) and there is heavy proteinuria (> 300 mg/day). This may, in part, be due to inhibition of compensatory glomerular capillary repair through the suppression of endothelial cell proliferation and angiogenic growth factor production by podocytes. Therefore, at present, polycystic kidney disease is the most promising therapeutic application for sirolimus in non-transplant renal diseases, and further studies are needed to clarify its role in other situations. PMID:19374918

  3. Evaluation of Bleeding Rates in Renal Transplant Patients on Therapeutic Intravenous Heparin

    PubMed Central

    Ringenberg, Theresa; Desanto, Heather; Opsha, Yekaterina; Costello, Jennifer; Schiller, Daryl

    2013-01-01

    Background: It is unknown whether coagulation properties differ between renal transplant and nontransplant patients. Objective: To assess whether renal transplant patients on intravenous (IV) heparin, titrated to therapeutic activated partial thromboplastin times (aPPT; 56-93 seconds), experienced a higher rate of bleeding compared to nontransplant patients. Methods: Twenty-nine renal transplant and 29 nontransplant patients receiving IV heparin for a deep vein thrombosis, pulmonary embolism, atrial fibrillation, or acute coronary syndrome were randomly identified through a retrospective chart review. Results: Renal transplant patients had higher bleeding rates on IV heparin therapy compared to nontransplant patients (31% vs 6.9%, respectively; P = .041). Renal transplant patients experienced a drop in hemoglobin of at least 1 g/dL or the need for a transfusion more often then nontransplant patients (69% vs 45%, respectively; P = .111), although the difference was not statistically significant. Conclusions: Further research is necessary to identify the factors contributing to increased rates of bleeding in renal transplant patients on IV heparin and to determine the ideal aPTT to appropriately balance anticoagulation in renal transplant patients. PMID:24474835

  4. Managing new-onset gout in pediatric renal transplant recipients: when, how, to what extent.

    PubMed

    Assadi, Farahnak

    2013-01-01

    Hyperuricemia and gout are common among adult renal transplant recipients, but it is rarely reported following pediatric renal transplantations. Treating gout in pediatric kidney transplant recipients presents clinical challenges to the management of both immunosuppressive regimen and hyperuricemia for their effects on serum uric acid levels, renal function and drug interactions. Most renal transplant recipients have a relative impairment of renal clearance of urate due to abnormalities in renal transport, explaining the association of hyperuricemia and decreased glomerular filtration rate. Risk factors for the development of gout include impaired renal function, hypertension, heart failure and diabetes mellitus. Calcineurin inhibitors, particularly cyclosporine, are the most important risk factor for gout in transplant recipients and should not be used in pediatric renal transplant recipients. Diuretic therapy increases the risk of gout by causing extracellular volume contraction with consequent enhancement of proximal tubular reabsorption. Corticosteroids are increasingly replacing nonsteroidal antiinflammatory drugs and colchicine for the treatment of acute gout flares because they have little effect on kidney function. Proper management is aimed at lowering serum uric acid level below 6.0 mg/dL with xanthine oxidase inhibitors such as allopurinol or febuxostat. Allopurinol and mycophenolate mofetil are safer to use in combination than are allopurinol and azathioprine. Febuxostat is an alternative to allopurinol in patients with allopurinol intolerance or hypersensitivity. Pegloticase is indicated for patients with severe gout in whom allopurinol and febuxostat have not been effective or tolerated. PMID:22941874

  5. The Tacrolimus Metabolism Rate Influences Renal Function after Kidney Transplantation

    PubMed Central

    Thölking, Gerold; Fortmann, Christian; Koch, Raphael; Gerth, Hans Ulrich; Pabst, Dirk; Pavenstädt, Hermann; Kabar, Iyad; Hüsing, Anna; Wolters, Heiner

    2014-01-01

    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. PMID:25340655

  6. The tacrolimus metabolism rate influences renal function after kidney transplantation.

    PubMed

    Thölking, Gerold; Fortmann, Christian; Koch, Raphael; Gerth, Hans Ulrich; Pabst, Dirk; Pavenstädt, Hermann; Kabar, Iyad; Hüsing, Anna; Wolters, Heiner; Reuter, Stefan; Suwelack, Barbara

    2014-01-01

    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. PMID:25340655

  7. Plasma homocysteine concentration changes after renal transplantation in children.

    PubMed

    Merouani, Aicha; Delvin, Edgar E; Genest, Jacques; Rozen, Rima; Lambert, Marie

    2002-07-01

    Hyperhomocysteinemia, a risk factor for vascular disease, is found in children as well as in 80% of adult patients with end-stage renal disease. The aim of this study was to assess the changes in plasma homocysteine concentrations after renal transplantation (RT). Plasma homocysteine, vitamin B(12), and folate concentrations were prospectively measured in six patients at three points, before and post transplantation (6 months, 4 years), and compared with controls using standardized scores (Z score) for each of these parameters. Folic acid supplementation was introduced after the evaluation at 6 months. Patients had elevated median plasma homocysteine Z scores during dialysis (4.12). When assessed at 6 months and 4 years, median plasma homocysteine Z scores were, respectively, 2.35 and 0.29. Median folate Z scores were 1.89 during dialysis, -0.26 at 6 months, and 3.26 at 4 years post RT. Median vitamin B(12) Z score was 2.12 during dialysis, 0.58 at 6 months, and -0.07 at 4 years post RT. Glomerular filtration rate (GFR) improved after RT, with median GFR of 84.5 ml/min per 1.73 m(2) at 6 months. This stabilized to a value of 70.5 ml/min per 1.73 m(2) at 4 years. When comparing values before and after RT at 6 months, changes were observed only for GFR ( P<0.03) and vitamin B(12) ( P<0.05). There were no changes in plasma homocysteine, folate, and serum albumin. At 4 years, a significant decrease in plasma homocysteine was observed ( P<0.05) with increased GFR ( P<0.03). No significant changes were observed in plasma albumin, folate, and vitamin B(12) concentrations. In conclusion, elevated plasma homocysteine in children during dialysis persists after RT despite a significant improvement in renal function. However, normalization was attained when patients were supplemented with folic acid. Further controlled studies are required to evaluate the determinants and treatment of elevated plasma homocysteine in pediatric transplant patients. PMID:12172766

  8. Quality of sleep and health-related quality of life in renal transplant recipients

    PubMed Central

    Liu, Hong-Xia; Lin, Jun; Lin, Xiao-Hong; Wallace, Linda; Teng, Sha; Zhang, Shu-Ping; Hao, Yu-Fang

