Treatment Of Renal Transplant Recipients Research Articles

Prostate Cancer in Transplant Receivers-A Narrative Review on Oncological Outcomes.

Prostate cancer (PCa) is a low tumor mutational burden (TMB) cancer with a poor response to immunotherapy. Nonetheless, immunotherapy can be useful, especially in metastatic castration-resistant PCa (mCRPC). Increased cytotoxic T lymphocytes (CTLs) density is correlated with a shorter overall survival (OS), an early biochemical relapse, and a generally poor PCa prognosis. An increased number of CCR4+ regulatory T cells (CCR4 + Tregs) relates to a higher Gleason score or earlier progression. The same therapeutic options are available for renal transplant recipients (RTRs) as for the population, with a comparable functional and oncological outcome. Radical retropubic prostatectomy (RRP) is the most common method of radical treatment in RTRs. Brachytherapy and robot-assisted radical prostatectomy (RARP) seem to be promising therapies. Further studies are needed to assess the need for prostatectomy in low-risk patients before transplantation. The rate of adverse pathological features in RTRs does not seem to differ from those observed in the non-transplant population and the achieved cancer control seems comparable. The association between PCa and transplantation is not entirely clear. Some researchers indicate a possible association between a more frequent occurrence of PCa and a worse prognosis in advanced or metastatic PCa. However, others claim that the risk and survival prognosis is comparable to the non-transplant population.

Evaluation of Eculizumab Use in Renal Transplant Recipients.

Introduction: Eculizumab is a monoclonal antibody that binds to complement protein C5, inhibiting complement-mediated thrombotic microangiopathy. It is approved for several indications including atypical hemolytic uremic syndrome. Additionally, eculizumab is used off-label for antibody-mediated rejection and C3 glomerulopathy in renal transplant recipients. Due to limited data available, the purpose of this study was to describe the use of eculizumab treatment in renal transplant recipients. Design: This retrospective single-center study evaluated the safety and efficacy of eculizumab for on- and off-label indications in renal transplant recipients. Adult renal transplant recipients receiving at least 1 dose of eculizumab posttransplant between October 2018 and September 2021 were included. The primary outcome evaluated was graft failure in patients treated with eculizumab. Results: Forty-seven patients were included in analysis. The median age at eculizumab initiation was 51 years [IQR 38-60], with 55% being female. Indications for eculizumab included atypical hemolytic uremic syndrome/thrombotic microangiopathy (63.8%), antibody-mediated rejection (27.7%), C3 glomerulopathy (4.3%), and other (4.3%). Graft failure occurred in 10 patients (21.3%) with a median of 2.4 weeks [IQR 0.5-23.3] from transplant to graft failure. At last follow-up (median 56.1 weeks), 44 (93.6%) patients were alive. After eculizumab initiation, renal function improved at 1 week, 1 month, and last follow-up. Conclusion: Eculizumab treatment demonstrated a benefit on graft and patient survival compared to reported incidence in thrombotic microangiopathy and antibody-mediated rejection. Due to the small sample size and retrospective design, further research is warranted to confirm these results.

SGLT-2 Inhibitor Treatment in Renal Transplant Recipients: A Single-Center Experience

SGLT-2 Inhibitor Treatment in Renal Transplant Recipients: A Single-Center Experience

Efficacy and Safety of Switching to Azathioprine for Mycophenolate-Induced Diarrhea in Renal Transplant Recipients

