Post-kidney Transplant Recipients Research Articles

The feasibility of Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients using a pre/posttest design

BackgroundWeight gain after a kidney transplant remains a major problem that can lead to adverse effects on morbidity and mortality. The posttransplant phase provides a window of opportunity to improve the engagement of self-management of care for lifestyle modifications for diet and physical activity. The purpose of our study was to (1) test the feasibility of recruitment, retention, and adherence for using the Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients (≥ 18 years of age) at baseline, 4, 8, and 12 weeks; and (2) estimate the preliminary effects of the TASK intervention in producing change over time for blood pressure (BP), weight, fruits/vegetable intake, fiber intake, sodium intake, self-efficacy to exercise, and perceived stress.MethodsThis study used a 12-week pre/posttest design using to test the feasibility of the TASK intervention. We applied paired t-tests and McNemar’s test to compare the outcomes at weeks 4, 8, and 12.ResultsWe met our recruitment goal (N = 20) and found a 15% attrition rate (n = 3) at Week 12. Adherence rate among the study completers for recording daily food intake was 83–94% over the 12 weeks and for recording daily physical activity was 17–33% over the 12 weeks. We observed improvements over time for BP, weight, fruits/vegetable intake, fiber intake, and sodium intake; these differences were non-significant, although clinically important. We did find a significant difference from baseline to 12 weeks in weight reduction (p = 0.02), self-efficacy to exercise (p = 0.003), and perceived stress (p = 0.04).ConclusionsThe data suggest the TASK intervention was feasible for kidney recipients to use and resulted in weight control, increased self-efficacy to exercise, and decreased perceived stress.Trial registrationClinicalTrials.gov #:NCT05151445

A-127 Bias and Precision of a NMR-based GFR Estimating Equation in Kidney Transplant Recipients

Abstract Background An accurate and reliable measurement of glomerular filtration rate (GFR) is essential to monitor for rejection and disease progression post-kidney transplantation. Measured GFR (mGFR) is the current gold standard. However, it has scarce availability at many centers and is labor intensive. Newer estimated GFR (eGFR) methods containing cystatin-C and/or other biomarkers have not been clinically validated in a post-transplant cohort. In this study, we evaluated a new NMR-based GFR (GFRNMR) equation that contains serum creatinine, cystatin C, myoinositol, and valine in post-kidney transplant recipients in a clinical routine setting. Methods Venipuncture for serum collection was performed immediately prior to mGFR measurement with urinary iothalamate clearance in 67 post-kidney transplant recipients. Serum was stored at 4°C and measured by NMR no later than four days after collection. eGFR was assessed using the following equations: i) GFRNMR, ii) CKD-EPI2021Cr (creatinine) and iii) CKD-EPI2021Cr,Cys (creatinine and cystatin-C). Bias was calculated as “eGFR—mGFR” for all equations. The Bootstrap method was employed to assess pairwise significance levels between bias distributions interquartile ranges (IQR), and P-value correction was determined with the Benjamini & Hochberg method. Precision, which was defined as percentage of samples within ±30% and ±15% from the mGFR value (P30 and P15, respectively), was calculated for each equation. Pairwise comparisons were made using McNemar’s Chi-squared and Benjamini & Hochberg correction. Precision was defined as the proportion of eGFR values concordant with mGFR values by CKD clinical stage. Results P30 for GFRNMR was significantly higher than CKD-EPI2021 Cr,Cys (97% vs 84%, P < 0.01) and higher than CKD-EPI2021 Cr (88%, P = 0.08). Similarly, P15 for GFRNMR was 63%; higher than for CKD-EPI2021 Cr (54%, P = 0.35) and CKD-EPI2021 Cr,Cys (51%, P = 0.19). Bias IQR for GFRNMR was 9.5 mL/min/1.73 m2 (median bias 2.0 mL/min/1.73 m2); significantly smaller than for CKD-EPI2021 Cr (Bias IQR 15.55 mL/min/1.73 m2, P < 0.05; median bias 1.47 mL/min/1.73 m2), and smaller than CKD-EPI2021 Cr,Cys (Bias IQR 14.4 mL/min/1.73 m2, P = 0.09; median bias 2.3 mL/min/1.73 m2). A broad range of medications such as immune modulators, and comorbidities such as hypertension, thyroid dysfunction, and coronary artery disease, did not interfere with GFRNMR performance. Conclusion NMR-based eGFR was less biased, more precise, and more accurate compared to creatinine and cystatin-C CKD-EPI eGFR equations in a post-kidney transplant setting. These findings suggest GFRNMR may more closely resemble mGFR in post-transplant patients and warrants further study on its potential use to improve clinical management in this patient group.