    2015-01-01

    Aims and objectives: The purpose of this study was to examine the sleep quality and health-related quality of life (HRQOL) in patients after renal transplantation and to explore the relationship between the quality of sleep and the HRQOL. Background: Sleep disorders are still an important clinical problem after renal transplantation. Previous studies mainly focused on patients’ sleep quality before kidney transplant. More studies are needed to document sleep quality after renal transplantation. Design: A cross-sectional design was used in this study. Methods: A convenience sample of renal transplant recipients was recruited at an outpatient transplant clinic of a general hospital in Beijing, China. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality of sleep. The Medical Outcomes Study 36-item Short Form (MOS SF-36) was used to measure health-related quality of life. Results: The average PSQI score of the 204 renal transplant recipients was 5.81±3.52, significantly lower than the norm. Fifty (24.5%) recipients were classified as having poor sleep quality (global PSQI > 7). The mean scores of renal transplant recipients for SF-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) were 47.57±6.71 and 48.26±9.66 respectively. Compared with residents in Sichuan province, recipients’ scores for SF-36 dimensions were statistically lower except the dimension of mental health. SF-36 scores of poor sleepers (PSQI > 7) were significantly lower than the good sleepers (PSQI ≤ 7) in both the MCS and PCS. Significant differences exist between the groups in physical function, bodily pain, vitality, and mental health dimensions. Conclusions: Sleep quality and HRQOL of patients after renal transplantation were lower than the norm. Poor sleep is associated with lower HRQOL. Relevance to clinical practice: Health professionals need to pay attention to sleep quality and HRQOL in renal transplant recipients and take appropriate measures to

  9. Renal blood flow transit time in the study of renal transplants

    SciTech Connect

    Sfakianakis, G.; Ihmeidan, I.; Kyriakides, G.; Martinez, B.; Hourani, M.; Miller, J.; Serafini, A.

    1985-05-01

    Radio-hippurate scintigraphy has been used to study renal transplant function because of its unique advantages over other noninvasive methods. Despite a great sensitivity in diagnosing the existence of a functional problem the test lacks in specificity. In an effort to differentiate between acute tubular necrosis (ATN) and graft rejection (RJ) the authors preceded hippurate scintigraphy by measurements of renal flow transit time (TT). After an intravenous injection of 8 mCi of Tc-99m-sulfur-colloid flow curves from the kidney and the abdominal aorta in 1 sec intervals for 1 min were obtained. Renal transit time was mathematically calculated and corrected for bolus and circulatory differences by dividing it with the corresponding Aortic TT (corrected Renal TT(cRTT). Radiohippuran (O-I-131-Hippurate), 150 ..mu..Ci was injected subsequently and of the different computer generated parameters the 30 min net cortical residual (% of the peak) activity (Hippuran Residual Activity, HRA) was found more sensitive and reproducible for comparisons. Results of documented cases showed a statistically significant difference. Uncomplicated cases (usually on antirejection therapy) showed a tendency to increasing the cRTTs with time (not significantly) but their HRAs were significantly lower than in ATN and RJ (p< 0.001).

  10. Successful pregnancy following single blastocyst transfer in a renal transplant recipient

    PubMed Central

    Muthuvel, V. Arun; Ravindran, Manipriya; Chander, Aravind; Veluswamy, Chandralekha

    2016-01-01

    Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients. PMID:27110079

  11. BK Nephritis and Venous Thrombosis in Renal Transplant Recipient Detected by 111In Leukocyte Imaging.

    PubMed

    Pucar, Darko; Klein, Kandace; Corley, James; Williams, Hadyn T

    2015-07-01

    Three months after deceased donor kidney transplant, a patient who presented with proteinuric renal dysfunction and fever of undetermined origin was found to have BK viruria by quantitative polymerase chain reaction analysis. An ¹¹¹In leukocyte scan showed increased renal transplant uptake consistent with nephritis and linear uptake in the knee. Venous duplex ultrasound revealed acute occlusive thrombosis in the superficial right lesser saphenous vein in the area of increased radiolabeled leukocyte uptake. This ¹¹¹In leukocyte scan performed for fever of undetermined origin demonstrated findings of BK nephritis in a renal transplant patient and associated acute venous thrombosis related to leukocyte colonization. PMID:26018698

  12. Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

    PubMed Central

    Coates, P. Toby; Barbara, Jeffrey; Hakendorf, Paul; Karim, Nazmul

    2016-01-01

    Introduction. Postrenal transplant bone disease is a significant problem. Factors influencing postrenal transplant bone status include high dose acute and low dose long-term steroid use, persistent hypercalcaemia, and graft failure. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre. Methods. This is a biochemical audit in which we studied renal transplant recipients from the Central Northern Adelaide Renal Transplant Services, South Australia. Inclusion criteria include kidney transplant patients with functioning graft since 1971 and at least 3 months after transplantation at the time of analysis. Hypercalcaemia was defined as persistently elevated serum corrected calcium greater than or equal to 2.56 mmol/L for three consecutive months. Results. 679 renal transplant recipients with a functioning graft were studied and 101 were hypercalcaemic between March 2011 and June 2011 (15%). 60% of the hypercalcaemic patients were male and 40% were female, with chronic glomerulonephritis (39%) being the commonest cause of their end stage kidney disease (ESKD). Prevalence was similar in those that had haemodialysis and peritoneal dialysis pretransplantation. Hypercalcaemia in the renal transplant population was not secondary to suboptimal allograft function but secondary to pretransplantation hyperparathyroidism with persistent high parathyroid hormone (PTH) levels after transplantation. Conclusion. There is a high prevalence of hypercalcaemia (15%) in renal transplant recipients. The predominant cause for hypercalcaemia is pretransplantation hyperparathyroidism. The magnitude of pretransplantation hyperparathyroidism is the major determinant for long-term parathyroid function rather than graft function or pretransplantation duration on dialysis or mode of dialysis. PMID:27493801

  13. Hepatitis E-associated encephalopathy in a renal transplant recipient

    PubMed Central

    de Vries, Marijke A; Samijn, Johnny P A; de Man, Rob; Boots, Johannes M M

    2014-01-01

    Hepatitis E virus genotype 3 is not rare in developed countries, and may cause chronic hepatitis in immunocompromised patients. This may not only lead to abnormalities in liver test and malaise, but to severe neurological symptoms as well. In this case, chronic hepatitis E infection caused encephalopathy, an atactic gait, Lhermitte's sign, incomplete bladder emptying and peripheral sensory neuropathy in a renal transplant recipient. The diagnosis was not performed until years after the onset of first symptoms and several months after the onset of neurological symptoms. If treated adequately, viral load can be reduced in over two-thirds of patients and neurological symptoms are often resolved. More widespread knowledge about this virus and its extrahepatic manifestations may lead to a quicker diagnosis, and may limit pathology. Serological screening should be added to standard pretransplant virological screening, so that, in the future, patients without antibodies could be vaccinated. PMID:24789162

  14. Contribution of Large Pig for Renal Ischemia-Reperfusion and Transplantation Studies: The Preclinical Model

    PubMed Central

    Giraud, S.; Favreau, F.; Chatauret, N.; Thuillier, R.; Maiga, S.; Hauet, T.

