Cases Of Renal Transplantation Research Articles

Recycling transplanted organs: An exceptional case and literature review.

Recycling transplant kidneys, in other words using an allograft which has previously been transplanted in one recipient for transplant in a second recipient, can be a source of opportunity for expanding the pool of available grafts in the United States and beyond. We describe a case of renal transplantation from a donor who had undergone a kidney transplant 3 years prior and had good graft function at the time of procurement. The recipient underwent transplantation uneventfully and to date has demonstrated excellent graft function. We also include a literature review of reported cases of recycled/retransplanted kidneys. -Recycling transplanted kidneys is a largely untapped resource which could help decrease the transplant waitlist. -Utilizing such kidneys does need special considerations in terms of procurement technique, backtable, crossmatch, recipient selection and follow-up.

Salvage of a Transplanted Kidney following Immediate Renal Artery Narrowing

Renal transplantation is considered the preferred treatment method for chronic renal failure. Early graft failure caused by transplant renal artery narrowing/stenosis is a common vascular complication after kidney transplantation. The classic symptoms include refractory hypertension, a decline in graft function, and fluid retention. Color Doppler sonography plays an important role in the diagnosis of renal artery narrowing; however, allograft artery angiography remains the gold standard. We report on a case of cadaveric donor renal transplantation, wherein the urine output markedly decreased within 7 h of transplantation due to renal arterial narrowing and the efforts that were made to salvage the kidney.

A Study on Early Surgical Complications in Renal Transplant Recipients

Introduction: Renal transplantation is one of the most effective treatment measures in patients with end-stage renal disease to improve their quality of life. However, postoperative surgical complications can be seen in 15% to 17% of cases, with significant morbidity in earlier periods. This study aims to study the incidence, presentation, and management of various surgical complications within 2 months of renal transplantation. Materials and Methods: This retrospective descriptive study included data from hospital records of 236 recipients who underwent renal transplantation from 2015 to 2022 at our institute. In addition, salient characteristics of the donors were also noted. Recipients whose hospital records were not available were excluded from the study. Surgery-related complications within 2 months of renal transplantation in recipients and their management were studied. Results: Of 236 cases of renal transplantation, 182 cases were live-related renal transplantation recipients, and 54 were deceased donor renal transplantation recipients. Surgical complications such as posttransplant urine leak in three patients, lymphocele in two patients, graft renal vein thrombosis in three patients, and anastomotic site pseudoaneurysm in one patient occurred. The overall incidence of early surgical complications in our study is 3.81%. The study reports the successful management of all these nine patients with necessary intervention. Conclusion: The early diagnosis of postoperative complications is essential for reducing mortality and preserving graft function.

Utility of bone marrow examination (BME) in the diagnosis of pyrexia of unknown origin (PUO).

Bone marrow examination (BME) is a useful tool in the diagnosis of haematological and non-haematological diseases. It plays an important role in early diagnosis of the underlying cause of pyrexia of unknown origin (PUO) and can influence the management of patients. Bone marrow aspiration (BMA) plays a very important role in establishing a definitive diagnosis in cases of PUO. The aim of this study was to review the indications and usefulness of bone marrow aspirates sent for microbiological evaluation as a diagnostic tool with histopathological correlation. A prospective study was conducted from 1 January 2017 to 30 September 2019 in the Department of Microbiology and Pathology on the bone marrow aspirates of patients of all groups. A total of 148 bone marrow aspirates were included. The cases were categorized as classical PUO (n = 81/148, 54.7%), nosocomial PUO (n = 4 /148, 2.7%), neutropenic PUO (n = 18/148, 12.1%), and immunocompromised PUO (n = 45/148, 30.4%), among which were systemic lupus erythematosus cases n = 8/45 (22.2%), human immunodeficiency virus positive cases n = 10/45 (17.7%), and renal transplant cases n = 27/45 (60%). A total of 28 BMAs were positive for microorganisms, out of which bacterial pathogens were n = 12 (42.8%), mycobacterial n = 12, 42.8%, fungal (n = 3, 10.7 %), and viruses (n = 1, 3.5%). This study helped in highlighting the role of bone marrow examination as an important diagnostic method in the diagnosis of infectious diseases.