Psychological Changes in Post Kidney Transplant Recipients: Phenomenology Study

Aims: Kidney transplantation can have a big impact on recipients, so they must be able to adapt to many changes, including psychological changes. Psychological changes are the most complained about by post- kidney transplant recipients. Psychological changes including feelings of anxiety and worry after kidney transplantation, these feelings arise due to post-transplant complications, feelings of guilt and fear of rejection, treatment regimens and uncertainty about the future. Therefore, recipients must be able to deal with psychological changes after kidney transplantation. Objective: To explore the psychological changes of post-kidney transplant recipients. Methods: A qualitative study using a phenomenological approach. This study was conducted on 6 participants who were undergone kidney transplantation. Purosive sampling was performed and data was collected through 35 to 60 min. Data collection in this study was carried out through in-depth interviews, audio recording and field notes. The data analysis technique uses the Collaizi method (1978). Result: This study obtained results including: psychological adaptation transitions and post-transplant anxiety control strategies. Conclusion: Kidney transplant provide better psychological changes if the recipients can implement strategies to control emotions. Therefore, it is important to have family, social and nurses support in controlling the psychological changes of post-kidney transplant recipients.

Factors associated with a higher need for antihypertensive medications at 12-months in postkidney transplant recipients: a retrospective cohort study.

The authors reviewed the pre-KTx cardiovascular (CV) imaging, and the changes of CV risk factors during the first-year post-KTx. The authors divided patients according to the number of their blood pressure medications at one year into two groups: requiring less than or equal to 1 and requiring greater than or equal to 2 medications (DTC hypertension). The target blood pressure during the time of this study was less than 140/90mmHg. Two hundred forty-five KTRs were included with an average age of 43.2. 56.3% were male and 79.2% were living donor KTRs. Pre-emptive KTx was 6.5%, previous coronary artery disease was 12.7%, diabetes and smoking 40.8 and 9%, respectively. 38% of the patients had DTC HTN. Risk factors were age (P<0.01), pre-KTx hypertension (P<0.01), and diabetes mellitus (P<0.01). Dialysis vintage, type of dialysis, type of KTx, and smoking were not different between the groups.Patients with abnormal pre-KTx CV imaging, including abnormal ejection fraction less than 55% (P=0.03), abnormal wall motion on echocardiography (P<0.01), abnormal perfusion stress test (P<0.01), higher calcium scoring (P<0.01), abnormal cardiac catheterization (P<0.01), or higher degree of calcifications on CT of pelvic arteries (P<0.01) were at higher risk of DTC hypertension. Post-KTx factors including rejection, change in serum creatinine and weight, A1c, new-onset diabetes post-KTx, and persistent hyperparathyroidism were not different between the groups.Multivariate analysis revealed associations with age (aOR=1.027), male sex (aOR=2.057), baseline diabetes mellitus (aOR=2.065), baseline HTN (aOR=2.82), and use of greater than or equal to 2 antihypertensive medications at 1-month post-KTx (aOR=6.146). At one year post transplantation, about a third of the KTRs required had DTC HTN. These patients were more likely to be older, males, diabetics, previously hypertensive, on greater than or equal to 2 HTN medications at 1-month post-KTx, and to have abnormal baseline pretransplant CV imaging.

