Complication Of Kidney Transplantation Research Articles

Transplantation rénale et receveurs obèses : revue du comité de transplantation de l’Association française d’urologie

Transplantation Committee of the French Association of Urology (CTAFU) conducted a review of the complication of kidney transplantation in obese recipients. A bibliographic research in French and English using Medline with the keywords "obesity", "body mass index", "kidney transplantation", "graft function", "survival", "wound complications", "graft rejection" and "graft survival" was performed. We limited the review for the last fifteen years because of the change in immunosuppressive treatment area. Only studies with more than 20obese patients were selected. Wound or infectious postoperative complications and delayed graft function are more frequent in obese patients than in non-obese recipients. Similarly, transplant survival at 5years is lower in obese patients. On the other hand, patient survival and acute rejection are the same between the two groups if recipient selection is carefully made, particularly with regard to heart complication. Kidney transplantation in obese patients is not an easy surgery with known complication. Obese patients will take time before transplantation to explain all the risk and a regular heart follow-up is crucial if we don't want to reduce patient survival. But obese survival is better if we proceed to kidney transplantation than if they stay on dialysis, arguing for a non-exclusion of the waiting list. So there is the need for a national study concerning obese patients on waiting list to enact future guidelines.

Complications of kidney transplantation with grafts from expanded criteria donors

The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50-60 years who had ≥ 2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine >1.5 mg/dL, or death caused by stroke. Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.

Potent Immunosuppression for ABO-Incompatible Renal Transplantation May Not Be a Risk Factor for Malignancy

ABO-incompatible (ABOi) renal transplantation has been increasing, but malignant tumor is a troubling complication of kidney transplantation due to potent immunosuppression. Few previous studies, however, have demonstrated that potent immunosuppression for ABOi living-donor renal transplantation (LDRT) is a risk factor for malignancy. In the present research, data on 252 LDRT patients ftom 2003 to 2008 were retrospectively analyzed to clarify whether ABOi LDRT was associated with malignancy. A potent immunosuppressive regimen for ABOiLDRT consisted of splenectomy, cyclophosphamide, and double-filtration plasmapheresis to minimize the risk of antibody-mediated rejection, in addition to conventional immunosuppresssants including calcineurin inhibitor, prednisolone, and anti-CD25 monoclonal antibody. A total of 11 incidences of malignancy were observed during a median follow-up of 48 months. The incidence rates in ABO-compatible (ABOc; n = 189) and ABOi (n = 63) LDRT groups were 4.2 % (8/189) and 4.8 % (3/63), respectively. Kaplan-Meier survival analysis showed no statistical difference in event-free survival for malignancy between ABOc and ABOiLDRT groups (log-rank P = .73). Multivariable Cox regression analyses identified no associations of malignancy with ABOi LDRT or any immunosuppressant use. In conclusion, our investigation suggested that potent immunosuppression with splenectomy and cyclophosphamide for ABOi LDRT may not be a risk fietor for malignancy.

Posttransplant Lymphoproliferative Disorder in Kidney Transplant Patients: A Report of 68 Cases

