Cadaveric Donor Kidney Transplantation Research Articles

Safe immunosuppression. New tool for personalized immunosuppressant treatment in renal transplantation. A case report

Background: The adjustment of immunosuppressive therapy after kidney transplantation (KT) to avoid graft rejection remains an important challenge for clinicians. It is difficult to achieve a good balance between under-immunosuppression (with an increased risk of graft rejection) and over-immunosuppression (with an increased risk of side effects) by only relying on the available information about immunosuppressive drugs (IMS). Immunobiogram® (IMBG) is a novel in vitro diagnostic test that provides clinicians with information about the patient’s sensitivity to individual IMS. Objective: To present a case report of a patient with renal transplant in the maintenance phase who presented several complications probably related to the immunosuppression during the follow-up, where the use of IMBG as complementary information helped clinicians to guide the therapeutical decision. Methods: IMBG is a first-in-class in vitro immunoassay that involves the culture of the patient peripheral blood mononuclear cells (PBMCs) in a semi-solid 3D matrix, then submitted to immune stimulation. It reveals the capacity of an IMS over a gradient to inhibit the activation of immune cells. The read-out allows the building of a dose-response curve per IMS tested, which is mathematically analyzed by a software using the key curve parameters and finally to be translated into a sensitivity map to IMS. Findings: We present a case report of a 72-year-old patient with a cadaveric donor kidney transplant receiving standard immunosuppressive treatment with mycophenolate, tacrolimus, and corticosteroids. The patient presented several episodes of infections during the follow-up (SARS-CoV2, Cytomegalovirus, spondylodisquitis by Staphylococcus aureus, and emphysematous cystitis) which were managed with different treatment adjustments such as de-escalation of mycophenolate and switching to mTOR. The information provided by the IMBG showed a lack of sensitivity to mTOR which allowed to confirm the final adjustment to a treatment with tacrolimus and corticosteroids, remaining the patient stable since then. Discussion: Despite various adjustments to the immunosuppressive therapy during the follow-up, the patient continued experiencing adverse effects that could be related to an over-immunosuppression state. The IMBG provided pharmacodynamic information that complemented the clinical and pharmacokinetic data available, facilitating the individualization of the treatment. Conclusion: The case highlights the potential of the IMBG as a complementary clinical tool for personalized treatment of kidney transplant patient management.

#6797 EFFICACY OF DESENSITIZATION TREATMENT IN HYPERIMMUNIZED PATIENTS AWAITING A CADAVERIC KIDNEY TRANSPLANTATION

Abstract Background and Aims On all kidney waiting lists, patients who have antibodies against more than 80% of a panel reactive antibody (PRA) are difficult to transplant, even with national or regional programs. Desensitization treatment with high-dose intravenous immunoglobulin and rituximab could be offered to patients with a long waiting time for a cadaveric donor to improve their odds of finding a kidney. Method Retrospective, single-center study including all hyperimmunized patients on the waiting list for a cadaveric kidney donor who received a desensitization treatment between 2010-2020. To be considered to the desensitization protocol, all the patients must have a PRA above 75% and have been on the waiting list more than 3 years, without any offer. Our treatment was based on the modified Cedars-Sinai Medical Center protocol. Eight hyperimmunized patients on the waiting list for a cadaveric donor kidney transplant (50% male with a mean age of 41.5±16.4 years) received desensitization treatment with intravenous immunoglobulin and Rituximab. Six of the 8 patients (75%) were on renal replacement therapy with hemodialysis and two on peritoneal dialysis (mean time on dialysis 48±14 months). 75% had received a previous transplant. The median PRA calculated was 98%. The time between desensitization and kidney transplantation, the percentage of reactivity against panel cells (PRA) before and after therapy, graft and donor survival, as well as episodes of acute rejection and viral infections were analyzed. The mean follow-up time after transplantation was 67 months. Results No patient presented significant side effects to desensitization treatment. Seven of the 8 patients (87.5%) could be transplanted from a cadaveric donor (negative crossmatch test), in a median 8 months after desensitization. No significant changes were observed in the PRA levels. In the immediate post-transplant period, there were 2 graft losses (28.6%) due to non-immunological causes (1 venous thrombosis in a patient with a coagulation disorder and 1 primary graft failure). Creatinine at discharge was 1.6±0.4 mg/dl and 1.4±0.2 a year after the transplant. Five-year censored death graft survival was 100%. Three patients presented viral replication (1 due to cytomegalovirus (CMV), 1 due to polyomavirus (BK) and another CMV+BK), which became negative after switching to m-Tor therapy. There were no episodes of acute rejection. No patient developed cancer during the follow-up. Conclusion Desensitization treatment with immunoglobulin and rituximab on hyperimmunized patients on the cadaveric waiting list is a safe and effective treatment that increases the chances of achieving a kidney transplant in highly sensitized patients.