Diarrhea is a common adverse effect of mycophenolate treatment in renal transplant recipients. In patients with mycophenolate-induced diarrhea, one option is to switch to mycophenolate to azathioprine. In this study, we aimed to define the safety and efficacy of switching from mycophenolate to azathioprine for mycophenolate-related diarrhea in renal transplant recipients. A total of 177 patients, 59 of whom were switched to azathioprine because of diarrhea and 118 of whom comprised a matched control group without diarrhea and continued mycophenolate treatment participated in this study. We analyzed the effect of switching to azathioprine from mycophenolate on amelioration of diarrhea and graft survival. We observed that 89.8% of patients who switched to azathioprine because of diarrhea had improved diarrhea complaints. Patients switched to azathioprine because of diarrhea had lower glomerular filtration rates (P < .001) and higher proteinuria (P < .001) compared with the control group before the switch. Patients switched to azathioprine compared with a subgroup of 59 control patients were matched to patients switched to azathioprine in terms of baseline renal function and proteinuria in addition to demographic parameters had higher 10-year graft loss compared with patients who continued mycophenolate (P=.03). Particularly in patients with a glomerular filtration rate <30 mL/min at the time of conversion, the risk of early graft loss was high. Although switching from mycophenolate to azathioprine was an effective approach to improve diarrhea, this approach is associated with increased risk of graft loss.

MO983EFFICACY AND SAFETY OF SWITCHING TO AZATHIOPRINE FOR MYCOPHENOLATE INDUCED DIARRHEA IN RENAL TRANSPLANT RECIPIENTS

Abstract Background and Aims Diarrhea is a common side effect of mycophenolate treatment in renal transplant recipients. In patients with mycophenolate induced diarrhea, one of the options is switching mycophenolate to azathioprine. In this study, we aimed to define the safety and efficacy of switching from mycophenolate to azathioprine for mycophenolate related diarrhea in renal transplant recipients. Method A total of 177 patients, 59 of whom were switched to azathioprine due to diarrhea and 118 of which were matched control group without diarrhea that continued mycophenolate treatment, participated in this study. We analyzed the effect of switching to azathioprine from mycophenolate on amelioration of diarrhea and graft survival. Results We observed that 89.8% of the patients who switched to azathioprine due to diarrhea had improved diarrhea complaints. Patients switched to azathioprine due do diarrhea had lower glomerular filtration rate (59 [15-125] vs. 74 [23-150] mL/min, p&amp;lt;0.001) and higher proteinuria (254 [49 – 15.500] mg/day vs. 184 [5 – 2329] mg/day, p&amp;lt;0.001) compared to control group before the switch. When patients switched to azathioprine were compared to a sub-group of 59 control patients who were matched to patients that switched to azathioprine in terms of baseline renal function and proteinuria in addition to demographic parameters, they had higher ten-years graft loss compared to patients that continued mycophenolate (p=0.03) (Figure 1). Particularly in patients with a glomerular filtration rate of less than 30 mL/min at the time of conversion, the risk of early graft loss was high. Conclusion Although switching mycophenolate to azathioprine was an effective approach to improve diarrhea, this approach is associated with increased risk of graft loss.

Maintenance Immunosuppressive Treatment of Renal Transplant Recipients in the Critical Care Unit

BackgroundIn intensive care unit (ICU), although there is no standard protocol for maintenance of immunosuppressive (IS) treatments for the kidney transplant recipients (KTx), the dose and the number of IS drugs are decreased according to the center’s experience. The aim of this study is to evaluate the changes in IS treatment during stays in the ICU and to evaluate the safety and results of this modification on the IS treatment in the ICU arbitrarily. MethodWe evaluated retrospectively our kidney transplant recipients in ICU between 2012 and 2017. The immunosuppressive protocols and the results were taken from the ICU documents. ResultsA total of 31 (18 male, 13 female) patients were suitable for the analysis. They were all under the triple IS protocol including Tacrolimus (Tac) + Mycophenolate mofetil (MMF) + steroid before the admission. The reason for ICU admission were severe sepsis in all patients. In ICU, 16 patients (51.6%) died, and a total of 10 patients were lost with functional graft. Change in IS treatment is as follows: a total of the 23 patients (74.2%) were given only steroids, and 8 patients (25.8%) were changed from triple to 2 drugs. Acute kidney injury developed in 42% (13 patients) of the patients in ICU. ConclusionIn our study, we observed that life-threatening severe infections were the main cause of ICU admission in KTx. Reduction in IS treatments are common practice, and reduction to a single dose of steroid was the most frequently chosen IS treatment. Eighty percent of patients are discharged with reduction of steroid gradually. None of the patients developed acute rejection and permanent graft injury.