Clinical characteristics of 15 cases of renal transplantation with pre-exsiting donor-specific antibody.

Currently, patients with pre-exsiting donor-specific antibody (DSA) are prone to antibody-mediated rejection (AMR) after surgery and are at a relatively high risk of postoperative complications and graft failure. The risk of postoperative complications and graft failure is relatively high. This study aims to discuss the clinical outcome of DSA-positive kidney transplantation and analyze the role and safety of preoperative pretreatment in DSA-positive kidney transplantation, providing single-center treatment experience for DSA-positive kidney transplantation. We retrospectively analyzed the clinical data of 15 DSA-positive kidney transplants in the Department of Renal Transplantation of First Affiliated Hospital of Zhengzhou University from August 2017 to July 2022. Eight cases were organ donation after citizen's death (DCD) kidney transplant recipients, of which 3 cases in the early stage were not treated with preoperative desensitisation therapy (DCD untreated group, n=3), and 5 recipients were treated with preoperative rituximab desensitisation (DCD preprocessing group, n=5). The remaining 7 cases were living related donors recipients (LRD) who received preoperative desensitisation treatment with rituximab and plasma exchange (LRD preprocessing group, n=7). We observed and recorded the incidence of complications with changes in renal function and DSA levels in the recipients and the survival of the recipients and transplanted kidneys at 1, 3 and 5 years, and to compare the differences in recovery and postoperative complications between 3 groups. All 15 recipients were positive for preoperative panel reactive antibody (PRA) and DSA and were treated with methylprednisolone+rabbit anti-human thymocyte immunoglobulin induction before kidney transplantation. DCD untreated group all suffered from DSA level rebound, delayed renal graft function (DGF) and rejection reaction after surgery. After the combined treatment, DSA level was reduced and the graft renal function returned to normal. The DCD preprocessing group were all without antibody rebound, 1 recipient developed DGF and the renal function returned to normal after plasmapheresis, and the remaining 4 recipients recovered their renal function to normal within 2 weeks after the operation. In the LRD preprocessing group, 2 cases had antibody rebound and 1 case had rejection, but all of them recovered to normal after treatment, and DSA was maintained at a low level or even disappeared. The incidence of DGF and rejection in the DCD untreated group were significantly higher than that in the DCD preprocessing group and the LRD preprocessing group; and there were no significant difference in the incidence of postoperative haematuria, proteinuria, bacterial and fungal infections, and BK virus infection between the 3 groups (all P>0.05). A total of 11 of the 15 recipients were followed up for more than 1 year, 6 for more than 3 years, and 1 for more than 5 years, and the survival rates of both the recipients and the transplanted kidneys were 100%. Effective preoperative pretreatment with desensitization therapy can effectively prevent antibody rebound in DSA-positive kidney transplantation and reduce perioperative complications.

Anesthesia in Renal Transplant

Background: Transplantation provides near-normal life and excellent rehabilitation compared to dialysis and is the preferred method of treating end-stage renal disease (ESRD) patients. Methods: We conducted a retrospective analysis of anesthesia management from 20 cases of live renal transplants carried out between August 2017 and April 2019 at Dr. Sardjito Central General Hospital, Yogyakarta. The subjects ' preoperative patient status, anesthesia management, and postoperative care were assessed. Results: Most patients had preoperative anemia, normal serum potassium, serum creatinine, and average ejection fraction. Anesthesia management began 24 hours before surgery, in which the patients were hospitalized, had peripheral IV access and fluid maintenance, and hemodialysis, followed by premedication 1 hour before surgery. Before surgery, anesthesia induction and intubation were done, followed by maintenance of anesthesia and intraoperative monitoring. Postoperative care consisted of the administration of analgesia and management of complications. Conclusion: Optimization of preoperative status, proper anesthesia management, and good postoperative care are keys to a successful renal transplant program.