MO950SIMULTANEOUS LIVER-KIDNEY TRANSPLANT. SIXTEEN YEARS OF MONOCENTRIC EXPERIENCE

Abstract Background and Aims Combined liver-kidney transplant is the best treatment for patients with hepatic and renal failure, even though some studies reported a poor patient survival. The aim of our study is to summarize the clinical characteristics of subjects who undergo simultaneous combined liver-kidney transplantation (SLKT) for advanced liver and kidney disease. Furthermore, we evaluated patient and kidney survival of SLKT recipients compared to solitary kidney transplant (KT) recipients. Method We performed a retrospective analysis of all SLKT recipients performed in a single transplant Center (University Hospital of Modena, Italy) from 01/01/2004 to 12/31/2016. All patients were aged more than 18 years. Results 34 SLKT were performed over 16 years of transplant activity. Mean age of recipients was 51.3 ±9.1years. Males accounted for 65% of the population. All patients were of Caucasians origin except one of African origin. Mean BMI was 69.5 ± 13.9 Kg. Hepatitis C Virus (HCV)-related cirrhosis was the main cause (38.1%) of hepatic failure. Other causes of hepatic disease were ADPKD (26.5%), hepatitis B Virus (HBV) (11.8%), alcohol (8.8%), combined HCV-HBV infection (5.9%), Von Gierke Disease (2.9%), primary biliary cirrhosis (2.9%), and autoimmune cirrhosis (2.9%). Six patients developed hepatocellular carcinoma before undergoing SLKT. Renal disease was caused by ADPKD (26.5%), diabetic nephropathy (14.7%), glomerulonephrites (29.4%), hepatorenal syndrome (8.8%) and other renal diseases (20.6%). Overall, 14.7% of patients was affected by Human Immunodeficiency Virus (HIV), 50% by hypertension and 41% by diabetes. Mean MELD at transplantation was 42 (39.2-46.5) and mean serum creatinine value in pre-emptive patients was 3.09 ±1.4 mg/dl. Mean of donors was 46.7±15.3 years and main cause of death was cranial trauma (47.1%), followed by cerebral haemorrhage (41.2%). Mean KDPI was 52% (22-63) and KDRI 1 (0.73-1.1). Mean time on waiting list was 2.8±1.2 years and half of patients was on dialysis maintenance before SLKT. Mean ischemia time were 6.5 ±1.3 and 12.3 ±2.1 hours for liver and kidney, respectively. Only one patient (2.9%) received double kidney transplantation. Primary induction agent was anti-IL2 receptor monoclonal antibodies (82.6%), thymoglobulin (13%) and with methylprednisolone (4.1%). Post SLKT, kidney early complication consisted of 3 delayed graft functions and 1 transplanctectomy in the only double kidney transplant recipient. At the end of the follow-up (8±4.1 years), mean creatinine was 1.44 ± 0.5 mg/dl and kidney survival accounted for 87.9%. Cox regression analysis showed recipient’ age as a protective factor (HR, 0.03; CI95%, 0.8-0.9) for kidney rejection and donor age as a risk factor (HR, 1.13,CI95% 1-1.1) for renal graft loss. Patient survival at 10 years was 91.2%. Two deaths were caused by infections (50%) and 2 by digestive haemorrhages (50%). SLKT recipients were confronted with 304 cadaveric donor KT recipients performed in the same transplant Center from 01/01/2006 to 12/31/2016. Statistical analysis showed that SLKT recipients had shorter waiting list, dialysis vintage and ischemia times. SLKT recipients had a major prevalence of diabetes and HCV infection but a lower prevalence of hypertension. DGF were less common in SLKT. Patient and graft survival a 1, 5 and 10 years did not show statistically significant differences between SLKT and KT. Conclusion Our analysis shows excellent kidney and patient survival in SLKT. SLKT and KT recipients had similar 1, 5 and 10-years patient and graft survival.