Abstract 2662Posttransplant Lymphoproliferative Disorder (PTLD) is a rare complication of kidney transplantation that often arises due to reactivation of the Epstein-Bar Virus (EBV). Given the rarity of this disease, a full understanding of its presentation and optimal therapies has yet to be determined. Out of the 3160 patients who received a kidney transplant at the Hospital of the University of Pennsylvania between October 1987 and December 2010, we provide a retrospective analysis of 68 patients who developed PTLD. These patients were 82% Caucasian, 62% male, and 9% combined kidney and pancreas transplant patients. The most common underlying diseases leading to transplantation were glomerulonephritis (26%) and diabetes mellitus (17%). Most patients received a kidney from an unrelated donor (74%) and experienced one or more rejection episodes prior to PTLD diagnosis (59%). The median age at PTLD diagnosis was 48 yrs (range 17–76 yrs), and the median time from transplantation to diagnosis was 3 yrs (range 6 days– 25 yrs). PTLD histology consisted of 48% monomorphic, 37% polymorphic, 7% plasmacytoma, 4% T cell, and 3% Hodgkin lymphoma. At diagnosis, patients were taking steroids (96%), cyclosporine (53%), tacrolimus (35%), azathioprine (52%), and/or mycophenolate mofetil (28%). Common initial PTLD symptoms include fever (48%), pain (42%), weight loss (33%), fatigue (33%), and mass (24%). The disease commonly presented in lymph nodes (38%), kidney allograft (29%), and/or GI tract (18%). Most PTLD cases were diagnosed at stage 1 (43%) or stage 4 (31%). Laboratory analyses reveal that 62% of patient tumors tested positive for EBV and 61% of patients had elevated LDH levels. Common PTLD therapies included reduction of immunosuppression (88%), treatment with rituximab (31%), surgery (29%), and/or radiation therapy (9%). Reduction of immunosuppression alone led to CR (50%), PR (8%), SD (4%), and PD (38%). Of the 68 patients, 21 (31%) ultimately died a PTLD related death.Interestingly, PTLD patients under age 40 were more likely to have allograft involvement (p=0.007) and a polymorphic histology (p=0.007). Furthermore, allograft involvement tended to occur sooner after transplant (p=0.0001) and those with allograft involvement were more likely to present with allograft failure (p= 0.0001). Compared to monomorphic PTLD, polymorphic PTLD was more likely to be EBV positive (82% vs 51%, p=0.03) and have a lower chance of PTLD-related death (15% vs 40%, p=0.03). Finally, patients with allograft PTLD were more likely to have a polymorphic histology (80%, p<0.001). In summary, PTLD occurs in about 2% of kidney recipients and is typically EBV-associated. EBV positive PTLD is more common in younger recipients, frequently presenting with polymorphic histology in the allograft and appears to have a better prognosis. Disclosures:No relevant conflicts of interest to declare.

Pathological findings and clinical analyses on delayed renal graft function

To uncover the pathological feature of delayed renal graft function (DGF) and to explore corresponding prevention and treatments, 84 recipients receiving renal biopsy in our center from December 2007 to September 2010 were enrolled in this study, and 32 cases belonged to DGF. B-type ultrasonography-guided renal needle biopsy with BARD (a company in USA) biopsy needle was performed. After H and E staining, histochemical staining and C4d immunohistochemical staining, pathological types of all biopsy specimens were identified based on Banff'05 standard. DGF was finally confirmed based on the pathologic state of renal graft, and meanwhile clinical data, treatments and curative effects of each patient were recorded and analyzed. After renal biopsy, all patients must be in supine position for 8 h, and anti-inflammatory treatment and hematischesis was given. The main cause of DGF was acute tubular necrosis (ATN) in 20 cases, acute rejection (AR) in 8 cases and nephrotoxicity of immunosuppressants in 4 cases, 31 cases received hemodialysis, and one case received surgical removal. After timely treatments, renal function gradually restored normal in 28 cases, serum creatinine was between 135 to 300 μmol/L in 3 cases, and renal graft was finally removed in one case due to AR. DGF is a common postoperative complication of kidney transplantation, with high incidence. ATN and AR are the main etiological factors of DGF. The appropriate style and timely performance of plasma exchange is crucial for the prognosis of DGF. Other complementary treatments are also conducive to the restoration of renal function. The majority of DGF can gradually recover by plasma exchange in combination with complementary treatments. Key words: Kidney transplantation, delayed renal graft function, rejection, immunosuppressants, dialysis.

MP-06.17 Dynamic Renogram and Urological Complications in Kidney Transplant: Is There A Role? Results of a Preliminary Monocentric Retrospective Study

Urological complications following kidney transplantation account for the highest morbidities in terms of functional impairment of the graft, graft loss and mortality. Ureteric complications are the commonest (stricture or anastomosis leakage), with an incidence around 2.5-14%. Dynamic renogram is a functional non-invasive test widely used as a first choice in nephrological graft complications, but widely used in the urological setting; it offers several advantages, giving functional information, not having nephrotoxicity, with very low radiation dose.

