scholarly journals Ganciclovir-Resistant Cytomegalovirus Infection in a Kidney Transplant Recipient Successfully Treated with Foscarnet and Everolimus

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Viola Menghi ◽  
Giorgia Comai ◽  
Olga Baraldi ◽  
Giovanni Liviano D’Arcangelo ◽  
Tiziana Lazzarotto ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Target Therapy ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Tacrolimus Dosage ◽  
Stable Renal Function

Cytomegalovirus (CMV) infection remains a major cause of morbidity, graft failure, and death in kidney transplant recipients. We describe a case of a 53-year-old CMV-seronegative man who underwent renal transplant from a CMV-positive donor and who developed ganciclovir- (GCV-) resistant CMV infection. Foscarnet was started while immunosuppressive therapy was modified with the introduction of everolimus minimizing tacrolimus dosage. Only two weeks after the start of this treatment regimen was the patient’s viral load negative. At two-year follow-up the patient has no clinical or laboratory signs of CMV infection and a good and stable renal function or graft survival. In our case, administration of an mTOR inhibitor combined with foscarnet led to rapid and persistent viral clearance without compromising short- and medium-term graft function. This combination therapy supports the need for the kidney transplant community to individualize a target therapy for each type of GCV-resistant CMV infection.

scholarly journals Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

2019 ◽  
Vol 13 (11) ◽  
Author(s):  
Axel Cayetano-Alcaraz ◽  
Juan Sebastian Rodriguez-Alvarez ◽  
Mario Vilatobá-Chapa ◽  
Josefina Alberú-Gómez ◽  
Bernardo Gabilondo-Pliego ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Kidney Transplant Patients ◽  
Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

Kidney graft function before pregnancy as a predictor of graft, maternal and fetal outcomes in pregnant renal transplant recipients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Filipe S. Mira ◽  
Joana Oliveira ◽  
Filipa Sousa ◽  
Dora Antunes ◽  
Ana Carolina Figueiredo ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Adverse Outcomes ◽  
Hypertensive Disorder ◽  
Renal Transplant Recipients ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Kidney Transplant Recipients

Abstract Objectives Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients. Methods All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated. Results There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes. Conclusions A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m2 before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.

scholarly journals P1640COLONIZATION AND INFECTION WITH ESBL-PRODUCING AND CARBAPENEM-RESISTANT ENTEROBACTERIACIEAE IN KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS, IMPACT OF RENAL GRAFT FUNCTION AND USE OF HOSPITAL RESOURCES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alessandra Palmisano ◽  
Eleonora Salsi ◽  
Paride Fenaroli ◽  
Anna Maria Degli Antoni ◽  
Ilaria Gandolfini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Renal Graft ◽  
Carbapenem Resistant ◽  
Hospital Resources

Abstract Background and Aims ESBL-producing and carbapenem resistant (CR) Enterobacteriaceae are a common cause of severe infection, morbidity and mortality in kidney transplant recipients (KTR). Few studies have investigated the risk factors for ESBL-producing/CR Enterobacteriaceae colonization and infection in this group of patients, the effect of colonization and infection on KTR’s renal graft function, and the use of hospital resources. Method Retrospective follow-up study on a consecutive series of patients undergoing kidney transplantation at Parma University Hospital (Italy) between January-2016 and December-2018. We performed a multivariable-adjusted analysis of the predictive factor associated with MDR infection/colonization via general linear models for prevalence- and risk- ratio. Renal function (eGFR) decline was compared by mixed-effects random-coefficients models, hospital resources by negative binomial regression. Results We enrolled 180 KTR (mean recipient’s age: 52.4 [SD 12.4]; males 65%; mean donor’s age: 54.6 [SD 15.6]) and followed them up for 2-years post transplantation. Cumulative prevalence of colonization 3-months post-transplantation and cumulative incidence of infection were 26.1% and 9.4% for ESBL, and 4.4% and 1.6% for CR. ESBL colonization was associated with hemodialysis vs peritoneal dialysis (93% vs 70% non-colonized; adjusted RR 0.21 [95% CI: 0.06 to 0.98]), dialysis vintage (mean months: 65 vs 42; adjusted associated with being above the median, RR 2.17 [95% CI: 1.32 to 3.55]) and retention of ureteral stent for more than one month after transplant (28% vs 12%; adjusted RR 2.09 [95% CI: 1.27 to 3.44]) ; ESBL infection was associated with retention of ureteral stent (47% vs 13%; adjusted RR 4.89 [95% CI 2.11 to 11.35]) whereas CR colonization was associated with surgical complication during transplant admission (50% vs 15%; adjusted RR 4.61 [95% CI 1.28 to 16.66]). Two patients (both with CR) died over the study follow-up, whereas none of the patients lost the graft. CR infection was associated lower baseline (3-months post-transplantation) eGFR compared to the other groups (-28.4mL/min/1.73m2 [95% CI: -50.5 to -6.3]); a numerically more rapid decline (up to - 5mL/min/year) of eGFR, albeit not statistically significant, was observed in patients with CR colonization compared to non-colonized at 2 years of follow-up. In comparison with non-colonized patients, adjusted mean days of carbapenem treatment in ESBL/CR colonized/infected was 5.7 vs 0.7 (P=0.003); length-of-hospital stay 5.8 vs 1.0 (P=0.055); days on drug-resistant-infection intravenous-outpatient-therapy 20.7 vs 0.1 (P= 0.008). Conclusions The study shows that ESBL and CR colonization and infection in KTR are statistically associated with longer hemodialysis vintage, urological procedures, and surgical complications. They cause an increase in the hospital resources use and may jeopardize transplant outcomes.