The development of adult T cell leukemia/lymphoma in renal transplant recipients: report of two cases with literature review

BackgroundsTherefore, reports on the risk of HTLV-1-related diseases in organ transplantation have increased in recent years, and the management of HTLV in renal transplantation remains a challenge.Patients and methodsWe retrospectively analyzed four HTLV-1-positive recipients or donors among 89 renal transplantation cases from 2006 to 2021.ResultsAmong the four HTLV-1-positive recipients, two patients developed adult T cell leukemia/lymphoma (ATL) derived from recipients at approximately 3 years (1016 days and 1195 days) after renal transplantation. Case 1 developed lymphoma-type ATL (an extranodal primary cutaneous variant), including skin and pulmonary lesions. The patient achieved CR with FK tapering and CHOP therapy following cord blood stem cell transplantation. However, the patient died 101 days after ATL development because of a severe fungal infection. Case 2 developed acute-type ATL with an unusual phenotype of CD4+8+30+. The patient was treated with FK tapering and palliative therapy because of poor PS. Notably, in case 1, histopathological findings showed high numbers of PD-1-positive TIL cells in ATL, suggesting exhausted T cells and a correlation with the early onset of ATL. Furthermore, in Case 2, histopathological findings revealed CD 30 expression in ATL cells, suggesting the importance of CD 30 in ATL development. Importantly, case 2 showed typical driver mutations, including CCR4 truncation mutations of the C-terminal, TBL1XR1 mutation, and TP53 mutation in the splice site. Notably, our present study and our previous study on renal transplantation strongly indicated that two out of two and one out of 59 “recipient” positive cases developed ATL, respectively. Furthermore, our previous nationwide study 4 out of 10 “donor” positive cases developed HAM. These findings showed that ATL may be derived from HTLV-I+ recipient cells and HAM may be derived from HTLV-1+ donor cells, although the precise mechanism remains unknown.ConclusionsThus, early onset and rapid progression of ATL with poor outcomes should be considered in HTLV-1 endemic areas. Furthermore, immunological or genetic mechanisms may be related to the development of ATL after renal transplantation. We believe that the mechanism of onset of ATL after transplantation may be important when considering the immune environment of ATL itself.

Cryptosporidiosis in HIV-seronegative patients: A case series

Enteric infections by are a frequent cause of diarrhea among immunocompromised and HIV infected patients but there are limited reports of their occurrence in immunocompetent patients. Cryptosporidiosis is a faeco-orally transmitted protozoan infection and is one of the leading causes of chronic parasitic diarrhea. Here we report a case series of cryptosporidiosis from three different patients where two patients are immunocompetent and one is a post renal transplant case. All the patients came with watery diarrhea for which stool samples were collected and examined by modified Ziehl Neelsen acid fast staining (Kinyoun’s method). On microscopic examination of smear, multiple, pink, round to oval acid fast oocysts of 4-6µm diameter were seen against a blue background morphologically resembling . Early diagnosis and prompt initiation of antiparasitic drugs aids in timely treatment and prevention of disseminated cryptosporidiosis.