IL-17 Expression by Tubular Epithelial Cells in Renal Transplant Recipients with Acute Antibody-Mediated Rejection

Acute rejection is still a common complication of kidney transplantation. IL-17 is known to be associated with allograft rejection but the cellular source and the role of this cytokine remains unclear. We investigated IL-17 graft expression in renal transplant recipients with acute antibody-mediated rejection (ABMR), acute T-cell-mediated rejection (TCMR), interstitial fibrosis and tubular atrophy (IFTA) and acute tubular damage due to calcineurin-inhibitor toxicity (CNI). In acute ABMR, tubular IL-17 protein expression was significantly increased compared to TCMR, where most of the IL-17⁺ cells were CD4⁺ graft infiltrating lymphocytes, IFTA and CNI control groups. The tubular expression of IL-17 in acute ABMR colocalized with JAK2 phosphorylation and peritubular capillaries C4d deposition. In addition, IL-17 tubular expression was directly and significantly correlated with the extension of C4d deposits. In cultured proximal tubular cells, C3a induced IL-17 gene and protein expression along with an increased in JAK2 phosphorylation. The inhibition of JAK2 abolished C3a-induced IL-17 expression. The use of steroids and monoclonal antibodies reduced IL-17 expression, JAK2 phosphorylation and C4d deposition in acute ABMR patients. Our data suggest that tubular cells represent a significant source of IL-17 in ABMR and this event might be mediated by the complement system activation featuring this condition.

Malignancies after kidney transplantation: a 40-year single-center experience in Korea

Cancer is a well-recognized complication of kidney transplantation (KT), but nearly almost all data have come from Western countries. The aim of this study was to determine the incidence, type, and risk factors of malignancy after KT in Korea. The 1695 patients who underwent KT between 1969 and 2009 were studied retrospectively. Results were compared with a cohort of patients without cancer from the same center. During the follow-up period, 136 of 1695 patients developed 141 post-transplant malignancies (PTM). The cumulative incidence of cancer at 1, 5, 10, 20, and 30 years was 0.64%, 2.42%, 7.89%, 21.49%, and 66.35% respectively. Stomach cancer was the most common PTM. Risk of Kaposi sarcoma, malignant lymphoma, skin cancer, cervical cancer, and renal cell carcinoma was more than 10-times higher in KT recipients. Multivariate logistic regression analysis showed that cancers were clearly associated with recipients' age, recipients' gender, duration of graft function and follow-up period. Our data suggest that most malignancies develop more frequently after KT, but the incidence of individual cancer is different from Western countries. A more vigorous cancer surveillance program should be adapted to risk associated with transplant recipients, especially older, female or long-term follow-up recipients or those with functioning grafts.

Torsion of intraperitoneal kidney transplant

Torsion of kidney transplant refers to rotation of the kidney transplant graft around its vascular pedicle resulting in vascular compromise and infarction. It is a rare complication of kidney transplantation associated with a high rate of graft loss. Clinical presentation and diagnostic imaging modalities are non-specific, and surgical exploration is therefore often delayed. We present a case report and review of the literature. Studies were identified by searching Medline and Embase from January 1954 to December 2010. Data was extracted regarding the clinical presentation, investigation, findings on surgical exploration, and treatment outcomes of patients with torsion of kidney transplant. Eight manuscripts with 16 cases of kidney torsion were found. Presenting symptoms were decreased renal function (13 cases), abdominal pain (10 cases), oliguria/anuria (9 cases), nausea and vomiting (4 cases), fever (3 cases), diarrhoea (3 cases), weight gain (2 cases), oedema (3 cases), fatigue (1 case) and impalpable graft (1 case). Investigations were Doppler sonography (11 cases), grey-scale sonography (7 cases), nuclear scintigraphy (5 cases), computed tomography scan (4 cases), and magnetic resonance imaging/magnetic resonance angiography (1 case). Of the 16 published cases of torsion, seven (44%) grafts were detorted and salvaged, three (19%) grafts were detorted but subsequently lost and six (38%) patients underwent immediate nephrectomy. A prompt consideration of the diagnosis of torsion of kidney transplant is required to prevent delay in surgical intervention. We recommend urgent Doppler ultrasound be used as first-line investigation, followed by prompt surgical exploration. We recommend the use of prophylactic nephropexy to prevent torsion.