Plasma Branched-Chain Amino Acid Concentrations and Glucose Homeostasis in Kidney Transplant Recipients and Candidates

Post-transplant diabetes mellitus (PTDM) encompasses new-onset and previously unrecognized type 2 diabetes. Kidney failure masks type 2 diabetes. Branched-chain amino acids (BCAA) are closely associated with glucose metabolism. Therefore, understanding BCAA metabolism both in kidney failure and after kidney transplantation may inform PTDM mechanisms. To understand the impact of present or absent kidney function on plasma BCAA concentrations. Cross-sectional study of kidney transplant recipients and kidney transplant candidates. Large kidney transplant center in Toronto, Canada. We measured plasma BCAA and aromatic amino acid (AAA) concentrations in 45 pre-kidney transplant candidates (15 with type 2 diabetes, 30 without type 2 diabetes) and 45 post-kidney transplant recipients (15 PTDM, 30 non-PTDM), along with insulin resistance and sensitivity by 75 g oral glucose loading for those in each group without type 2 diabetes. Plasma AA concentrations were analyzed using MassChrom AA Analysis and compared between groups. The insulin sensitivity for oral glucose tolerance tests or Matsuda index (a measure of whole-body insulin resistance), Homeostatic Model Assessment for Insulin Resistance (a measure of hepatic insulin resistance), and Insulin Secretion-Sensitivity Index-2 (ISSI-2, a measure of pancreatic β-cell response) was calculated from fasting insulin and glucose concentrations, and compared with BCAA concentrations. Each BCAA concentration was higher in post-transplant subjects than pre-transplant subjects (P < .001 for leucine, isoleucine, valine). In post-transplant subjects, each BCAA concentration was higher in PTDM versus non-PTDM (odds ratio for PTDM 3-4 per 1 SD increase in BCAA concentration, P < .001 for each). Tyrosine concentrations were also higher in post-transplant subjects than pre-transplant subjects, but tyrosine did not differ by PTDM status. By contrast, neither BCAA nor AAA concentrations were different in pre-transplant subjects with or without type 2 diabetes. Whole-body insulin resistance, hepatic insulin resistance, and pancreatic β-cell response did not differ between nondiabetic post-transplant and pre-transplant subjects. Branched-chain amino acid concentrations correlated with the Matsuda index and Homeostatic Model Assessment for Insulin Resistance (P < .05 for each) only in nondiabetic post-transplant subjects-not in nondiabetic pre-transplant subjects. Branched-chain amino acid concentrations did not correlate with ISSI-2 in either pre-transplant or post-transplant subjects. The sample size was small, and subjects were not studied prospectively for the development of type 2 diabetes. Plasma BCAA concentrations are higher post-transplant in type 2 diabetic states, but do not differ by diabetes status in the presence of kidney failure. The association of BCAA with measures of hepatic insulin resistance among nondiabetic post-transplant patients is consistent with impaired BCAA metabolism as a characteristic of kidney transplantation.

Erratum: Dietary intake in early post kidney transplant recipients and identified issues in nutritional management[Japanese Journal of Transplantation 2021: 56(2): 149-157

Erratum: Dietary intake in early post kidney transplant recipients and identified issues in nutritional management[Japanese Journal of Transplantation 2021: 56(2): 149-157

The impact of COVID-19 on kidney transplantation and the kidney transplant recipient - One year into the pandemic.

SummaryThe COVID‐19 pandemic has significantly changed the landscape of kidney transplantation in the United States and worldwide. In addition to adversely impacting allograft and patient survival in postkidney transplant recipients, the current pandemic has affected all aspects of transplant care, including transplant referrals and listing, organ donation rates, organ procurement and shipping, and waitlist mortality. Critical decisions were made during this period by transplant centers and individual transplant physicians taking into consideration patient safety and resource utilization. As countries have begun administering the COVID vaccines, new and important considerations pertinent to our transplant population have arisen. This comprehensive review focuses on the impact of COVID‐19 on kidney transplantation rates, mortality, policy decisions, and the clinical management of transplanted patients infected with COVID‐19.