    2011-01-01

    Animal experimentation is necessary to characterize human diseases and design adequate therapeutic interventions. In renal transplantation research, the limited number of in vitro models involves a crucial role for in vivo models and particularly for the porcine model. Pig and human kidneys are anatomically similar (characterized by multilobular structure in contrast to rodent and dog kidneys unilobular). The human proximity of porcine physiology and immune systems provides a basic knowledge of graft recovery and inflammatory physiopathology through in vivo studies. In addition, pig large body size allows surgical procedures similar to humans, repeated collections of peripheral blood or renal biopsies making pigs ideal for medical training and for the assessment of preclinical technologies. However, its size is also its main drawback implying expensive housing. Nevertheless, pig models are relevant alternatives to primate models, offering promising perspectives with developments of transgenic modulation and marginal donor models facilitating data extrapolation to human conditions. PMID:21403881

  15. Simultaneous pancreas-kidney transplant for type I diabetes with renal failure: Anaesthetic considerations.

    PubMed

    Kumar, Lakshmi; Surendran, Sudhindran; Kesavan, Rajesh; Menon, Ramachandran Narayana

    2016-02-01

    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. PMID:27013753

  16. Lower Respiratory Tract Infection in a Renal Transplant Recipient: Do not Forget Metapneumovirus

    PubMed Central

    Noel, N.; Rammaert, B.; Zuber, J.; Sayre, N.; Mamzer-Bruneel, M. F.; Leruez-Ville, M.; Mascard, L.; Lecuit, M.; Lortholary, O.

    2012-01-01

    Human metapneumovirus (hMPV) is emerging as a cause of a severe respiratory tract infection in immunocompromised patients. hMPV pneumonia has only been seldom reported in nonpulmonary solid organ transplanted patients, such as renal transplant recipients. We report here a case of a 39-year-old patient presenting with fever, cough, and interstitial opacities on CT scan diagnosed as a nonsevere hMPV pneumonia 11 years after a renal transplantation. Infection resolved spontaneously. Differential diagnosis with Pneumocystis pneumonia was discussed. We review the medical literature and discuss clinical presentation and detection methods that can be proposed in solid organ transplant recipients. PMID:23213611

  17. Endothelial progenitor cells and asymmetric dimethylarginine after renal transplantation.

    PubMed

    Teplan, Vladimír; Mahrová, Andrea; Králová-Lesná, Ivana; Racek, Jaroslav; Valkovský, Ivo; Štollová, Milena

    2015-03-01

    Levels of the endogenous nitric oxide synthase inhibitor asymmetrical dimethylarginine (ADMA) are elevated and endothelial progenitor cells (EPCs) decreased in patients undergoing renal transplantation (Tx) and may contribute to cardiovascular complications. In this study, we tested the hypothesis that elevated ADMA and decreased EPC can be positively influenced with regular physical exercise early after Tx. Blood samples for analysis of ADMA and EPC were obtained from randomly selected 64 patients after Tx who agreed to participate in a supervised aerobic exercise program for 6 months (group I). Samples were collected before the training began, 1 month after surgery (with stabilized renal function), and at 6 months after initiation. Sixty-two age, sex, human leukocyte antigens (HLA) typing, duration of previous dialysis, history of cardiovascular disease, and immunosupression regimen-matched transplant patients who did not exercise regularly were examined as controls (group II). There were no differences in ADMA levels and EPC count between both groups before the training program began. After 6 months of exercise, ADMA concentration in the group I decreased (3.50 ± 0.45 vs. 2.11 ± 0.35 μmol/L; P < .01) and was also lower comparing with group II (2.11 ± 0.23 vs. 3.25 ± 0.35 μmol/L; P < .01). In the same period, EPC cells increased from 2.085 ± 650 cells/mL versus 3.991 ± 560 cells/mL, P < .01 in group I; but in group II, changes were nonsignificant (P = .11). Blood lipids, HbA1c, insulin, and systolic blood pressure were also affected by the training program. Elevated ADMA level and decreased EPC count were significantly influenced by early regular exercise in patients after Tx. PMID:25576240

  18. Incipient renal transplant dysfunction associates with tubular syndecan-1 expression and shedding.

    PubMed

    Adepu, Saritha; Rosman, Colin W K; Dam, Wendy; van Dijk, Marcory C R F; Navis, Gerjan; van Goor, Harry; Bakker, Stephan J L; van den Born, Jacob

    2015-07-15

    Syndecan-1 is a transmembrane heparan sulfate proteoglycan involved in regenerative growth and cellular adhesion. We hypothesized that the induction of tubular syndecan-1 is a repair response to incipient renal damage in apparently stable, uncomplicated renal transplant recipients. We quantified tubular syndecan-1 in unselected renal protocol biopsies taken 1 yr after transplantation. Spearman rank correlation analysis revealed an inverse correlation between tubular syndecan-1 expression and creatinine clearance at the time of biopsy (r = -0.483, P < 0.03). In a larger panel of protocol and indication biopsies from renal transplant recipients, tubular syndecan-1 correlated with tubular proliferation marker Ki67 (r = 0.518, P < 0.0001). In a rat renal transplantation model, 2 mo after transplantation, mRNA expression of syndecan-1 and its major sheddase, A disintegrin and metalloproteinase-17, were upregulated (both P < 0.03). Since shed syndecan-1 might end up in the circulation, in a stable cross-sectional human renal transplant population (n = 510), we measured plasma syndecan-1. By multivariate regression analysis, we showed robust independent associations of plasma syndecan-1 with renal (plasma creatinine and plasma urea) and endothelial function parameters (plasma VEGF-A, all P < 0.01). By various approaches, we were not able to localize syndecan-1 in vessel wall or endothelial cells, which makes shedding of syndecan-1 from the endothelial glycocalyx unlikely. Our data suggest that early damage in transplanted kidneys induces repair mechanisms within the graft, namely, tubular syndecan-1 expression for tubular regeneration and VEGF production for endothelial repair. Elevated plasma syndecan-1 levels in renal transplantation patients might be interpreted as repair/survival factor related to loss of tubular and endothelial function in transplanted kidneys. PMID:25972509

  19. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient.