#4488 OLD BIOPSY IS ALWAYS GOLD, REVISING MEMBRANOPROLIFERATIVE GN DIAGNOSIS IN A RENAL TRANSPLANT PATIENT

Abstract Background and Aims MPGN resulting from hepatitis C virus (HCV) infection typically shows granular deposition of immunoglobulin M (IgM), C3, and both kappa and lambda light chains. Immunoglobulin G (IgG) may or may not be present, and C1q is typically negative, the same pathology can be found in other viral infections. The recurrence rate post-transplantation is high, with 33% of immune-complex MPGN. Graft loss is even higher 65%, especially among patients with idiopathic MPGN. Treatment of a patient with significant proteinuria can be tricky, as no proven treatment is described yet, but plasmapheresis and induction with cyclophosphamide were described for heavy proteinuria >3.5 g/day. Method 79 year old female patient, known case of live unrelated renal transplantation in December 2013, primary renal disease is unknown. She had a history of equivocal hepatitis C virus antibodies, but Hepatitis C virus RNA was not detected. She is also known to have Type II Diabetes Mellitus and hypertension. The patient had baseline creatinine of 100-120 micromol/L. 24 hr urine protein was 0.8 g/Day but started rising quickly to reach a peak of 9.2 g/g seven months post-transplantation to nephrotic range proteinuria but her serum albumin level was always above 35 g/L. Serum protein electrophoresis showed no M band, a kappa/ Lambda ratio 1.21 within a normal range (0.260-1.65). Anti- nuclear antibody (ANA), P-ANCA, C-ANCA, and Double-stranded DNA all were negative. Complements were within normal range C3 1.39 g/L (0.79 -1.52), C4 0.44 g/L(0.17-0.57)m rheumatoid factor and Anti- citrullinated peptide antibodies were negative. Hepatitis b Virus surface antigen and core antibodies were not reactive, HIV screening was negative. Urine analysis showed RBCs but no RBC casts. Renal biopsy showed mild mesangial expansion and mild l increase in mesangial cells and matrix. Some glomeruli show increased lobulation with increase in mesangial cells and matrix with segmental endocapillary proliferation There is double contour of the glomerular basement membrane with scattered spikes and holes within the basement membrane seen best with silver stain. There is mild increase in the thickness of glomerular basement membrane. There is focal mild lymphocytic infiltration. Tubulitis is not seen in the examined material. One Focal area of mild interstitial fibrosis. Sampled blood vessels are unremarkable. The stain for C4d is negative. Immunofluorescence showed granular capillary wall immunoreactivity to IgM (+2), C4 (+1), C1q (+1), and Lambda light chain (+2). The glomeruli show no immunoreactivity to IgG, IgA, C3, Kappa and fibrin. The glomeruli show (+) staining for albumin. Tubular protein reabsorption droplets showed immunoreactivity for albumin, IgG, IgM, C3, kappa and lambda light chains. Electron microscopy showed many subendothelial, and mesangial electron-dense deposits. The patient was on maintenance immunosuppression medications inform of mycophenolic acid 720 mg, cyclosporine; 250mg BID, and Prednisolone 5 mg daily.Revisiting the new classification of membranoproliferative glomerulonephritis is challenging in this patient, since there is the dominance of IgM deposition by immunofluorescence and C4 but not C3 makes it challenging, the negative monoclonal band in serum electrophoresis and negative autoimmune workup excludes immune complex mediate MPGN, leave idiopathic MPGN a possibility, keeping in mind that hepatitis C virus infection was never confirmed. On the other hand, IF showed IgM with C4 subendothelial and mesangial dense deposits that excludes away the C4 glomerulopathy. Results Whether this is a recurrence of glomerular disease early on post-transplantation or denovo membranoproliferative disease, she responded well to the addition of losartan 100 mg daily, with a reduction of her urinary protein to less than 1 g/g. the patient never received treatment for the hepatitis C virus. Conclusion In our patient, it is difficult to conclude if the cause of MPGN is recurrence or denovo GN, especially with severe proteinuria that responded well to ACEi treatment. The pathological findings can be tricky.

#3385 A STUDY OF CLINICAL SPECTRUM AND THE OUTCOME IN LIVE KIDNEY TRANSPLANT RECIPIENTS IN A TERTIARY CARE CENTRE OF INDIA