Urologic Complications in Kidney Transplantation: A Single-Center Experience

Introduction Urologic complications are an important cause of morbidity in kidney transplantation. To prevent this occurrence, several studies have reported the benefit of stenting. The aim of this study was to compare the efficacy of two different types of stents to protect the urinary anastomosis in kidney transplantation. Methods We performed a retrospective analysis of 139 kidney transplant recipients who underwent ureteralneocystostomy by the Lich-Gregoire technique between January 1995 and July 2010. On the basis of the type of stent we divided transplant patients into two groups: group A ( n = 90), the internal-external Bracci catheter and group B ( n = 49), the double-J stent. The urologic complications evaluated in both groups were: urinary tract leakage, obstruction, and infections. We also recorded the duration of the postoperative hospitalization. Results The incidences of urinary fistulae and ureteral strictures between the two groups were similar (around 3%). A higher incidence of urinary infections, however, was registered among group A compared with group B (46% vs 10%; P < .05). The postoperative hospitalization period was consequently longer in group A then group B (35 ± 3 vs 24 ± 2 days; P < .05). Conclusion In our series of kidney transplantations, the occurrence of urinary fistulae and ureteral strictures was not influenced by the type of stent. The use of a double-J stent, however, appeared to be associated with a significantly decreased incidence of urinary tract infections leading to shorter postoperative hospitalizations.

A Rare Case of Herpes Simplex Type 1 Bronchopneumonia Associated With Cardiomegaly in Renal Transplantation

Introduction We report a rare case of herpes simplex virus (HSV) type 1B in patient with kidney transplant as a possible cause of patient death. Case Report A 32-year-old renal transplanted Caucasian man was referred for asthenia, fever, anemia, chest pain, cough, dyspnea, myalgias, peripheral edema, acute renal failure, diffuse cutaneus and mucous vesicles, and acute weight gain. The home therapy consisted of tacrolimus, sodic mycophenolate, and steroids. Laboratory data, bronchoscopy, and bronchial mucosal biopsy revealed HSV1B. We administered antiviral and antibiotic agents and reduced tacrolimus with clinical resolution. But after 10 days from discharge, the patient was admitted for acute cardiomegaly. So using ex adiuvantibus criteria we administered antiviral therapy with complete clinical improvement. Conclusion According to the literature, posttransplant HSV1B infection is a rare but severe complication of kidney transplantation associated with poor graft survival and a high mortality. Only an early, accurate diagnosis with efficient treatment permitted resolution of the problem. Our report stresses the difficulty of HSV2B clinical diagnosis and treatment.

Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

New-onset diabetes after transplantation (NODAT) is an increasingly recognised metabolic complication of kidney transplantation that is associated with increased morbidity and mortality. This study aimed to determine the incidence of NODAT and identify risk factors for development of NODAT among kidney allograft recipients in a single centre. We retrospectively reviewed all kidney allograft recipients in our centre between 1998 and 2007. NODAT were determined using criteria as per American Diabetes Association guidelines. Logistic regression analyses were performed to identify predictors of NODAT. Among 388 patients included in the analysis, NODAT was reported in 94 patients (24.2%) after a median follow-up time of 52.1 months. The cumulative incidence of NODAT was 15.8%, 22.8% and 24.5% at 1, 3, and 5 years following transplantation. Seven clinical factors were independent predictors of NODAT: older age, HLA B13 and B15 phenotypes, use of sirolimus, acute rejections, higher pre-transplant and post-transplant (day 1) plasma glucose levels. Patients with NODAT had poorer outcomes in both graft and patient survival. Our study demonstrates a significant risk and burden of NODAT in an Asian transplant population. Risk stratification and aggressive monitoring of blood glucose early post-transplantation is necessary to identify high-risk patients so that appropriate tailoring of immunosuppression and early institution of lifestyle modifications can be implemented.