    PubMed

    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

  20. The management of urological complications in renal transplant patients.

    PubMed

    Al-Shaer, M B; Al-Midani, A

    2005-01-01

    To determine the incidence and management of urological complications after live-donor renal transplantations at our center, we studied the medical records of 122 patients who underwent live kidney transplantation with a stented Lich-Gregoire anastomosis for ureteric reimplantation. The overall incidence of urological complications was 7.3 %. The early complications included four cases of ureteric stenosis, two cases of urinary leaks (one vesical fistula and one ureterovesical fistula) and one case of lymphocele causing ureteric obstruction. On the other hand, the late complications (> 6 months after surgery) included two cases of vesicoureteral reflux. No graft was lost and there was no urinary complication-related mortality. There was no association with recipient age, related or non-related donor or cold ischemic time. The urinary complications were mostly caused by ureteral ischemia and extrinsic compression by lymphocele; the stent caused vesicular fistula in one patient and clot anuria caused ureteral obstruction in another. In conclusion, the Lich-Gregoire technique has low complication rate and technical ease to perform compared with Barry's extravesical technique. PMID:18202495

  1. Renal transplantation in 22 children with nephropathic cystinosis.

    PubMed

    Ehrich, J H; Brodehl, J; Byrd, D I; Hossfeld, S; Hoyer, P F; Leipert, K P; Offner, G; Wolff, G

    1991-11-01

    In 1989, 22 children (11 boys, 11 girls aged 8-23 years) with nephropathic cystinosis, who had received a total of 28 renal allografts over the previous 14 years, were reviewed. Nineteen were alive, of whom 17 had functioning grafts 5 months to 13 years after transplantation. The mean serum creatinine level in these 17 was 135 mumol/l. Patient and graft survival did not differ from non-cystinotic children. Persistent hypothyroidism was found in 3 patients, transient diabetes mellitus in 1, severely disturbed vision in 1 and brain atrophy in 11. Arterial hypertension was present in 16 patients. Growth retardation was universal, although in 4 patients on cyclosporin A post-transplant catch-up growth occurred. Five patients over 15 years completed puberty. Readjustment in terms of school performance was good but was less good for psychosocial development. None of the patients had ever been treated with cystine-depleting agents; the data will therefore provide a historical control group with which to compare the results from a group treated with these agents. PMID:1768583

  2. Urinary Tract Infection among Renal Transplant Recipients in Yemen

    PubMed Central

    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. PMID:26657128

  3. Intra-corporeal robotic renal auto-transplantation

    PubMed Central

    Lee, Jason Y.; Alzahrani, Tarek; Ordon, Michael

    2015-01-01

    Renal auto-transplantation (RATx) is a suitable option for managing patients with long upper ureteric or pan-ureteric strictures. The current gold standard approach to RATx is a laparoscopic nephrectomy followed by open auto-transplantation. The advent of robotic-assisted laparoscopic surgery has allowed us to apply minimally-invasive techniques to ever-more complex surgical procedures. We present the case of a 38-year-old patient referred to our institution for management of a failed laparoscopic pyeloplasty resulting in a long upper ureteric stricture with complete ureteric obstruction. After complete evaluation, RATx was determined as a suitable management option. Completely intracorporeal right RATx was performed robotically with intraperitoneal cold perfusion. Total operative time was 6.5 hours, with total ischemia time of only 79 minutes (4 minutes warm ischemia, 48 minutes cold ischemia, 27 minutes re-warming time), comparable to the gold standard approach for RATx. To our knowledge, this is the first reported case of a completely intracorporeal robotic RATx in Canada. PMID:26664514

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

    PubMed

    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. PMID:26657128

  5. ABO-incompatible renal transplantation in developing world - crossing the immunological (and mental) barrier.

    PubMed

    Jha, P K; Bansal, S B; Sethi, S K; Jain, M; Sharma, R; Nandwani, A; Phanish, M K; Duggal, R; Tiwari, A K; Ghosh, P; Ahlawat, R; Kher, V

    2016-01-01

    ABO incompatibility has been considered as an important immunological barrier for renal transplantation. With the advent of effective preconditioning protocols, it is now possible to do renal transplants across ABO barrier. We hereby present a single center retrospective analysis of all consecutive ABOi renal transplants performed from November 2011 to August 2014. Preconditioning protocol consisted of rituximab, plasmapheresis and intravenous immunoglobulin (IVIG) and maintenance immunosuppression consisted of tacrolimus, mycophenolate sodium, and prednisolone. The outcome of these ABOi transplants was compared with all other consecutive ABO-compatible (ABOc) renal transplants performed during same time. Twenty ABOi renal transplants were performed during the study period. Anti-blood group antibody titer varied from 1:2 to 1:512. Patient and graft survival was comparable between ABOi and ABOc groups. Biopsy proven acute rejection rate was 15% in ABOi group, which was similar to ABOc group (16.29%). There were no antibody-mediated rejections in ABOi group. The infection rate was also comparable. We conclude that the short-term outcome of ABOi and ABOc transplants is comparable. ABOi transplants should be promoted in developing countries to expand the donor pool. PMID:27051135

  6. Self-reported sleep disturbances in renal transplant recipients

    PubMed Central

    2013-01-01

    Background Poor sleep quality (SQ) and daytime sleepiness (DS) are common in renal transplant (RTx) recipients; however, related data are rare. This study describes the prevalence and frequency of self-reported sleep disturbances in RTx recipients. Methods This cross-sectional study included 249 RTx recipients transplanted at three Swiss transplant centers. All had reported poor SQ and / or DS in a previous study. With the Survey of Sleep (SOS) self-report questionnaire, we screened for sleep and health habits, sleep history, main sleep problems and sleep-related disturbances. To determine a basis for preliminary sleep diagnoses according to the International Classification of Sleep Disorders (ICSD), 164 subjects were interviewed (48 in person, 116 via telephone and 85 refused). Descriptive statistics were used to analyze the data and to determine the frequencies and prevalences of specific sleep disorders. Results The sample had a mean age of 59.1 ± 11.6 years (60.2% male); mean time since Tx was 11.1 ± 7.0 years. The most frequent sleep problem was difficulty staying asleep (49.4%), followed by problems falling asleep (32.1%). The most prevalent sleep disturbance was the need to urinate (62.9%), and 27% reported reduced daytime functionality. Interview data showed that most suffered from the first ICSD category: insomnias. Conclusion Though often disregarded in RTx recipients, sleep is an essential factor of wellbeing. Our findings show high prevalences and incidences of insomnias, with negative impacts on daytime functionality. This indicates a need for further research on the clinical consequences of sleep disturbances and the benefits of insomnia treatment in RTx recipients. PMID:24112372

  7. Neuropsychologic side-effects of tacrolimus in pediatric renal transplantation.

    PubMed

    Kemper, Markus J; Spartà, Giuseppina; Laube, Guido F; Miozzari, Marco; Neuhaus, Thomas J