Abstract Background and Aims Kidney transplantation has become the treatment of choice for end-stage renal disease as it leads to longer survival and superior quality of life. There is a remarkable disparity in the access and outcome of kidney transplant across the world. Limited health care resources, difficulty in access or sometimes non availability of appropriate medications, difficulties with transportation, limited availability of Nephrologists are common challenges in developing countries and also within a country like India due to diverse socioeconomic and cultural backgrounds. We present the pattern of infection, various causative organisms, causes of allograft dysfunction and the clinical outcome of the admitted live kidney transplant recipients in Nephrology department of a tertiary care center from North-East India. Method This was a single center retrospective observational study carried out in Nephrology Department of Gauhati Medical College, Guwahati, India. The data were collected from the medical records. All the admissions of live renal allograft recipients during the period May 2017- May 2022, were included in the study. Results Out of a total of 156 admissions of renal transplant recipients, male to female ratio was 3.7: 1. Among the live KTRs basic disease, most common was chronic glomerulonephritis (44.8%) followed by CTID (23.9%). Infection related complications were present in 72 (46.1%) cases. Among infection UTI (n = 29, 16.6%) was most common followed by pneumonia (n = 24, 15.4%). Various causes of graft dysfunction (biopsy proven) were ATI (Acute tubular injury), CNI toxicity, chronic ABMR, acute ABMR, recurrence of basic disease, acute TCMR and chronic TCMR. NODAT was found in 14 (9%) of the cases. Out of theses 4 cases, 1 had bacterial pneumonia and 3 had UTI. Of 72 admissions with infection, total 8 patients succumbed to their illness with mortality rate of 11.1%. The most common cause of mortality was sepsis due to UTI. Conclusion The number of admissions of renal transplant cases has increased significantly in last 5 years, indicating the increased availability and affordability of renal transplantation in our country. Of 156 admitted live KTRs, infection was seen in 46.1% (n = 72) cases. UTI remained the most common infection (n = 29, 16.6%) followed by pneumonia (n = 24, 15.4%). Graft dysfunction was seen in 33.9% (n = 53) cases. Chronic ABMR was the most common cause (n = 30, 19.2%) for graft dysfunction. Neglect of necessary hygiene, ignorance of regular follow up and dysregulated immunosuppressive doses have contributed to high infection rate. Lack of regular follow up in post-transplant period due to logistic issues or lack of education and awareness, lack of access to immunosuppressive drugs, etc. are major contributing factors for graft dysfunction in our set up. The condition worsens with the difficult terrain, repeated floods, and lack of transportation from remote areas in Nort Eastern part of India.

An Extremely Rare Masquerader – A Case of Chronic Allograft Dysfunction

47 year old lady who was detected to have hypertension at the age of 25 years, with renal dysfunction (Creatinine – 2.5 mg/dl), progressed to End stage renal disease requiring hemodialysis at the age of 31 years. She was on maintenance hemodialysis for the next 18 months and underwent a deceased donor renal transplant in 2009. Her post transplant period was uneventful and her creatinine was 1.2 until September 2021. Her creatinine showed a gradual rise to 1.9 mg/dl with increased requirement of anti hypertensives and increasing proteinuria with protein estimation showing 3950 mg/day. She underwent an allograft biopsy which showed duplication of the glomerular basement membranes and glomerulitis with c4d negative on immunofluorescence. She was treated with intravenous immunoglobulin and Rituximab for the same with not much improvement. However, an ultrasound of the transplant kidney showed bulky and echogenic transplant kidney with mild hydronephrosis and prominent renal sinus fat. MR Urogram showed extensive lymphangiectasia around the transplant kidney and ureter with markedly enlarged and edematous kidney. The collecting system and ureter are encased by the lymphangiectasia. After the treatment of CABMR her creatinine improved to 1.7 mg/dl and proteinuria reduced to 2100 mg/day. However her lymphangiectasia persisted and is being managed conservatively with no intervention planned. There are very few reported cases of Lymphangiectasia post renal transplant.

Anaesthetic challenges in the management of renal transplant recipients - An institutional review.

Objective: To provide an overview of our institutional experience with anaesthetic management of renal transplant data in terms of demographics, preoperative status, anaesthesia management, and postoperative care. Study Design: Descriptive study. Setting: Pakistan Kidney and Liver Institute and Research Center, Lahore. Period: January 2022 to June 2022. Material & Methods: This descriptive study included 203 cases of renal transplant. We reviewed the medical records of these patients for demographics, preoperative anaesthetic assessment, intraoperative anaesthesia records, and postoperative care unit notes. Data was analyzed using SPSS Version 25. Results: The mean age of the patients was 35.75 + 10.1 years, and most of the patients had co-morbidities. The preoperative echocardiographic findings were significant in 52.7% of the patients, and 87.2% were on dialysis preoperatively. General anaesthesia was used in 99.5% of cases. Mean volume of intravenous fluid was 5.8 L, and 9.35% required ionotropic support, 9.9% received transfusion intraoperatively while 3.9% required postoperative mechanical ventilation. Conclusions: Renal transplant recipients have significant co-morbidities and require a meticulous approach for successful perioperative anaesthetic management.