Post-Traumatic Growth among Patients after Living and Cadaveric Donor Kidney Transplantation: The Role of Resilience and Alexithymia.

The aim of this study was to determine the role of resilience and alexithymia in the post-traumatic growth as a response to extreme stress in patients after kidney transplantation and to determine whether there are differences in the level of posttraumatic growth in patients after living and cadaveric donor kidney transplantation. The relationships between these variables were also evaluated. The questionnaire survey of 91 kidney recipients took place in 2018 and 2019. The following tools were used: authorial post-transplant questionnaire for recipients and validated questionnaires, Post Traumatic Growth Inventory (PTGI-R), Resilience Coping Scale Questionnaire, and Toronto Alexithymia Scale Questionnaire (TAS20). The results obtained showed significant differences between the group of kidney recipients from living donors and recipients from cadaveric donors, in terms of overall post-traumatic growth, as well as changes in self-perception and a greater appreciation for life. Post-traumatic growth in both groups was related to the level of resilience and the level of alexithymia. Resilience is an accurate predictor of posttraumatic growth in general and for each of the groups of recipients separately.

Right renal vein lengthening with cava patch in cadaveric donor kidney transplantation: cohort study

Background: Right kidney transplant can become a surgical challenge, due to anatomical length disparity between the right and left veins. From 2011, lengthening of the right renal vein has been used in our program. The objective was to evaluate the outcome among kidney transplant recipients with or without the use of a cava patch, comparing safety, complications and patient / graft survival in both groups.Methods: Retrospective single center cohort study between 2011-2020 in a Kidney transplant program at Mexico.Results: 27 right cadaveric kidney transplant recipients were identified, 13 (48%) with and 14 (52%) without right renal vein lengthening (RRVL). Median overall operative time was 135 (120-157) minutes, with no significant difference between groups (p=0.181), even in overweight or obese recipients. Perioperative bleeding and postoperative drainage output was similar in both groups. There were two graft failures among recipients without RRVL one due to arterial bleeding and the other secondary to venous thrombosis. After one year of follow up, renal graft function and graft survival was similar in both groups.Conclusions: RRVL technique is safe and facilitates anastomoses in complex cases. Although no statistically significant difference in operative time was found between the groups, the RRVL technique in overweight / obese patients was thirty minutes faster. Routine use of this technique is suggested in cadaveric donor right kidney transplants.

Increased Delta Neutrophil Index Is Associated With Poor Prognosis in Cadaver Donor Kidney Transplantation

ObjectiveDelta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocyte in acute infection, has been reported as a useful, predictable marker for mortality in patients with sepsis. We have hypothesized that an increased recipient DNI is associated with poor prognosis in cadaver donor kidney transplantation. MethodsWe investigated patients undergoing kidney transplantation from cadaver donors from March 2013 to January 2018. Rejection was diagnosed by kidney biopsy with Banff classification and excluded subclinical rejection. ResultsIn a total of 73 patients undergoing cadaver kidney transplantation, 25 (34.2%) patients were diagnosed with rejection based on the Banff classification. Among them, 11 patients were diagnosed with early rejection. The recipients' postoperative DNI (%) was different between patients with early rejection and patients without rejection (0.18 vs 1.21, P < .001). In the univariate logistic regression analysis, cold ischemic time, donor preoperative last creatinine level, postoperative DNI level, and perioperative infection were predictive of early rejection. However, in a multivariate adjusted logistic regression test, only a high level of DNI (odds ratio 12.307, 95% confidence interval [CI] 1.22–129.82) was associated with early rejection. The C-statistic was 0.777 (95% CI 0.604–0.951, P = .004) for DNI. In multivariate Cox regression analysis, the donor's last creatinine level (hazard ratio 2.25, 95% CI 1.26–4.13) and preoperative DNI (hazard ratio 14.02 95% CI 2.62–75.26) were predictors of renal survival. ConclusionsIncreased DNI in cadaver donor kidney transplantation recipients might be one of the predictive values of early kidney rejection and prognosis.