    2003-04-01

    Calcineurin inhibition with tacrolimus has been used after renal transplantation (RTPL) as rescue therapy for insufficient immunological control or if cyclosporin A (CSA) toxicity occurred. Neurologic side-effects occur but are rare in children, usually presenting as tremor; however, serious complications, e.g. the posterior leukoencephalopathy syndrome are also documented. Twenty children (10 girls) were switched to tacrolimus: 11 (55%) for immunological reasons (n = 9: steroid-resistant rejection; n = 2: recurrent rejections) and nine for CSA side-effects. Tacrolimus was started at a median of 8 wk (range 10 d to 8.7 yr) after RTPL and was continued for a median of 2.5 yr (range 5 wk to 4.6 yr). Renal function significantly improved over a period of 12 months following conversion to tacrolimus (glomerular filtration rate 56 +/- 19 vs. 66 +/- 16 mL/min/1.73 m2; p < 0.03; n = 13). Fifteen of 20 (75%) patients tolerated tacrolimus well. The most frequent side-effects were neuropsychological and behavioral symptoms in three children, ranging from anorexia nervosa-like symptoms with weight loss, amenorrhea, depression and school problems to severe insomnia and to aggressive and anxious behavior in one child. Only the latter child was exposed to toxic tacrolimus blood levels. All side-effects were fully reversible after discontinuation of tacrolimus. In conclusion, tacrolimus had a beneficial effect on renal function and was well tolerated in the majority of pediatric patients. However, neuropsychologic and behavioral side-effects are important and maybe underrecognized in children. PMID:12709079

  8. Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation.

    PubMed

    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 (<18 years) were randomly assigned (1:1) to receive either Tac ( n=103) or CyA microemulsion ( n=93) administered concomitantly with azathioprine and corticosteroids. The primary endpoint was incidence and time to first acute rejection. Baseline characteristics were comparable between treatment groups. Tac therapy resulted in a significantly lower incidence of acute rejection (36.9%) compared with CyA therapy (59.1%) ( P=0.003). The incidence of corticosteroid-resistant rejection was also significantly lower in the Tac group compared with the CyA group (7.8% vs. 25.8%, P=0.001). The differences were also significant for biopsy-confirmed acute rejection (16.5% vs. 39.8%, P<0.001). At 1 year, patient survival was similar (96.1% vs. 96.6%), while 10 grafts were lost in the Tac group compared with 17 graft losses in the CyA group ( P=0.06). At 1 year, mean glomerular filtration rate (Schwartz estimate) was significantly higher in the Tac group (62+/-20 ml/min per 1.73 m(2), n=84) than in the CyA group (56+/-21 ml/min per 1.73 m(2), n=74, P=0.03). The most frequent adverse events during the first 6 months were hypertension (68.9% vs. 61.3%), hypomagnesemia (34.0% vs. 12.9%, P=0.001), and urinary tract infection (29.1% vs. 33.3%). Statistically significant differences ( P<0.05) were observed for 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

  9. Role of imaging in clinical islet transplantation.

    PubMed

    Low, Gavin; Hussein, Nassrein; Owen, Richard J T; Toso, Christian; Patel, Vimal H; Bhargava, Ravi; Shapiro, A M James

    2010-03-01

    Islet transplantation is an innovative and effective clinical strategy for patients with type 1 diabetes whose clinical condition is inadequately managed even with the most aggressive medical treatment regimens. In islet transplantation, purified islets extracted from the pancreas of deceased donors are infused into the portal vein of the recipient liver. Engrafted islets produce insulin and thus restore euglycemia in many patients. After islet transplantation performed with the original Edmonton protocol, 80% of patients were insulin independent at 1 year and approximately 20% were insulin independent at 5 years. With more recent technical advances, 50% of patients or more maintain insulin independence 5 years after islet transplantation. The success rate with single-donor islet infusions has markedly improved over time. Even in patients who lose insulin independence, islet transplantation is considered successful because it provides improved glycemic control and a higher quality of life. Imaging plays an important role in islet transplantation and is routinely used to evaluate potential recipients, guide the transplantation process, and monitor patients for posttransplantation complications. Because of the success of islet transplantation and its increasing availability worldwide, familiarity with the role of imaging is important. PMID:20228322

  10. Interventions for impaired bladders in paediatric renal transplant recipients with lower urinary tract dysfunction.

    PubMed

    Al-Khudairi, Naji; Riley, Paul; Desai, Divyesh Y; Reid, Christopher; Marks, Stephen D; Mamode, Nizam

    2013-04-01

    Dysfunctional bladders in paediatric patients were thought to be a contraindication for renal transplantation, but advances in surgical techniques have meant that surgical correction can allow safe transplantation. This study compares the outcomes of renal transplantation for different interventions, and the timing of such interventions, in relation to transplantation. We identified all paediatric renal transplant recipients with LUTD that received intervention for their impaired bladders at two hospitals between 2002 and 2010. Outcome measures included patient and graft survival, perioperative complications, UTI incidence, acute rejection episodes and serum creatinine levels. A total of 288 allografts were transplanted, 77 were in 75 children with LUTD, of which 46 received intervention. Patient survival was 100% in the intervention group and 97% in the nonintervention group (P = 0.815). Death-censored graft survival was 96% and 100% respectively (P = 0.688). In the groups receiving intervention pretransplant or post-transplant, graft survival rates were 95% and 100% respectively (P = 0.476). The follow-up serum creatinine levels were higher in the pretransplant intervention group (P < 0.001). Interventions for dysfunctional bladders can be performed safely in paediatric renal transplant recipients. The mode of intervention and timing of intervention, in relation to transplant, do not influence outcomes if guided by careful assessment and investigation. PMID:23350943

  11. The Role of T Cell Costimulation via DNAM-1 in Kidney Transplantation

    PubMed Central

    Kraus, Anna K.; Chen, Jin; Edenhofer, Ilka; Ravens, Inga; Gaspert, Ariana; Cippà, Pietro E.; Mueller, Steffen; Wuthrich, Rudolf P.; Segerer, Stephan

    2016-01-01

    DNAX accessory protein-1 (DNAM-1, CD226) is a co-stimulatory and adhesion molecule expressed mainly by natural killer cells and T cells. DNAM-1 and its two ligands CD112 and CD155 are important in graft-versus-host disease, but their role in solid organ transplantation is largely unknown. We investigated the relevance of this pathway in a mouse kidney transplantation model. CD112 and CD155 are constitutively expressed on renal tubular cells and strongly upregulated in acutely rejected renal allografts. In vitro DNAM-1 blockade during allogeneic priming reduced the allospecific T cell response but not the allospecific cytotoxicity against renal tubular epithelial cells. Accordingly, absence of DNAM-1 in recipient mice or absence of CD112 or CD155 in the kidney allograft did not significantly influence renal function and severity of rejection after transplantation, but led to a higher incidence of infarcts in CD112 and CD155 deficient kidney allografts. Thus, DNAM-1 blockade is not effective in preventing transplant rejection. Despite of being highly expressed, CD112 and CD155 do not appear to play a major immunogenic role in kidney transplantation. Considering the high incidence of renal infarcts in CD112 and CD155 deficient grafts, blocking these molecules might be detrimental. PMID:26840537