Detection of donor-specific HLA antibodies: A retrospective observation in 350 renal transplant cases

BackgroundThe main objective of this study was to determine the results of the cell-based assay (CDC-XM and FC-XM), and correlate with the results of solid phase assay (L-SAB). MethodsIn this retrospective study, 350 prospective renal transplant recipients were tested for the presence of HLA antibodies by CDC-XM, FC-XM and L-SAB screening with their corresponding donor. ResultsT-cell-FC-XM showed a sensitivity of 71.43% and a specificity of 91.50% for detecting class I L-SAB (+), while B-cell-FCXM showed a sensitivity of 94.94% and a specificity of 61.99% for detecting class II L-SAB (+). On the other hand, T-CDC-XM showed a sensitivity of 32.14% and a specificity of 98.64% for detecting class I L-SAB (+), while B-CDC-XM showed a sensitivity of 44.30% and a specificity of 94.83% for detecting class II L-SAB (+). In this study, the results indicated that DSA class I MFI value of 2845 and above significantly (p ≤0.001) correlated with T-cell-FC-XM positivity, while MFI value of 4585 and above (p ≤0.001) showed strong predictive accuracy of a positive T-cell-CDC-XM. However, DSA class II MFI cut-off of 1988 and above significantly (p ≤0.001) correlated with B-cell-FC-XM positivity, while MFI value of 5986 and above (p ≤0.001) showed strong predictive accuracy of a positive B-cell-CDC-XM. ConclusionsOur study showed that CDC-XM has poor sensitivity, while FC-XM has poor specificity to detect DSA. L-SAB has good correlation with T-cell-FC-XM (p < 0.0001) but not with B-cell-FC-XM (P = 0.31). DSA strength >2845 and > 1988 significantly correlated with T-cell-FC-XM positivity and B-cell-FC-XM positivity, respectively. While, a MFI value of >4585 and > 5986 significantly correlated with T-cell-CDC-XM positivity and B-cell-CDC-XM positivity, respectively. These MFI cut-off values could serve as a surrogate marker for CDC-XM and FC-XM tests and may help in resolving the limitations of cell-based techniques. In conclusion, we found that L-SAB is more sensitive and specific than CDC-XM and FC-XM and therefore may be used as a test of choice.

Cancer risk and mortality in multiple sclerosis: The need for vigilance

Several investigators have addressed the possibility of a link between cancer and multiple sclerosis (MS). The consensus view favours an increased risk, but analysis is compromised by multiple confounders, including small sample sizes, age and socio-economic group of the population in question, level of education and whether a cancer diagnosis was based on the less reliable death certificates compared to cancer registries. Coupled with this is the problem of subsequent cancer-related mortality in those with MS compared to those without MS. Until 1996 patients were treated chiefly with steroids, azathioprine, cyclophosphamide and occasionally mitoxantrone. Each of these has its own potential long-term risk of cancer probably least of all with steroids. Mitoxantrone has a small but definite risk of acute myeloid leukaemia particularly if patients are exposed to more than 60mg/M2 ( Lebrun and Rocher, 2018 Lebrun C Rocher F. Cancer risk in patients with multiple sclerosis: potential impact of disease-modifying drugs. CNS drugs. 2018; 32 (Oct): 939-949 Google Scholar ). Azathioprine is connected with a particularly high rate of non-Hodgkin lymphoma in renal transplant cases ( Kinlen, 1992 Kinlen L. Immunosuppressive therapy and acquired immunological disorders. Cancer research. 1992; 52 (Oct 1): 5474s-5476s Google Scholar ) but this has not been found for large studies in MS that had a follow-up range of <10 years and a total dose exposure of no more than 600g ( Casetta et al., 2007 Casetta I Iuliano G Filippini G. Azathioprine for multiple sclerosis. Cochrane Database of Systematic Reviews. 2007; Google Scholar ).

A RARE CASE OF MASSIVE RENAL VEIN HEMORRHAGE IN TRANSPLANT FOR LUPUS NEPHRITIS END-STAGE RENAL DISEASE

A RARE CASE OF MASSIVE RENAL VEIN HEMORRHAGE IN TRANSPLANT FOR LUPUS NEPHRITIS END-STAGE RENAL DISEASE

Transplantation in a Recipient with Crossed Renal Ectopia and Donor with Early Branching of the Left Renal Artery - A Case Report

Comprehensive preoperative evaluation of potential donors is crucial for selecting the right donor. Early segmentary arterial branching is present in 10%–12% of cases. Expert surgeons require at least 1 cm of main donor renal artery to clamp and properly anastomose the artery in the recipient. We report a case of live-related renal transplantation wherein the recipient had a crossed renal ectopia and the donor had early branching of the left renal artery (&lt;5 mm from the aorta).