Mycobacterium tuberculosis: Active disease and latent infection in a renal transplant cohort.

Our aim was threefold: first, to determine the incidence of active TB in our cohort, second to investigate the risk factors for active TB and third, to understand current screening practices. The ultimate goal was to use our findings to inform development of local and national guidelines. The records of all adult patients who underwent renal transplantation at our centre from 2005 to 2014 were retrospectively reviewed to assess current screening practices, the risks for and burden of active TB. A total of 660 individuals underwent renal transplantation during this period, totalling 3647 person years of follow up. Two patients were diagnosed with active TB after renal transplant, resulting in an incidence of 55 per 100 000 person-years. Of 656 transplant recipients, 102 (15.5%) were born in high TB incidence countries and 89 (13.5%) had an interferon gamma release assay (IGRA) at any point. Individuals born in high TB risk countries had a much higher incidence of active TB (353 per 100 000 person-years). Ten individuals had positive IGRA tests, of whom two were treated for active TB, two received chemoprophylaxis and six were not treated. In the absence of formal guidelines, IGRA-based screening for LTBI was infrequently performed. Our data suggest that screening and treatment of renal transplant recipients born in high incidence countries is an important preventive measure.

Virological Response to Sofosbuvir-Based Treatment in Renal Transplant Recipients With Hepatitis C in Pakistan.

Direct-acting antiviral agents have recently been recommended in renal transplant recipients. Considering our previous encouraging responses with combined sofosbuvir and ribavirin in renal transplant recipients and the availability of daclatasvir, we aimed to evaluate the effectiveness and safety of sofosbuvir-based direct-acting antiviral agents in our population. All renal transplant recipients who received sofosbuvir-based direct-acting antivirals from August 2015 to March 2018 were included in our study. Patients were treated with sofosbuvir and ribavirin for 24 weeks or with combined sofosuvir, daclatasvir, and ribavirin for 12 weeks. Patient demographics and baseline laboratory parameters were collected. Rapid virologic response, end of treatment response, and sustained virologic response at 12 weeks were analyzed. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 20.0, IBM Corporation, Armonk, NY, USA). In our study group of 79 patients, mean age was 36.5 ± 10.2 years and 60 were men (78.5%). Fiftysix patients (70.9%) were treatment naive; of the remaining patients, 20 received interferon before transplant and 3 were treated with sofosbuvir and ribavirin after renal transplant. Genotype 1 was observed in 42 patients (53.2%), whereas mixed genotype (1 and 3) was shown in 10 patients (12.6%). Sixty-two patients (78.5%) received sofosbuvir and ribavirin, and 17 patients (21.5%) received sofosbuvir, daclatasvir, and ribavirin. End of treatment response was achieved in 78 recipients (98.1%). Anemia was observed in 13 patients (16.4%). Hepatitis C virus was successfully eradicated in renal transplant recipients who received a combination of sofosbuvir plus ribavirin or sofosbuvir, daclatasvir, and ribavirin. These combinations were effective and well tolerated in our study population, even in those with mixed genotype, with no major adverse events.

Importance of the Dental Treatment in Renal-Transplant Recipients~Single Center Experience~