Dietary intake in early post kidney transplant recipients and identified issues in nutritional management

Dietary intake in early post kidney transplant recipients and identified issues in nutritional management

An Overview of the Long-term Follow-up of the Adult Post-kidney Transplant Recipients in Sudan: A Single-Center Experience.

Kidney transplant remains the definitive treatment for patients with end-stage renal disease. A retrospective cohort was conducted in Dr. Selma Center for Kidney Diseases (DSCKD) to determine the pattern of follow-up and outcomes of adult kidney transplant recipients (KTRs) on long-term follow-up. Patients presented for follow-up during the period from January to June 2018 were studied regarding their demographic features, kidney transplant surgery, immunosuppressive therapy, graft function, and post-transplant complications. Data analysis was done using the Statistical Package for the Social Sciences version 16.0. During the study period, a total of 941 adult and pediatric KTR presented to DSCKD for follow-up. Only 792 KTRs were included in the study; those were adults, with their first kidney transplant, completed one year post-transplant, and agreed for enrollment. The mean age of the studied population was 47 ± 4.3 years. The majority were males, 74.2%. The median duration of follow-up was 7.4 years (interquartile range 3-11). Most transplants were through living-related donations, 78.8%. The combination of prednisolone, tacrolimus, and azathioprine remains the most common immunosuppressive regimen prescribed; delivered to 47.5% of recipients. Post-transplant complications were predominantly recurrent infections, diabetes mellitus, and hyperlipidemia seen in 54.5%, 42.4%, and 24.7% of recipients, respectively. On cross-comparisons living unrelated donor transplant recipients were found to have increased post-transplant complications, with a reduced kidney graft function at the end of the 1st year and throughout follow-up, when compared to living related donor transplant recipients. A prospective multi-center study with long-term follow-up remains essential for further evaluation of the long-term outcomes of the KTR in Sudan.

Prevalence of AT1R antibody (AT1R-Ab) among Malaysian multi-ethnic population

BackgroundAngiotensin II type 1 receptor antibody (AT1R-Ab) is a non-HLA antibody that has been reported to cause antibody-mediated rejection and graft loss in kidney transplantation. The prevalence of positive AT1R-Ab varies between 8% and 18% in different regions. Thus, this study aims to determine the prevalence of AT1R-Ab among the Malaysian population. MethodologyAll sera for AT1R-Ab were collected at the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. The sera were centrifuged and kept refrigerated at −80 °C before being transported to the South Australian Transplantation and Immunogenetics Laboratory (SATIS). Enzyme-linked immunosorbent assay kit (One Lambda) was used for the detection of AT1R-Ab, and it was performed according to the manufacturer's instructions. The level of >17.1 U/mL was considered to be AT1R-Ab positive; 10.0–17.1 U/mL at risk, and <10.0 U/mL negative. ResultsA total of 115 samples were collected from 99 patients pre and post-kidney transplant recipients. From the pre-transplant sera (n = 68) 17.7% were positive, 35.3% were at risk and 47.0% were negative. The positive AT1R-Ab cohort were relatively younger, with a mean age of 34.7 ± 8.3 years old and statistically significant, with a p-value of 0.028. Among the sera that were tested positive, 19.0% were from the Chinese ethnicity, 6.7% from Malay and 16.7% from Indian. There was no difference in the rejection episodes, persistent or de novo HLA-DSA, and graft function between the group (AT1R-Ab negative vs AT1R-Ab at risk and positive) and the results were consistent in a model adjusted for all potential confounders. ConclusionThe prevalence of positive (>17.1 U/mL) pre-transplant AT1R-Ab was 17.7% and 35.3% were at risk (10.0–17.1 U/mL) in our pre-transplant cohort.