scholarly journals BK virus infection and outcome following kidney transplantation in childhood

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
James McCaffrey ◽  
Vijesh J. Bhute ◽  
Mohan Shenoy
Keyword(s):  
Virus Infection ◽  
Kidney Transplant ◽  
Graft Function ◽  
Clinical Intervention ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Younger Age

AbstractBK virus associated nephropathy (BKN) is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. We retrospectively analysed all patients who received a kidney transplant and received follow up care in our centre between 2009–2019. Among 106 patients included in the study (mean follow up 4.5 years), 32/106 (30.2%) patients experienced BK viraemia. The incidence of BKN was 7/106 (6.6%). The median time of BK viraemia development post-transplant was 279.5 days compared to 90.0 days for BKN. Development of BKN was associated with younger age at transplantation (p = 0.013). Development of BK viraemia was associated with negative recipient serology for cytomegalovirus (CMV) at time of transplantation (p = 0.012) and a higher net level of immunosuppression (p = 0.039). There was no difference in graft function at latest follow up between those who experienced BKN and those without BKN. This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Judicious monitoring of BK viraemia in paediatric transplant recipients, coupled with timely clinical intervention can result in similar long-term outcomes for BKN patients compared to controls.

scholarly journals Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

2021 ◽  
Author(s):  
Paula Anton Pampols ◽  
Hernando Trujillo ◽  
Edoardo Melilli ◽  
Blanca Urban ◽  
Justo Sandino ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Graft Function ◽  
Immunosuppressive Agent ◽  
Immunosuppressive Drugs ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Immunosuppressed Patients ◽  
The Impact

Abstract Background Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Methods Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units, who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. Results At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes or de novo donor-specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. Conclusions Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.

Association of Nutritional Assessment by Phase Angle With Mortality in Kidney Transplant Patients in an 8-Year Follow-Up

2019 ◽  
Vol 29 (4) ◽  
pp. 321-326
Author(s):  
Eda kaya ◽  
Alev Bakir ◽  
Yusuf Kenan Koseoglu ◽  
Mehmet Velidedeoglu ◽  
Sinan Trabulus ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Phase Angle ◽  
Cardiovascular Events ◽  
Cell Mass ◽  
Graft Function ◽  
Bioimpedance Analysis ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Additional Tool

Background: Phase angle is a bioimpedance analysis parameter that indirectly shows body cell mass. Its association with mortality has been shown in patients receiving dialysis treatment. However, assessment with mortality in kidney transplant recipients has not been studied previously. Methods: We examined 158 kidney transplant recipients who underwent bioimpedance analysis 8 years ago in a cross-sectional study. We contacted them again and investigated the presence of cardiovascular events, cancer, angina pectoris, and claudication. Data regarding mortality, graft failure, and creatinine values were collected from recipients’ files. Findings: During the follow-up period, 15 recipients died, 26 lost graft function, 36 experienced cardiovascular events, and 4 developed cancer. Phase angle was significantly associated with mortality during the 8-year follow-up period of kidney transplant recipients ( P < .001). The cutoff value for phase angle as a predictor of mortality was ≤5.85. Moreover, a phase angle value lower than 5.85 indicated 5.33 times higher risk of mortality. Discussion: Phase angle was a predictor of mortality in kidney transplant recipients. Since phase angle is an inexpensive, easy-to-perform, and noninvasive method, it might be considered as an additional tool to assess survival in kidney transplant recipients.