  12. The Role of T Cell Costimulation via DNAM-1 in Kidney Transplantation.

    PubMed

    Kraus, Anna K; Chen, Jin; Edenhofer, Ilka; Ravens, Inga; Gaspert, Ariana; Cippà, Pietro E; Mueller, Steffen; Wuthrich, Rudolf P; Segerer, Stephan; Bernhardt, Guenter; Fehr, Thomas

    2016-01-01

    DNAX accessory protein-1 (DNAM-1, CD226) is a co-stimulatory and adhesion molecule expressed mainly by natural killer cells and T cells. DNAM-1 and its two ligands CD112 and CD155 are important in graft-versus-host disease, but their role in solid organ transplantation is largely unknown. We investigated the relevance of this pathway in a mouse kidney transplantation model. CD112 and CD155 are constitutively expressed on renal tubular cells and strongly upregulated in acutely rejected renal allografts. In vitro DNAM-1 blockade during allogeneic priming reduced the allospecific T cell response but not the allospecific cytotoxicity against renal tubular epithelial cells. Accordingly, absence of DNAM-1 in recipient mice or absence of CD112 or CD155 in the kidney allograft did not significantly influence renal function and severity of rejection after transplantation, but led to a higher incidence of infarcts in CD112 and CD155 deficient kidney allografts. Thus, DNAM-1 blockade is not effective in preventing transplant rejection. Despite of being highly expressed, CD112 and CD155 do not appear to play a major immunogenic role in kidney transplantation. Considering the high incidence of renal infarcts in CD112 and CD155 deficient grafts, blocking these molecules might be detrimental. PMID:26840537

  13. Acute hepatitis C infection in a renal transplant recipient: primacy of the liver or kidney?

    PubMed Central

    Althaf, Mohammed Mahdi; Abdelsalam, Mohamed Said; Rashwan, Mohamed; Nadri, Quaid

    2014-01-01

    We present a case where a renal transplant recipient contracted chronic hepatitis C virus (HCV) infection post-transplantation. The disease progressed and deteriorated leading to fibrosing cholestatic hepatitis that mandated treatment. Treatment with pegylated interferon α-2a and ribavirin was successful in salvaging the liver and eradicating the virus but as a consequence lead to treatment-resistant acute rejection and loss of the renal allograft. PMID:24907214

  14. Infective endocarditis and meningitis due to Scedosporium prolificans in a renal transplant recipient.

    PubMed

    Uno, Kenji; Kasahara, Kei; Kutsuna, Satoshi; Katanami, Yuichi; Yamamoto, Yoshifumi; Maeda, Koichi; Konishi, Mitsuru; Ogawa, Taku; Yoneda, Tatsuo; Yoshida, Katsunori; Kimura, Hiroshi; Mikasa, Keiichi

    2014-02-01

    Scedosporium prolificans is a ubiquitous filamentous fungi that may cause disseminated diseases in neutropenic patients with hematological malignancies. We report a fatal case of renal transplant recipient who developed both infective endocarditis and meningitis due to S. prolificans during treatment with micafungin and itraconazole for chronic necrotizing aspergillosis. Breakthrough Scedosporium infection should be considered among differential diagnosis of invasive fungal diseases in patients with renal transplant recipients receiving antifungal agents. PMID:24462439

  15. Commercial renal transplantation: A risky venture? A single Canadian centre experience

    PubMed Central

    Kapoor, Anil; Kwan, Kevin G.; Whelan, J. Paul

    2011-01-01

    Background: Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Methods: Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Results: Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Discussion: Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any

  16. Role of the lectin complement pathway in kidney transplantation.

    PubMed

    Farrar, Conrad A; Zhou, Wuding; Sacks, Steven H

    2016-10-01

    In the last 15 years two major advances in the role of complement in the kidney transplant have come about. The first is that ischaemia reperfusion injury and its profound effect on transplant outcome is dependent on the terminal product of complement activation, C5b-9. The second key observation relates to the function of the small biologically active fragments C3a and C5a released by complement activation in increasing antigen presentation and priming the T cell response that results in transplant rejection. In both cases local synthesis of C3 principally by the renal tubule cells plays an essential role that overshadows the role of the circulating pool of C3 generated largely by hepatocyte synthesis. More recent efforts have investigated the molecules expressed by renal tissue that can trigger complement activation. These have revealed a prominent effect of collectin-11 (CL-11), a soluble C-type lectin that is expressed in renal tissue and aligns with its major ligand L-fucose at sites of complement activation following ischaemic stress. Biochemical studies have shown that interaction between CL-11 and L-fucose results in complement activation by the lectin complement pathway, precisely targeting the innate immune response to the ischaemic tubule surface. Therapeutic approaches to reduce inflammatory and immune stimulation in ischaemic kidney have so far targeted C3 or its activation products and several are in clinical trials. The finding that lectin-fucose interaction is an important trigger of lectin pathway complement activation within the donor organ opens up further therapeutic targets where intervention could protect the donor kidney against complement. PMID:27286717

  17. The effect of the American Heart Association step one diet on hyperlipidemia following renal transplantation.

    PubMed

    Moore, R A; Callahan, M F; Cody, M; Adams, P L; Litchford, M; Buckner, K; Galloway, J

    1990-01-01

    Cardiovascular disease is a frequent cause of morbidity and mortality following renal transplantation. The percentage of deaths due to ischemic cardiovascular disease and cerebrovascular accidents nearly equals that caused by infection among patients receiving their first transplant, according to data from the European Dialysis and Transplant Association Registry. Hypercholesterolemia is a risk factor for cardiovascular disease frequently identified following renal transplantation, and diets low in fat and cholesterol have been suggested as treatment. Previous studies have not reported the response of LDL cholesterol to dietary treatment, and it is this form of cholesterol that is most closely related to cardiovascular disease. The American Heart Association has provided nutritionists with guidelines for the treatment of hyperlipidemic patients which include the Step One Diet. Previous dietary studies of renal transplant recipients have allowed a slightly higher intake of fat than that currently recommended by the AHA. We wondered if an easily reproducible diet well known to nutritionists such as the AHA Step One Diet would be effective in lowering cholesterol levels in hyperlipidemic renal transplant recipients. The purpose of our study was not to define the mechanisms of posttransplant hyperlipidemia, but rather to assess the effectiveness of dietary intervention on hyperlipidemia following renal transplantation. PMID:2301029