Erectile dysfunction pre and post kidney transplant recipients in Duhok city; cross sectional study

IntroductionSexual dysfunction is a common problem in patients with chronic kidney disease. Disturbances in sexual function are noticed in early stages of chronic kidney diseases and deteriorate further as renal function declines. This is due to uremic effects, comorbid illness, anemia, hormonal disturbances, autonomic neuropathy, vascular diseases, hyperparathyroidism, hyperprolactinemia, side effects of medications, and psychosocial factors. Patients and methodThis is a cross-sectional study which included 59 male patients who underwent renal transplantation for more than 6 months. The International Index of Erectile Function (IIEF-5) was adopted in our study to record the erectile function. ResultsThe mean age was 49.41 years, and the mean number of hemodialysis per month was 5.31. The cause of the chronic kidney disease was diabetes mellitus in 35.59%, glomerulonephritis in 20.34%, and hypertension in 16.95%, other causes were diagnosed in order of decreasing frequency. Most patients developed improvement in the erectile function after transplantation. There was significant correlation with 3 of the elements of the IIFE-5.i.e; penile hardness pre-penetration, Maintaining erection during intercourse, and Difficulty to maintain erection to complete the intercourse (p values 0.015, 0.011, and 0.023) respectively, and the overall improvement after transplantation which showed a p-value of less than 0.031, while there was no significant correlation with Confidence with erection and Satisfaction with intercourse before and after transplantation (p values 0.113 and 0.121) respectively. One of the patients (1.7%) developed severe dysfunction after that. ConclusionED is common sequel of chronic kidney disease. The etiology is multifactorial and may be worsen by advanced age, presence of diabetes mellitus and prolonged duration of hemodialysis. Renal transplantation has a positive impact on sexual function and lead to improvement of erectile dysfunction. Erectile dysfunction that persists after kidney transplantation is usually attributed to multiple preexisting comorbidities.

Two-year retrospective study of the effect of preemptive kidney transplantation and pretransplant mineral bone factors on calcium in post-kidney transplant recipients.

Preemptive kidney transplantation (PEKT) incidence has recently increased in Japan. The effect of PEKT and mineral bone factors before kidney transplantation (KTx) on long-term calcium (Ca) levels remains unknown. Eighty-one consecutive patients at Nagoya Daini Red Cross Hospital were included in this study (PEKT group with 41 patients and non PEKT group with 40 patients). Ca metabolism, including intact fibroblast growth factor 23 (iFGF23), were measured before KTx and intact parathyroid hormone (iPTH), and corrected Ca (cCa) were measured before KTx and 6months (M), 12M, and 24M after KTx. In PEKT group, cCa levels at 24M were higher from the baseline level. At baseline, cCa levels had a positive correlation with iFGF23 levels (r = 0.51; p < 0.001) and a negative correlation with iPTH levels (r = 0.51; p < 0.001). The cCa difference between baseline and 24M was 0.8 ± 0.6mg/dL in PEKT group and 0.3 ± 0.7mg/dL in non-PEKT group (p = 0.001). A multivariate linear regression analysis showed iFGF23 and iPTH at baseline in entire groups were useful markers on calcium levels at 24M. However, in PEKT group, both markers were found to be not associated with Ca at 24M, whereas in non PEKT group, iPTH was the only effective marker. This study suggested that iFGF23 and iPTH may be useful markers of the calcium status after KTx. However, no correlation was noted in PEKT group.

210O - High incidence and mortality of transitional cell carcinoma in Thai kidney transplant patients