FP773Increased post-operative recipient's delta neutrophil index is associated with early graft rejection in cadaver donor kidney transplantation

FP773Increased post-operative recipient's delta neutrophil index is associated with early graft rejection in cadaver donor kidney transplantation

Successful Treatment for BK Virus Nephropathy by Leflunomide in a Kidney Transplant Patient: A Case Report

IntroductionThe immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL. MethodsImmunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function. ResultsThe kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment. ConclusionEarly detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner.

Fatal Curvularia brain abscess in a heart and kidney transplant recipient

A 42-year-old woman with history of heart failure status post orthotopic heart transplant and end stage renal disease presented to the hospital with decompensated heart failure that progressed to cardiogenic shock. She underwent a new orthotopic heart transplant and cadaveric donor kidney transplant. Three weeks later, she experienced right facial droop and right upper extremity weakness. Computed tomography showed a left frontal cortical lesion with vasogenic edema and a central hemorrhagic component. Given the concern for an angioinvasive mold infection, she was started on voriconazole and amphotericin B. Brain biopsy was performed and histopathology revealed septated hyphae with acute angle branching. Mycology culture isolated Curvularia sp. Unfortunately, her mental status deteriorated with subsequent development of multiorgan failure that led to death.

Colonoscopy as Part of Pre-Transplant Work-Up in Successful Kidney Transplant Candidates: Single-Center Experience and Review of Literature.

BackgroundScreening colonoscopy is not obligatory in kidney pre-transplant work-up guidelines. According to recommendations, only transplant recipients over age 50 years should be screened. The aim of this study was to characterize endoscopic findings revealed as part of pre-transplant work-up.Material/MethodsWe retrospectively reviewed pre-transplant work-up charts of 434 adult patients who received a cadaveric donor kidney transplantation (KT) from 2012 to 2015. Endoscopic findings analysis with age subgroup (<50 and ≥50) analysis were performed.ResultsOut of 434 of patients that underwent KT, 29% have had a colonoscopy. In 75.6% of those, pathologies were found. Hemorrhoids were found in 33% and polyps in 30.7% of patients. Adenoma detection rate (ADR) was 18.1% (67.5% distal predominance). Advanced ADR was 10.2% (distal predominance). Diverticulosis was found in 28.3% of patients and ulcerative colitis was found in 2.4%. In age subgroup analysis, ADR was higher in patients ≥50 years compared to those <50 years (21.6% vs. 4%; p=0.041).ConclusionsColonoscopy as part of pre-transplant work-up enables removal of precancerous lesions and management of benign findings. All candidates meeting criteria for the general population should be screened. Patients under age 50 years could also benefit from colonoscopy as part of the pre-transplant work-up. Therefore, we suggest that baseline colonoscopy should be included in pre-transplant work-up guidelines for all patients, regardless of age. However, further studies are needed to confirm this recommendation.

Reflections on My Lifetime Teacher: Dr. Willem J. Kolff.

Reflections on My Lifetime Teacher: Dr. Willem J. Kolff.

Association between flow cytometric crossmatching and graft survival in Thai cadaveric-donor kidney transplantation.

The flow cytometry cross-match (FCXM) technique is a sensitive method and has been reported to predict and protect graft rejection more efficiently than the conventional complement-dependent cytotoxicity cross-match (CDCXM) and the anti-human globulin-complement dependent cytotoxicity (AHG-CDC) methods. We performed retrospective FCXM in 270 cadaveric donor kidney transplant patients with negative CDC and AHG. The correlation between FCXM with graft rejection and graft survival within 1 year to 3 years was analysed. There were 97 (35.9%) samples with positive FCXM. Only 7 (2.6%) of the 270 samples had evidence of antibody-mediated rejection (AMR) at the first year, which increased to 10 (3.7%) AMR samples after 3 years. Interestingly, there was a significant association between FCXM results with the graft outcome at 1 year (P = 0.046). However, when the association was analysed at 3 years after transplantation, it did not reach statistical significance. FCXM detected concordant positive results in 4 out of 8 samples. These samples had mean fluorescence intensity (MFI) of the donor-specific antibody (DSA) higher than 2,000. The DSA was identified by a single antigen bead. Although positive FCXM, particularly for HLA class I, was significantly associated with graft loss from AMR within 1 year of transplantation in this study, there were a lot of FCXM false positives, as high as 35.9%. Additional studies are required to further assess the usefulness of FCXM in Thailand.