  18. An unanticipated role for survivin in organ transplant damage.

    PubMed

    Cassis, P; Solini, S; Azzollini, N; Aiello, S; Rocchetta, F; Conti, S; Novelli, R; Gagliardini, E; Mister, M; Rapezzi, F; Rapezzi, S; Benigni, A; Remuzzi, G; Conway, E M; Noris, M

    2014-05-01

    Ischemia/reperfusion (I/R) injury is a major determinant of graft survival in kidney transplantation. Survivin, an inhibitor of apoptosis that participates in the control of mitosis and cell cycle progression, has been implicated in renal protection and repair after I/R injury; however, no study has been performed in the transplant setting. We investigated the role of survivin in modulating posttransplant I/R injury in syngeneic and allogeneic kidney grafts, and studied whether protection from I/R injury impacted on the recipient immune system, on chronic allograft nephropathy and rejection. We used genetically engineered mice with survivin haploinsufficiency and WT mice in which survivin over-expression was induced by gene-delivery. Survivin haploinsufficiency in syngeneic grafts was associated with exuberant I/R tissue injury, which triggered inflammation eventually resulting in graft loss. Conversely, survivin over-expression in the grafts minimized I/R injury and dysfunction in syngeneic grafts and in a clinically relevant fully MHC-mismatched allogeneic combination. In the latter, survivin over-expression translated into limited anti-donor adaptive immune response and less long-term allograft injury with protection from renal parenchymal damage. Our data support survivin over-expression in the graft as a novel target for protocols aimed at limiting tissue damage at the time of transplant ultimately modulating the recipient immune system. PMID:24731002

  19. Kidney transplantation as treatment for end stage renal disease.

    PubMed

    Santiago-Delpín, Eduardo

    2011-01-01

    Within this review the author presents what kidney transplantation can and cannot do; it's state of the art; experience in Puerto Rico; major problems, obstacles and pitfalls; and the cutting edge of clinical transplantation and of transplantation immunology. PMID:23210334

  20. Family caregivers' burden, quality of life, and health following patients' renal transplantation.

    PubMed

    Wicks, M N; Milstead, E J; Hathaway, D K; Cetingok, M

    1998-09-01

    Improved quality of life and physical functioning among renal transplant recipients have been documented; however, little of the literature has addressed the effects of transplantation on family caregivers. The purpose of this exploratory descriptive study was to characterize the level of subjective burden, quality of life, and self-rated health of caregivers who assist family members prior to transplantation as well as at 6 months following. The study sample included 19 caregivers of 19 renal transplant recipients. In general, caregiver burden, quality of life, and self-rated health did not improve following patients' transplants. In addition, 9 of 19 family caregivers reported increased burden. Because much of healthcare is family-based and greater reliance on family support seems inevitable, further studies are needed to examine the impact of transplantation on the family as well as the impact of the family on patients' posttransplant outcomes. PMID:9866547

  1. Outcomes of Renal Transplantation in Brunei Darussalam over a Twenty-Year Period (1993–2012)

    PubMed Central

    Khalil, Muhammad Abdul Mabood; Tan, Si Yen; Ahmed, Dalinatul; Zinna, Shaukat; Chong, William

    2014-01-01

    Objectives. Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Up until 2012, all renal transplantations were performed in overseas centres, either as government-sponsored (living-related transplantation) or as self-sponsored (commercialized transplantation) ones. We hypothesize that graft and patient survival of Brunei renal transplant patients are on a par with international standards. Materials and Methods. Data of all renal transplant patients in Brunei were analysed over a twenty-year period from registry records and case notes. Comparative survival data from other countries were obtained from PubMed-listed literature. Results. A total of 49 transplantation procedures were performed in foreign centres between 1993 and 2012. 29 were government-sponsored and 20 were self-sponsored transplantations. The 5- and 10-year overall patient survival rates were 93.3% and 90.1%, respectively. The 5- and 10-year overall graft survival rates were 91.1% and 81.2%. There is no difference in the survival outcomes of government-sponsored and self-sponsored patients. Living-related (government-sponsored) and commercialised (self-sponsored) grafts had equivalent survival to those reported in the literature. Conclusion. Our survival data was on par with those achieved in many countries. We hope to use this information to convince local stakeholders and patients to favour transplantation as the preferred modality of RRT. PMID:25478205

  2. An Insight Into the Immunologic Events and Risk Assessment in Renal Transplantation

    PubMed Central

    Khan, Asif; Nasr, Patricia; El-Charabaty, Elie; El-Sayegh, Suzanne

    2016-01-01

    Organ transplantation has always been considered to be the optimal therapeutic intervention in patients with end-stage organ failure. In the US, approximately 615,000 patients are diagnosed with end-stage renal disease and less than 30% have received a kidney transplant. One of the crucial drawbacks in successful renal transplantation is allograft rejection. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. Post-transplant immune monitoring and optimization of the immunosuppressive therapy using non-invasive biomarkers can effectively predict impending graft rejection and may spare the need for renal biopsy. This article provides an insight into the immunomodulations of renal transplant recipients. It depicts the immune system including several types of kidney rejection and reviews the biomarkers that may serve in near future, as surveillance tools for graft monitoring. Finally, a summary on the main immunosuppressive drugs used in kidney transplant both in the induction and maintenance phases is also covered. PMID:27081421

  3. A case of invasive cytomegalovirus duodenitis in an immunosuppressed patient 15 months after renal transplantation.

    PubMed

    Kazanji, N; Davila, F; Manickam, P; Wang, Y; Bossory, L

    2015-06-01

    Cytomegalovirus (CMV) remains one of the most important infections in kidney transplantation. Only a handful of images have been reported in the literature thus far. We present classic pathologic and gross images of CMV duodenitis in an immunosuppressed patient more than one year post-renal transplantation. PMID:25582982

  4. Calcineurin activity in tacrolimus-treated renal transplant patients early after and 5 years after transplantation.

    PubMed

    Mortensen, D M; Koefoed-Nielsen, P B; Jørgensen, K A

    2006-10-01

    The pharmacodynamic (PD) action of tacrolimus (FK) within the T-cell is inhibition of calcineurin phosphatase (CaN). Determination of CaN activity provides us with an important PD marker. Eleven renal transplant patients treated with FK were investigated on day 14 following transplantation and 5 years later. Blood samples drawn before as well as 1, 2, 3, and 4 hours after oral intake of FK were analyzed for CaN activity and blood FK concentrations. Twenty healthy subjects had one blood sample drawn for CaN activity, which was measured as the release of (32)P from a phosphorylated peptide. Radioactivity of (32)P was quantitated by liquid scintillation counting with the results converted to units of CaN utilizing a calibration curve. On day 14, we observed significant inhibition of CaN activity at T:1, 2, and 3 compared with the predose level (P = .002; P = .015; P = .015). Furthermore, all measured CaN activities were significantly different from those observed in healthy nonmedicated subjects. In contrast, at 5 years posttransplant only the CaN activity at T:2 was significantly inhibited compared with the predose level (P = .02). Additionally, all CaN activities at this time were not significantly different from CaN activities in the healthy subjects. We were not able to demonstrate individual CaN activity profiles in the patients. The lack of CaN inhibition at 5 years after transplantation despite relevant drug concentrations, probably reflected the lower drug dose used long after transplantation. This result raises the question of whether CaN inhibition is necessary to hold graft function and whether FK possess CaN-independent mechanisms of action. PMID:17098028