Dawn of a new beginning- First renal transplant in patient with HIV in Nepal

Human immunodeficiency virus infection was traditionally considered an absolute contraindication for transplantation because of the concern that immunosuppression would accelerate HIV disease progression, resulting in increased mortality and a "waste" of organs. Since potent antiretroviral therapy became widely available in 1996, the prognosis of patients with HIV infection has dramatically improved. HIV-infected patients are now accepted recipients of both HIV-infected and HIV- uninfected donor organs in specialized transplant centers worldwide. However, due to stigma about the disease and lack of appropriate expertise, renal transplant in HIV patients has not been done in Nepal. Here, we report the first case of renal transplantation done in patient with HIV in Nepal. So, even in a resource limited setting like Nepal, HIV-positive ESRD patients with stable disease should be given the benefit of kidney transplantation as patient and graft survival are reasonably good with better quality of life.

Renal Transplantation in Pure Autonomic Failure.

Renal Transplantation in Pure Autonomic Failure.

Effects of different sensitization events on HLA alloimmunization in renal transplant cases; a retrospective observation in 1066 cases

BackgroundPatients awaiting solid organ transplantation may develop anti-HLA antibodies after sensitization events such as transfusions, pregnancies, or previous transplantations. However, the effects of a particular sensitization event on HLA alloimmunization have not been well studied in parallel using cell-based assays and solid-phase assays. In this study, we evaluated and compare how different sensitization events affect the HLA antibody screening (HLA-Ab) and donor specific antibody (DSA) status in solid renal organ transplantation patients. MethodsHLA antibody (HLA-Ab) screening tests like complement-dependent cytotoxicity crossmatch (CDC-XM), flow cytometry crossmatch (FC-XM) and Luminex panel-reactive antibody (L-PRA) were performed in all 1066 patients (635 males and 431 females). If any of these tests turned out to be positive, a Luminex single antigen bead (L-SAB) assay was performed for DSA identification. Test positive rates and antibody strengths were analyzed according to the different sensitization events and gender. ResultsIn this study, HLA-Ab screening tests positive rates (L-PRA, FC-XM and CDC-XM) were significantly higher in patients with previous transplantation (73.91%, 100% and 56.52% p < 0.001), previous pregnancy (57.46%, 70.14% and 18.85% p < 0.001) or blood transfusion (27.33%, 35.55% and 7.33% p < 0.001) compared with patients without a sensitizing event (6.17%, 13.58% and 1.09). In this study, re-transplantation group showed significantly stronger antibody strength (DSA) than non sensitized group (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 2659, 3329; P < 0.001) and those with single sensitization events of transfusion (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 5790.26, 6004.16; P < 0.001) or pregnancy (class I & II MFI 11418, 17,837 vs class I and II MFI 8631.71, 7253.29; P < 0.001). ConclusionsPregnancy and blood transfused had high allo-immunization rate for class I HLA antigens. While re-transplantation patients had high allo-immunization rate for both the HLA classes (HLA- class I and HLA- class II). Re-transplantation group showed significantly stronger antibody strength, followed by pregnancy and then transfusion.

A case of successful renal transplantation of Charcot‐Marie‐Tooth disease associated with FSGS due to mutation of the INF2 gene

Focal and segmental areas of glomerular sclerosis (FSGS) have various subcategories. Here, we report on a 35-year-old man who suffered from Charcot-Marie-Tooth disease (CMT) with FSGS carrying the INF2 mutation (c.206 T > C, p.L69P). The INF2 mutation might cause abnormal actin filaments of the podocytes and Schwann cells, leading to CMT associated with FSGS. He successfully underwent living donor kidney transplantation from a mother with a normal INF2 gene without any serious adverse events. Following genetic testing, the identification of the INF2 mutation allows a recipient to reduce the use of immunosuppressive drugs. Genetic testing may provide a treatment plan for kidney transplantation.