Introduction The second position of the cause of death of renal transplant (RTx) recipients is an infection in our country. Therefore, the management of the infection before and after the RTx is important in improving the prognosis of RTx recipients. By the way, most of RTx of our country are living RTx, and there is extremely little cadaveric RTx, and the mean waiting time of cadaveric RTx is extremely long with approximately 15 years. As for the living RTx, the preoperative close inspection is carried out for plan surgery elaborately, but, in cadaveric RTx, the pre-operative examination of the patients is often insufficient for emergency surgery. During a RTx wait, many patients conduct the systemic evaluations such as endoscopy, the computed tomography in hemodialysis (HD) centers, but the treatment of oral lesions such as tooth caries, periodontal disease is not performed enough in many cases. It is with infection focus by an immunosuppressive drug after RTx when we perform RTx without these being treated enough and it is sometimes aggravated and comes to have a poor prognosis. Therefore the treatment of the oral lesion of RTx recipients is important. Patient The RTx program has been started in our department in May, 2006. 90 RTx (71 living, 19 cadaver) have been performed so far. Tooth caries was detected just before RTx and extracted a tooth in oral surgery promptly in 7 cadaveric RTx patients. Also, four living and six cadaveric RTx patients were treated for oral surgery because of gingival hypertrophy, tooth caries after RTx. Recently, we experienced one RTx patient whom a brain abscess developed in from tooth caries 11 years after cadaveric RTx. Case 56 years old, male. He has suffered HD for 17 years. He has been performed cadaveric RTx in October, 2006. In April, 2017, he was increased predonine dose because of severe proteinuria. And tooth caries occurred in the middle of July, 2017. Subsequently, over 39 degrees fever, headache, and vomiting developed, points out a brain abscess by onset, in head CT and MRI in August, 2017. The same Klebsiella pneumoniae was detected in bacterial culture of examination of cerebrospinal fluid, the tooth caries and was thought with the brain abscess that occurred by transmission from tooth caries. Conclusion It may occur for a brain abscess as a cause for severe tooth caries and periodontal disease under immunosuppressive status after RTx. Also, when severe tooth caries or periodontal disease is pointed out before RTx to a RTx candidate, we evade or may have to postpone RTx. Therefore we should usually examine an oral lesion in a RTx candidate and recipient, and it is necessary to cure as needed.

Re: Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review

Re: Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review

Radical Prostatectomy for Localized Prostate Cancer in Renal Transplant Recipients: 13 Cases Studied at a Single Center

ObjectivesWe aimed to evaluate the feasibility and efficacy of surgical prostatectomy in renal transplant recipients (RTRs). MethodsBetween January 2008 and February 2017, we identified 13 RTRs who were diagnosed with localized prostate cancer and underwent radical prostatectomy. We reviewed all available clinicopathologic data for these 13 patients. ResultsThe median patient age was 61 years and median serum prostate-specific antigen (PSA) was 8.79 ng/mL. The mean period between transplantation and diagnosis of prostate cancer was 136 months. The sources for the kidney transplants included 10 living and 3 deceased donors. Biopsies indicated that the Gleason scores were 7 in 10 patients and 8 to 10 in 3 patients. Meanwhile, the D'Amico risk classification indicated an intermediate risk in 9 patients and a high risk in 4 patients. Eight patients were at stage cT1 and 5 were at stage cT2. The surgical procedure was retropubic radical prostatectomy in one recipient, laparoscopic radical prostatectomy in 3 recipients, and robot-assisted radical prostatectomy in 9 RTRs. Intraoperative complications were not noted in any patient, although one patient demonstrated postoperative complications (Clavien grade ≥ 3). An indwelling urinary catheter was required in 3 patients for over 3 weeks due to delayed wound healing. Biochemical recurrence evaluated by PSA monitoring occurred in four patients. Postoperative graft function was stable in all but one patient who required resumption of dialysis before prostatectomy; however, all patients are alive at the time of publication with 12 patients showing well-functioning renal allografts. ConclusionProstatectomy may be a feasible and effective technique as an initial treatment for RTRs with localized prostate cancer.

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Background/Aims: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital. Methods: Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens. Results: The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often. Conclusion: The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role.

Prostate cancer treatment in renal transplant recipients: a systematic review.