BackgroundPost-transplant malignancy (PTM) has been well established complication of kidney transplantation, but the reported data was mainly from Caucasian population. This study was conducted to determine the incidence and mortality rate of PTM in Praram 9 Hospital. MethodsWe retrospectively retrieved medical data of 858 patients who underwent kidney transplantation at our center over the past 27 years. ResultsThere were 57 of 858 (6.6%) patients developed malignancy. The most common site of PTM was genitourinary tract cancer (26 of 57, 45.6%), of which transitional cell carcinoma (TCC) was represented in the highest range (20/26, 79.2%), followed by renal cell carcinoma (RCC, 4/26) and prostate cancer (2/26). The second and third most common PTM were hepatocellular carcinoma (HCC, 9 of 57, 15.5%) and colon cancer (5 of 57, 8.6%), respectively. Lung cancer, post transplantation lymphoproliferative disease were also found (n = 4, each). Other malignancies were as followed: skin cancer (3), breast cancer (3), pancreatic cancer (1), thyroid cancer (1), parotid gland cancer (1) and gastrointestinal stromal tumor (1). The overall mortality rate of PTM was 64.91%. Among 20 patients with TCC, up to 8 patients died from this cancer (mortality rate 40%). Albeit, the mortality rate was zero in skin cancer and RCC of both native and transplanted kidney. ConclusionsTransitional cell carcinoma was not only the most common PTM in contrast to the Caucasian data, but it also caused the high mortality rate among Thai kidney transplant patients. Our study suggests that a more aggressive surveillance for TCC is required in both pre and post kidney transplant recipients for the early detection and treatment of this cancer. This surveillance should be expanded to the other Asian population in other countries. Legal entity responsible for the studySuthanit Laowalert. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Disseminated cutaneous cryptococcal infection in kidney transplant recipient

Postkidney transplant infectious complications are always challenging due to atypical organisms, varied presentation, and the balanced treatment to avoid rejection. They are often fatal if not diagnosed and treated in time. High clinical suspicion and decreasing immunosuppression are the important points to remember. This is a case report of postkidney transplant recipient with disseminated cryptococcal infection. The patient improved with functioning graft with appropriate antifungal treatment.

Nutrition Trends in Kidney Transplant Recipients: the Importance of Dietary Monitoring and Need for Evidence-Based Recommendations.

Many physiological properties of the renal system influence nutrient metabolism, elimination, and homeostasis. Kidney failure poses significant challenges to maintaining adequate nutrition, most of which transplantation ameliorates. Comprehensive recommendations for managing nutritional derangements for patients with chronic kidney disease and end stage renal disease exist; however, there are only sparse guidelines for post-transplant malnutrition and adverse outcomes. Not only are guidelines limited, but little is known about dietary trends of post-kidney transplant recipients. This review describes guidelines for prevalent metabolic and nutritional complications post-kidney transplantation and also evaluates changes in caloric intake and diet composition after transplantation. This topic is important because nutrition influences allograft function and a number of cardiovascular risk factors including blood pressure, dyslipidemia, weight, and diabetes. In addition, many dietary recommendations and modifiable lifestyle changes should be tailored for specific complications of transplant patients, namely immunosuppression side effects, dietary restrictions, and electrolyte imbalances.

Outcomes of bisphosphonate and its supplements for bone loss in kidney transplant recipients: a systematic review and network meta-analysis

BackgroundMineral bone disease constitutes a common complication of post-kidney transplantation, leading to great disability. As there is no consensus on the optimal treatment for post-kidney transplant recipients (KTRs), we aimed to evaluate the efficacy and safety of bisphosphonate and its combined therapies.MethodsWe incorporated relevant trials to perform a network meta-analysis from direct and indirect comparisons. We searched PubMed, Embase and the CENTRAL and the reference lists of relevant articles up to August 1, 2017, for randomized controlled trials. The primary outcome was bone mineral density (BMD) change at the femoral neck and the lumbar spine.ResultsFrom a total of 864 citations, 18 randomized controlled trials with a total of 1200 participants were included. Five different regimens were considered. Bisphosphonate plus calcium revealed a significant gain in percent BMD change than calcium alone at the femoral neck (mean difference (MD), 5.83; 95% credible interval (CrI), 1.61 to 9.27). No significant difference was detected when restricting to absolute terms. At the lumbar spine, bisphosphonate and calcium with or without vitamin D analogs outperformed calcium solely (MD, 0.07; 95% CrI, 0.00 to 0.13; MD, 0.06; 95% CrI, 0.02 to 0.09). Compared to calcium with vitamin D analogs, adding bisphosphonate was associated with marked improvement (MD, 0.03; 95% CrI, 0.00 to 0.05). Considering percent terms, combination of bisphosphonate with calcium and vitamin D analogs showed greater beneficial effects than calcium alone or with either vitamin D analogs or calcitonin (MD, 10.51; 95% CrI, 5.92 to 15.34; MD, 5.48; 95% CrI, 2.57 to 8.42; MD, 6.39; 95% CrI, 0.55 to 12.89). Both bisphosphonate and vitamin D analogs combined with calcium displayed a notable improvement compared to calcium alone (MD, 7.24; 95% CrI, 3.73 to 10.69; MD, 5.02; 95% CrI, 1.20 to 8.84).ConclusionsOur study suggested that additional use of bisphosphonate was well-tolerated and more favorable in KTRs to improve BMD.