scholarly journals Nepalese Kidney Transplant Recipient in a Follow up Clinic: Related and Unrelated Living Donor

2008 ◽  
Vol 47 (171) ◽  
Author(s):  
Ram Krishna Dulal ◽  
S Karki
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Donors ◽  
Female Ratio ◽  
Long Run ◽  
The Usa

A cohort retrospective study was conducted on all follow up kidney transplant recipients at Transplant Follow up Clinic from June 16, 2003 to July 15, 2008. The main objective of this study was to find out the demographic pattern of the kidney transplant recipients and type of donors. Among 452 recipients, the transplantation were done in India (449), Germany (2) and in the USA (1) with male to female ratio of 3:1. Kidney donors were unrelated 315 (69.69%), related 134 (29.43%) and some did not disclose 4 (0.88%). Most of the kidney transplantation (93.75%) were done in 45 different hospitals in India and about three quarters (71.7%) of them were operated in the private hospitals in various states of India; only 2 (4.16%) in Germany and 1 (2.08%) in USA. Newar was the largest population 142 (31.4%) and second largest group was Mangol 124 (27.4.4%) that comprised of Gurung, Rai, Magar, Tamang etc. Brahmins were the third largest population 91 (20.1%). In this study the youngest recipients was 14 years and the oldest was of 75 years. The mean age was 41 (SD 13.84). This study showed that 35 (7.7%) died, 8 (1.7%) reported rejection and underwent re-transplantation and 238 patient have lost follow up till early 2008. Kidney transplantation should be promoted as it is cheaper compared to dialysis in the long run. This study found that unrelated kidney donors have outnumbered the related donors in Nepalese kidney transplant recipients which emphasize the importance of unambiguous documentation and also a provision of lawful action against the middle-men if found involved in an illegal kidney related activities in Nepal. Organ transplantation is an important integral part of human health and should be regularize and promote lawfully to protect humans from trafficking for kidney, possible kidnapping, killing and stealing. 

scholarly journals MO993IMMUNOSUPPRESSION MINIMIZATION IN KIDNEY TRANSPLANT RECIPIENTS HOSPITALIZED FOR COVID-19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Paula Anton Pampols ◽  
Hernando Trujillo ◽  
Edoardo Melilli ◽  
Blanca Urban ◽  
Justo Sandino Pérez ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Graft Function ◽  
Immunosuppressive Agent ◽  
Immunosuppressive Drugs ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Immunosuppressed Patients ◽  
The Impact

Abstract Background and Aims Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Method Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. Results At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes neither de novo donor specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. Conclusion Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.    

scholarly journals Soluble Complement Component 1q Receptor 1 (sCD93) Is Associated with Graft Function in Kidney Transplant Recipients

Biomolecules ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1623
Author(s):  
Małgorzata Kielar ◽  
Paulina Dumnicka ◽  
Ewa Ignacak ◽  
Alina Będkowska-Prokop ◽  
Agnieszka Gala-Błądzińska ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Complement Component ◽  
Clinical State ◽  
Kidney Graft ◽  
Inverse Association ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
One Year

Cluster of differentiation 93 (CD93), also known as complement component 1q receptor 1 is a transmembrane glycoprotein expressed in endothelial and hematopoietic cells and associated with phagocytosis, cell adhesion, angiogenesis and inflammation. The extracellular part, soluble CD93 (sCD93), is released to body fluids in inflammation. Data on sCD93 in kidney diseases are limited. Our aim was to evaluate serum sCD93 in long-term kidney transplant recipients as a marker of inflammation and endothelial dysfunction that may be potentially useful in early recognition of graft dysfunction. Seventy-eight adult patients with functioning kidney graft and stable clinical state were examined at least one year after kidney transplantation. Serum sCD93 was measured by enzyme immunosorbent assay. Estimated glomerular filtration rate (eGFR) and albuminuria or proteinuria were assessed at baseline and over one-year follow-up. Increased sCD93 was associated with lower baseline eGFR independently of the confounders. Moreover, sCD93 was negatively associated with eGFR during one-year follow-up in simple analysis; however, this was not confirmed after adjustment for confounders. Baseline sCD93 was positively associated with baseline albuminuria and with increased proteinuria during the follow-up. Serum sCD93 was not correlated with other studied inflammatory markers (interleukin 6, C-reactive protein, procalcitonin and C3 and C4 complement components). To the best of our knowledge, this is the first report regarding the concentrations of sCD93 in kidney transplant recipients and one of the first reports showing the inverse association between sCD93 and renal function. Serum sCD93 should be further evaluated as a diagnostic and prognostic marker in renal transplantation.

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