The aim of this review was to summarize the current evidence and to highlight the main issues future research needs to address regarding prostate cancer (PCa) treatment in renal transpant recipients (RTRs). We conducted a search of AMED, Medline and Embase up to 17 November 2016 to investigate oncological and functional outcomes of PCa treatment in RTR. Type and use/protocols of immunosuppression and peri-operative antibiotic drugs were also assessed. The search was implemented manually. Exclusion criteria were absence of full text or absence of information that allowed us to differentiate oncological and/or functional outcomes of each therapeutic approach used. We included 241 patients from 27 retrospective studies published between 1991 and 2016; seven of the studies were case-control and 20 were case series. We also considered nine case reports published between 1999 and 2016. Follow-up ranged from 1 to 120 months. PCa was organ-confined, with Gleason score ≤6 in 75.2% and 60.4% of patients. Surgery was the most frequent treatment used (n = 186), for which cancer-specific (CSS) and overall survival (OS) rates were both 96.8%. Functional outcomes, including continence and erectile function, and complications were less frequently reported and were generally similar to those reported for radical prostatectomy (RP) in non-RTRs. Other treatment methods in the patients included in the review were radiotherapy (RT) ± androgen deprivation therapy (ADT; n = 34; OS 88.2%; CSS 88.2%), ADT alone (n = 14; OS 42.9%; CSS 64.3%), brachytherapy (BT; n = 11; OS and CSS 100%), watchful waiting (n = 4) and active surveillance (n = 1). Overall no treatment-related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Outcomes of PCa treatment in RTRs are encouraging and do not appear to be inferior to those of non-RTR. RP was the most commonly assessed approach, whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High-quality studies are needed because the current level of evidence is low, and our results should therefore be interpreted with caution.

Twenty-four hour urinary cortisol excretion and the metabolic syndrome in prednisolone-treated renal transplant recipients

Chronic prednisolone treatment in renal transplant recipients (RTR) causes metabolic abnormalities, which cluster in the metabolic syndrome (MS). It also suppresses the hypothalamic–pituitaryadrenal (HPA)-axis. We investigated whether HPA-axis suppression, as measured by 24h urinary cortisol excretion, is associated with presence of the MS and its individual components, in outpatient RTR with a functioning graft for >1year. Urinary cortisol was measured in 24h urine, using LC–MS/MS (LOQ 0.30nmol/L). We included 563 RTR (age 51±12years; 54% male) at median 6.0 [IQR, 2.6–11.5] years post-transplantation. MS was present in 439/563 RTR (78%). Median 24h urinary cortisol excretion was 2.0 [IQR, 0.9–5.1]nmol/24h. Twenty-four hour urinary cortisol excretion was independently associated with MS presence (OR=0.80 [95% CI, 0.66–0.98], P=0.02). It was also independently associated with bodyweight (st.β=−0.11, P=0.007), waist circumference (st.β=−0.10, P=0.01), BMI (st.β=−0.14, P=0.001), fasting triglycerides (st.β=−0.15, P=0.001), diabetes (st.β=−0.12, P=0.005), and number of antihypertensives used (st.β=−0.13, P=0.003). Suppressed HPA-axis activity, as reflected by decreased 24h urinary cortisol excretion, is associated with higher prevalence of MS and its individual components (i.e. central obesity, dyslipidemia, diabetes, hypertension) in prednisolone-treated RTR. Assessment of 24h urinary cortisol excretion by LC–MS/MS may be a tool to monitor metabolic side-effects of prednisolone in RTR.

Systematic Review on Role of Mammalian Target of Rapamycin Inhibitors as an Alternative to Calcineurin Inhibitors in Renal Transplant: Challenges and Window to Excel.

This review focuses on the current limited evidence of graft function and graft survival in various immunosuppressive regimens involving mammalian target of rapamycin inhibitors with or without calcineurin inhibitors. We evaluated the current literature for describing the role of mammalian target of rapamycin inhibitors as an alternative to calcineurin inhibitors by searching the PubMed, EMBASE, Cochrane, Crossref, and Scopus databases using medical subject heading terms. Our detailed analyses of all relevant literature showed use of mammalian target of rapamycin inhibitor-based de novo regimens, early calcineurin inhibitor withdrawal with subsequent introduction of mammalian target of rapamycin inhibitor-based regimens, and late conversion from a calcineurin inhibitor-based regimen to mammalian target of rapamycin inhibitor-based regimens. Notably, early calcineurin inhibitor withdrawal with subsequent introduction of mammalian target of rapamycin inhibitor-based regimen seemed to be a more practical and realistic approach toward immunosuppressive treatment of renal transplant recipients. However, in view of the high rejection rate observed in these studies, it is advisable not to offer these regimens to patients with moderate to high immunologic risk. The present evidences suggest that treatment with mammalian target of rapamycin inhibitors allows early and substantial calcineurin inhibitor minimization. The mammalian target of rapamycin inhibitors everolimus and sirolimus are preferred due to their complementary mechanisms of action and favorable nephrotoxicity profile, which have opened the way for calcineurin inhibitor reduction/withdrawal in the early posttransplant period.