Management of chronic parvovirus infection in postkidney transplant with prophylactic intravenous immunoglobulin therapy

Parvovirus (PV) infection is a rare cause of persistent anemia in kidney transplant recipients. The diagnosis of PV infection depends on a high index of suspicion, persistent anemia, red cell aplasia in the bone marrow, and positive polymerase chain reaction for PV B19. Treatment with intravenous immunoglobulin (IVIg) has shown to improve anemia but persistence of PV is common after treatment. This case report highlights a postkidney transplant recipient who had PV infection, treated with IVIg but had multiple relapses. He was managed with monthly IVIg prophylactic therapy for 6 months following which he had complete clearance of PV. PV B19 results in multiple relapses in postkidney transplant patients. Monthly prophylaxis therapy with higher dose delivery of IVIg can result in the clearance of PV and relapse-free response. Further studies may be required to determine the duration of prophylaxis therapy.

Hallucination in kidney transplant recipient: A rare complication of voriconazole

Postkidney transplant recipients are more susceptible to opportunistic infections including fungal infections. Voriconazole is a broad-spectrum antifungal with a good safety profile even in patients with renal dysfunction. Hallucination is a rare and underreported complication of oral voriconazole therapy, especially in kidney transplant recipients. Two patients of postrenal transplant who developed hallucination following oral therapy with voriconazole have been highlighted here. Symptoms improved in both patients following a reduction in dosage or cessation of therapy. This case report highlights the fact that even though voriconazole-induced hallucinations are a rare complication, it is important to be aware of the same so as to be able to diagnose it and institute appropriate corrective measures.

Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.

Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients. This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis. Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P < 0.001) and higher intrinsic religiosity (14.0 ± 1.6 vs. 12.8 ± 2.5; P = 0.016) compared to the non-adherents. Organizational and non-organizational religiosity did not differ between these groups. By logistic regression, non-adherence was associated with lower self-efficacy (OR 0.81, IC 0.70-0.92, P = 0.002), chance locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006). Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population.

Prednisolone can Prevent Post-Herpetic Neuralgia in Post-Kidney Transplant Recipient

Background and study aim: Post-herpetic neuralgia (PHN) is a neuropathic painful condition that is one of the most frequent complications of an acute herpes zoster infection. Till now, there is no general agreement on the definition of PHN. Some studies described a wide range of definitions, including any pain that comes after disappearing of the herpes zoster rash, whereas other studies applied the definition of pain that persist for more than one or two months after the onset of rash. The aim of this study was to assess the effect of oral prednisolone with antiviral therapy on prevention of post-herpetic neuralgia in post-kidney transplant recipient. Patients and methods: 40 patients were divided into two groups, the first one (group A) involved 20 patients who had renal transplant within the past five years and have received oral prednisolone (10 mg/day) and the second one (group B) involved also 20 patients but they are immune-competent without co-morbidity. Follow up was done at one, three and six months to assess the pain. Results: At time of admission and discharge, there was significant difference between group A and group B as regard zoster pain. The same significance was observed between two groups during follow up after one and three months and not observed after six months. Conclusion: Oral corticosteroid can promote modest benefits in decreasing the pain of herpes zoster and the incidence of PHN in post-kidney transplant recipient.