Old Male Living Renal Transplant Recipients More Likely to Be at Risk for Colorectal Cancer

Background The development of posttransplant malignancy is a well-recognized complication of kidney transplantation due to immunosuppressive therapy. The literature on colorectal malignancy in living renal transplant recipients are limited; most of the data have been collected from deceased donor cases. As living kidney donation is now growing, we sought to define the characteristics and pattern of gastrointestinal malignancy among this group. Methods This cross-sectional, multicenter study analyzed the incidence and characteristics of colorectal malignancy among 17 patients with gastrointestinal malignancy after living donor renal transplantation between 1985 and 2009 in Iran. We observed a new-onset, biopsy-proven colorectal malignancy in eight patients of mean age 49.6 ± 10.3 years (range = 27–60) at transplantation time and a mean age of 61.1 ± 8.6 years (range = 53.4–78.6) at cancer diagnosis. Results The cumulative incidence rate of colorectal malignancy of 0.03% was restricted to the male gender (100%), all of whom had functioning grafts. The mean period from transplantation to diagnosis was 99.7 ± 10.4 months (range = 5–284). The majority of the recipients were aged more than 50 years ( n = 5) and the most frequent immunosuppressive drug was azathioprine ( n = 5); none had received antithymocyte globulin/antilymphocyte globulin. It was mostly a late-onset malignancy with 50% of recipients presenting beyond 5 years from transplantation. They were followed for a mean of 9.2 ± 2.4 (range = 6–12) months after cancer diagnosis with three patients having succumbed within 9 months. Conclusion Due to the long latency after transplantation and the poor outcomes of colorectal malignancy these patients require long-term screening tests for early detection and due to their poor outcomes a new therapeutic approach.

The Influence of Intraoperative Central Venous Pressure on Delayed Graft Function in Renal Transplantation: A Single-Center Experience

Introduction Delayed graft function (DGF) is a common complication in kidney transplantation. We sought to evaluate possible correlates for DGF including intraoperative parameters, focusing on fluid replacement and central venous pressure (CVP) values among patients undergoing kidney transplantation at our center. Methods One hundred fifty-five cadaveric donor transplantations performed at our center between 2001 and 2005 were selected for the study. We compared intraoperative parameters together with 15 other clinical and socio-demographic recipient and donor variables among patients experiencing DGF (n = 58) versus those with immediate graft function (IGF; n = 97). All significant variables at P < .05 upon univariate analysis were entered into a multivariate logistic regression model to identify risk factors for DGF. Results CVP at awakening of ≤8 mm Hg (odds ratio [OR] = 3.53; 95% confidence interval [CI], 1.63–7.63), fluid input during surgery ≤2.250 mL (OR = 2.12; 95% CI, 1.00–4.51), and recipient age ≥50 years (OR = 2.72; 95% CI, 1.11–6.68) were the strongest correlates of DGF. Conclusions Our data suggested that reduced intraoperative perfusion as measured using CVP monitoring might increase DGF risk. This study provides the rationale to further investigate the optimal CVP target during this surgery.

Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

BackgroundThe differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak.Case PresentationA 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall.ConclusionsRenal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly.

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

Introduction: New onset post transplant diabetes mellitus (PTDM) is a common complication of kidney transplantation with a negative impact on patient and graft survival. Non-white ethnicity is a well known risk factor for PTDM. Methods: This is a retrospective study of 221 Sudanese patients who received live donor kidney transplantation in Ahmed Gasim kidney transplant center between December 2001 and December 2007, focusing on the incidence, clinical course and prognosis of PTDM during the first post transplant year, and relating this to calcineurin inhibitor use. Results: The 12 months cumulative incidence of PTDM in our transplant population was 17.6% and all cases required treatment with insulin. 53.8% of PTDM cases were transient with a median duration of 76 days; by 12 months post transplant only 6.2% of patients were receiving insulin. The 12 months cumulative incidence of PTDM was higher in the tacrolimus compared to cyclosporine groups (25.4% versus 6.6%; OR 4.8, 95% CI: 1.9-12.1; P=0.00). During the follow up period 57.6% of PTDM patients in the tacrolimus group were able to discontinue insulin compared to 33.3% of PTDM patients in the cyclosporine groups (OR 2.7, 95% CI: 0.4-17; P=0.3). By 12 months post transplant, the proportion of patients receiving insulin was not significantly different between the two groups (8.0% versus 4.0%; OR 2.1, 95% CI 0.5-8.4; P = 0.2). Conclusion: The incidence of PTDM in our transplant population is not different from that reported in published randomized controlled trials and similarly, in the majority of cases PTDM was transient. Key words: Post transplant diabetes mellitus, kidney transplantation, tacrolimus, cyclosporine, calcineurin inhibitor