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM).

BackgroundTherapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM).MethodologyTen patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE.Principal FindingsTPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness.Conclusions/SignificanceTPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies.

Comparison of depression between kidney transplant recipients from live donors with cadavers in hospitals of Mashhad University of Medical Sciences

Abstract Background & aim: Kidney transplant surgery may impact various aspects of the life and results in individual and psychological problems. Receiving a kidney from a cadaver donor is associated with beliefs related to death of donor and with recipient’s survival. The aim of this study was to compare the rate of depression in patients receiving kidney from living donors with cadaveric donor kidney transplant ,patients that were referred to nephrology clinics in hospitals of Mashhad University of Medical Sciences in 2010. Materials & methods: A descriptive – comparative design was used. The sample of the study consisted of 60 patients receiving kidney from living donors and 60 cadaveric kidney transplantation attended to nephrology clinics in hospitals of Mashhad University of Medical Sciences. Data were collected by a demographic questionnaire and Beck depression Inventory. The reliability of this test was evaluated with test-retest and Pearson correlation test was 0. 95. Data were analyzed with SPSS software (version 13). Finding: Depression scores in living kidney transplantation group were 11. 6±5. 7 , and in the cadaveric group was 16. 4±9. 4. Independent t-test showed a significant difference between two groups scores of depression (P . [January 24, 2010] Pascazio L et al, (2010) Anxiety, depression and emotional profile in renal transplant recipients and healthy subjects: A comparative study. Transplantation Proceedings. 42(9) 3586-3590 Pawar A et al «Cognitive and emotional effects of renal transplantation»,1 January 2006, [on line] . [3 Apr 2010]. Perez S-G et al (2008) Influence of the psychological state of relatives on the quality of life ofpatients at 1 year after transplantation. Transplantation Proceeding. 40(9)3109-11. Rezaei R et al (2009)[ Comparison of body image in hemodialysis patients with kidney transplant patients]. payesh Quarterly . 8(3) 279-287. (Persian). Sayin A et al (2007) Quality of life in hemodialysis, peritoneal dialysis, and transplantation patients. Transplantation Proceeding. 39(10) 3047-3053. Shah VS, et at (2006) Qualify of life and psychosocial factors in renal transplant Recipients. Transplantation Proceedings. 38(5) 1283-1285. Sugawara H et al (2008) Paradoxical depression in renal transplant recipient. Transplantation Proceeding. 40(10) 3448-3450. Szeifert L et al(2010) Symptoms of depression in kidney transplantations: A cross-sectional study. American Journal of Kidney Diseases (AJKD). 55(1)132-140. Toimamueang U et al (2003) Stress and coping strategies among renal transplant candidates in a stress and coping strategies among renal transplant candidates in a Thai medical center. Transplant Proceedings. 35(1) 292-3. Virzi A, et al (2007) Depression and quality of life in living related renal transplantation. Transplantation Proceedings. 39(6) 1791-1793. Weng LC, et al (2006) Effects of self-efficacy, self-care behaviors on depressive symptom of Taiwanese kidney transplant recipients. Journal of Clinical Nursing, 17(13) 1786-1794.

Case Scenario: Residual Curarization in Diabetic Polyneuropathy

Case Scenario: Residual Curarization in Diabetic Polyneuropathy

S167 Vascular events during live and cadaveric donor kidney transplantation and salvage of graft experience from 2050 recipients

S167 Vascular events during live and cadaveric donor kidney transplantation and salvage of graft experience from 2050 recipients

Effects of Ischemia-Reperfusion Injury in Kidney Transplantation: Risk Factors and Early and Long-Term Outcomes in a Single Center