  5. Urothelial carcinoma of the allograft kidney developed in a renal transplant patient

    PubMed Central

    Gökçe, Mehmet İlker; Kocaay, Akın Fırat; Aktürk, Serkan; Tüzüner, Acar

    2016-01-01

    Renal transplantation is the best option in the treatment of end-stage renal disease However these patients are under the risk of developing malignancies particularly due to effects of immune supression. These malignancies tend to be more agressive compared to the general population. Here, we present a case of urothelial carcinoma develoing in the ureter of allograft kidney.

  6. Medication Adherence and Treatment Satisfaction Among Renal Transplant Recipients.

    PubMed

    Alkatheri, Abdulmalik A; Albekairy, Abdulkareem M; Jarab, Anan; Bustami, Rami; Khalidi, Nabil; Alshaya, Abdulrahman; Bin Saleh, Khalid; Alraddadi, Sultan; Alharbi, Shmeylan; Vasudevan, Senthilvel; Alsayyari, Abdullah; Qandil, Amjad M

    2016-01-01

    BACKGROUND Evidence suggests that patients who are more satisfied with their treatment show better adherence with the prescribed therapy. Although there is valuable data about medication adherence among renal transplant recipients (RTRs), there is a limited literature about their treatment satisfaction and its relation to adherence. The aim of the present study was to investigate factors that can predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in renal transplant recipients. MATERIAL AND METHODS Adult RTRs were included in the study using convenient sampling. The participants were asked to complete the 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Scale TSQM 1.4 in addition to several socio-demographic and treatment-related data. The results were statistically analyzed using univariate and multivariate logistic regression modelling in a stepwise procedure. RESULTS A total of 151 RTRs were included in the study, of which 52 were classified as adherent (34%). Univariate analysis showed that, in comparison with non-adherent RTRs, the adherent group demonstrated significantly higher satisfaction scores in the domains of convenience (96.6±8.7 vs. 85.3±19.3), side effects (95.9±14.1 vs. 82.6±24.1), and global satisfaction (93.4±9.8 vs. 86.7±16.7), while they had marginally higher satisfaction scores in the effectiveness domain (90.4±11.6 vs. 86.5±14.5). Results from multiple logistic regression showed that higher likelihood of adherence was significantly associated with increased satisfaction score in the convenience domain [AOR=1.76, 95% CI=(1.21, 2.55); p=0.003] and marginally related to increased satisfaction scores in the side effects domain [AOR=1.31, 95% CI=(0.99, 1.74); p=0.061]. Male RTRs were significantly more likely to be adherent than female RTRs [AOR=2.23, 95% CI=(1.02, 4.84); p=0.043]. CONCLUSIONS Although the adherence rate among RTRs is relatively

  7. Risk of Post-Lung Transplant Renal Dysfunction in Adults With Cystic Fibrosis

    PubMed Central

    Mayer-Hamblett, Nicole; Aitken, Moira L.; Goss, Christopher H.

    2012-01-01

    Background: Cystic fibrosis (CF) is one of the leading indications for lung transplantation. The incidence and pre-lung transplant risk factors for posttransplant renal dysfunction in the CF population remain undefined. Methods: We conducted a cohort study using adults (≥ 18 years old) in the CF Foundation Patient Registry from 2000 to 2008 to determine the incidence of post-lung transplant renal dysfunction, defined by an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. Multivariable Cox proportional hazards modeling was used to identify independent pretransplant risk factors for post-lung transplant renal dysfunction. Results: The study cohort included 993 adult lung transplant recipients with CF, with a median follow-up of 2 years. During the study period, 311 individuals developed renal dysfunction, with a 2-year risk of 35% (95% CI, 32%-39%). Risk of posttransplant renal dysfunction increased substantially with increasing age (25 to < 35 years vs 18 to < 25 years: hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; vs ≥ 35 years: HR, 2.45; 95% CI, 1.73-3.47) and female sex (HR, 1.56; 95% CI, 1.22-1.99). CF-related diabetes requiring insulin therapy (HR, 1.30; 95% CI, 1.02-1.67) and pretransplant renal function impairment (estimated glomerular filtration rate, 60-90 mL/min/m2 vs > 90 mL/min/m2: HR, 1.58; 95% CI, 1.19-2.12) also increased the risk of posttransplant renal dysfunction. Conclusions: Renal dysfunction is common following lung transplant in the adult CF population. Increased age, female sex, CF-related diabetes requiring insulin, and pretransplant renal impairment are significant risk factors. PMID:22222189

  8. Renal Papillary Necrosis: Role of Radiology

    PubMed Central

    Pandya, Vaidehi K.

    2016-01-01

    Renal Papillary Necrosis (RPN) is idefined as Ischemic necrobiosis of the papilla in the medulla of the kidneys. Variety of etiological factors are recognized which cause papillary necrosis, such as analgesic nephropathy, diabetes mellitus, urinary obstruction and sickle cell haemoglobinopathy. The early diagnosis of RPN is important to improve prognosis and reduce morbidity. Radiological Imaging offers early diagnosis and can guide prompt treatment of papillary necrosis and can minimize a decline in renal function. Here we report three cases of RPN with typical imaging findings. One of them was diabetic and hypertensive female with recurrent Urinary tract Infections and other was a male with no known co-morbidity. Both of them were diagnosed to have renal papillary necrosis on CT scan and were managed operatively and conservatively, respectively. Third case was a healthy female being investigated to be renal donor for her son. Here RPN was an incidental finding and was treated conservatively. Thus CT scan could detect it pre-operatively and complications due to transplantation of a kidney with papillary necrosis were avoided. So, we want to emphasize the importance of Radiology, particularly CT scanning in detection of RPN and to guide early and prompt treatment. PMID:26894147

  9. Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient.

    PubMed

    Gouveia, Ana Isabel; Borges-Costa, João; Soares-Almeida, Luís; Santana, Alice; Guerra, José

    2013-01-01

    Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients. PMID:27429257

  10. Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient

    PubMed Central

    Gouveia, Ana Isabel; Borges-Costa, João; Soares-Almeida, Luís; Santana, Alice; Guerra, José

    2013-01-01

    Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients. PMID:27429257