Visceral leishmaniasis in the early post-transplant period after kidney transplantation: clinical features and therapeutic management

Visceral leishmaniasis (VL) is a rare complication of kidney transplantation, with <100 cases reported in the literature. It is a life-threatening condition and usually occurs as a late complication after transplantation, with a median delay of 18 months between transplantation and onset of disease. We report the clinical features and management of 5 kidney transplant recipients who presented with VL in the early post-transplant period. All patients were successfully treated with liposomal amphotericin B (L-AMB), but 2 patients experienced graft loss. VL should be considered in the differential diagnosis in kidney transplant recipients living in endemic areas, who present with unexplained fever and pancytopenia in the early post-transplant period. Leishmania serology should be included in the screening of all transplant recipients, in order to identify a group of patients who could benefit from preemptive anti-Leishmania therapy. Therapy with L-AMB is highly effective and well tolerated in kidney transplant recipients with VL.

A Rare Case of Colic Thrombotic Microangiopathy in Renal Transplantation

Introduction We report a case of thrombotic microangiopathy (TM) in patient with UC and kidney transplantation. Case Report A 59-year-old Caucasian may with a renal transplant, with atrial fibrillation and ulcerative colitis (UC), was referred for asthenia, fever (38°C), anemia, colicky pain, and bloody diarrhea. The maintenance therapy consisted of CSA, sodium mycophenolate, steroids, ticlopidine, and mesalazine. Laboratory data, colonscopy, and colic mucosal biopsy revealed de novo colic TM. We administered antibiotics and antishock therapy, reducing CSA, withdrawing ticlopedine and maintaining mesalazine with the resolution of the problem. Conclusion Posttransplantation TM is an uncommon but severe complication of kidney transplantation associated with reduced graft survival and a high risk for death. Only an early, accurate diagnosis with optimal treatment permits resolution of the problem.

Retransplantation After BK Virus Nephropathy in Prior Kidney Transplant: An OPTN Database Analysis

BK virus (BKV) has emerged as a major complication of kidney transplantation. Since June 30, 2004, the OPTN in the USA collects BKV as a primary or secondary cause of graft loss and also if treatment for BK virus (TBKV) is administered. In this study, we determined characteristics of those recipients of repeat kidney transplants from the OPTN database, where either (a) a graft loss occurred between June 30, 2004 and December 31, 2008 and database recorded prior TBKV in that allograft or (b) a graft loss between June 30, 2004 and December 31, 2008 was attributed primarily or secondarily due to BKV. In the study time period, 823 graft losses have occurred where TBKV or graft failure attributable to BKV was reported in prior transplant; of these, 126 have received a retransplant as of June 5, 2009. Induction and maintenance immunosuppression usage mirrored current trends. As of June 5, 2009, 118/126 grafts are still functioning, one graft failure attributed to BKV. TBKV was reported in 17.5% of the retransplants. In the retransplants performed through December 31, 2007, 1-year acute rejection rate was 7%, 1-year and 3-year Kaplan-Meier graft survival rates and median GFR were 98.5%, 93.6%, 65.5 and 68.4 mL/min, respectively. Retransplantation after BKV appears to be associated with good results.

Renal paratransplant hernia: a surgical complication of kidney transplantation

Renal paratransplant hernia is an uncommon and potentially fatal complication of renal transplantation. In this condition, bowel herniates through a defect in the peritoneum over the transplanted kidney and becomes trapped. Six cases have been reported previously, and we herein report three cases encountered in 668 kidney recipients. Abdominal pain and distention with or without vomiting were the main symptoms, presenting within 4days after surgery. Abdominal CT scan confirmed the presence of bowel obstruction and paratransplant hernia. All three patients underwent emergent laparotomy, and resection of necrotic bowel was required in one patient who died of multiple organ failure 1week after laparotomy. Renal paratransplant hernia is uncommon and potentially fatal, thus, prompt diagnosis and early surgical intervention are critical. Additionally, meticulous surgical technique during transplantation may help avoid this complication.