IntroductionIschemia-reperfusion injury (IRI) causes a high rate of delayed graft function (DGF), the most frequent complication in the immediate postoperative period after cadaveric donor kidney transplantation. Herein we evaluated the impact of donor and recipient characteristics on DGF development in terms of the incidence of acute rejection episodes, hospital stay, renal function, and long-term graft and patient survivals. Materials and MethodsBetween February 1998 and July 2011, 761 patients underwent cadaveric donor kidney transplantations. DGF was defined as the need for dialysis in the first week. Patients were subdivided according to initial graft function as immediate graft function (IGF) or DGF. ResultsDGF observed in 241 patients (31.6%) was associated independently with expanded criteria donors, extended cold ischemia time, Karpinsky histological score, and prior dialysis duration both univariate and multivariate analysis. The incidence of acute rejection episodes was 18.1% among the DGF group versus 1.3% in the IGF group (P < .01). DGF significantly reduced both graft and patient survivals at 6, 12, 36, and 60 months. ConclusionDGF was responsible for a longer hospital stay, worse early and long-term renal function, a higher incidence of acute rejection episodes as well as reduced graft and patient survivals.

Constrictive Pericarditis After Renal Transplantation: Three Case Reports

IntroductionPericardial exposure can be see in chronic kidney disease, but constrictive pericarditis (CP) development, which is usually present with signs of right-sided heart failure is rare. In renal transplant recipients CP can lead to graft dysfunction and serious liver disease. We present herein 3 such CP patients. Patient 1A 37-year-old male patient with end-stage renal disease (ESRD) due to membranoproliferative glomerulonephritis was on chronic hemodialysis (HD). He underwent living donor kidney transplantation in 1995. In 2006 he was admitted with complaints of shortness of breath, weakness, and abdominal distention. Patient 2A 17-year-old male patient with ESRD due to vesicoureteral reflux had 6 months of HD and underwent living donor kidney transplantation in 2008. Six months after transplantation, he showed leg edema, massive ascites, hepatosplenomegaly, and pretibial edema. Patient 3A 52-year-old male patient was 21 years after HD initiation when cadaveric donor kidney transplantation was performed in August 2011. Four months after transplantation, he presented with a shortness of breath and fatigue. Echocardiography revealed 2–3 degree aortic regurgitation and increased pericardial brightness. ConclusionAll patients underwent right-sided heart catheterization, leading to a diagnosis of constrictive pericarditis, requiring total pericardiectom. Pathological examination of the pericardium showed typical diffuse fibrosis.

Polyoma BK Virus: An Oncogenic Virus?

We report a case of a 65-year-old gentleman with a history of end stage renal disease who underwent a successful cadaveric donor kidney transplant four years ago. He subsequently developed BK virus nephropathy related to chronic immunosuppressant therapy. Three years later, misfortune struck again, and he developed adenocarcinoma of the bladder.

11-Year Single-Center Experience in Living-Donor Kidney Transplantation in Poland

Living-donor kidney transplantation (LDKT) is a viable option that is characterized by better short- and long-term results than cadaver-donor kidney transplantation (CKT). In Poland number of LDKT is low (2%–3%). We collected data on all 29 LDKTs performed in our center between 1999 and 2010; 82.7% were obtained from living related donors. The mean recipient age was 34.4 ± 12.8 years (range, 15–58) and mean donor age was 48.5 ± 7 years. Most donors were women ( n = 17; 62%). In 3 cases the LDKT was a second transplantation. The mean numbers of HLA class I and II mismatches were 2.18 ± 0.98 and 0.93 ± 0.6 respectively. The mean total ischemia time was 3.22 ± 1.74 hours. Induction therapy included antithymocyte globulin daclizumab 4; (13.7%) (n = 7; 24.1%); 27.6% of recipients were placed on cyclosporine based immunosuppression and the remaining 72.4% on tacrolimus with 69% also receiving mycophenolate mofetil. All recipients were prescribed steroids. Delayed graft function was observed in 3 cases and an acute rejection episode in 4 subjects. One-year patient and graft survivals were both 100% (98% and 83% for CKT). Five-year patient and graft survival were 100% and 89.6%, respectively, compared with 83% and 69% in CKT. The mean serum creatinine levels at 1, 6, 12, and 60 months were 1.59 ± 0.4, 1.51 ± 0.3, 1.51 ± 0.4 and 1.49 ± 0.3 mg/dL respectively. Our results, albeit concerning a small group of patients, confirmed excellent outcomes of LDKT, which should be actively promoted in our country.