Evolution of IKDRC as a liver transplant centre in public sector

To evaluate the nature and incidence of neurologic complications in recipients of living donor renal transplantation. Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants and there is paucity of data regarding the same. The epidemiology of infective agents varies according to geographical locations.We included 856 patients of live related renal transplantation at our institution between January 2002 and December 2009. All recipients who were found to have some clinical, laboratory, or radiological evidence of neurological involvement were considered. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were recorded. Occurrence of acute rejections, chronic allograft nephropathy (CAN), delayed graft function, and new onset diabetes after transplant (NODAT) were recorded.Of the total 856 renal transplant recipients, a total of 93 (10.8%) patients were found to have some clinical, laboratory, or radiological evidence of neurological involvement. A total of 69 (73.3%) developed CNS complications with a mortality rate of 37.7%. CNS infections occurred in 47 (5% of total) recipients and accounted for the largest group (68.1%). Fungi were the commonest etiological agents, 22 (46.8%), and were associated with 40% mortality. Cryptococcal meningitis was occurring in 19 (27.5%), with mortality in 31.6% of these. Other fungal infections were aspergillosis in two and mucormycosis in one. All patients with aspergillosis and mucormycosis had a fatal outcome. The second largest group on CNS complications comprised of patients with cerebrovascular accidents, which occurred in 13 patients (18.8%), and were associated with a mortality of 23%. Eight patients with ischemic stroke had survived. Two had hemorrhagic stroke and both had a fatal outcome. Three patients had subdural hematoma with 33.3% mortality. Four patients had toxic encephalopathy as a result of fulminant systemic sepsis with mortality in all. Other less common CNS complications included intracranial space occupying lesion in two, postoperative psychosis in two, and hypoglycemic coma in one. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. A total 61 (65.5%) patients, which comprises 7% of the total transplant recipients, presented with some complications involving the peripheral nervous system (PNS). The most common manifestations were tremor in 26.5%, followed by paresthesias in 18.3%, steroid-induced myopathy in 11.8%, ulnar neuropathy in 4.4, and femoral neuropathy in 2.2%. These complications were more common with tacrolimus.We conclude that complications involving the neurological system occur in 10.5% of all transplant patients with 8% involving CNS and 7% involving the PNS. The high mortality rates associated with CNS complications warrant early diagnosis and aggressive treatment in renal transplant recipients.

Neuroinflammation in patients with psychosis: First results of a placebo controlled study with 8 gram valaciclovir daily

To evaluate the nature and incidence of neurologic complications in recipients of living donor renal transplantation. Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants and there is paucity of data regarding the same. The epidemiology of infective agents varies according to geographical locations.We included 856 patients of live related renal transplantation at our institution between January 2002 and December 2009. All recipients who were found to have some clinical, laboratory, or radiological evidence of neurological involvement were considered. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were recorded. Occurrence of acute rejections, chronic allograft nephropathy (CAN), delayed graft function, and new onset diabetes after transplant (NODAT) were recorded.Of the total 856 renal transplant recipients, a total of 93 (10.8%) patients were found to have some clinical, laboratory, or radiological evidence of neurological involvement. A total of 69 (73.3%) developed CNS complications with a mortality rate of 37.7%. CNS infections occurred in 47 (5% of total) recipients and accounted for the largest group (68.1%). Fungi were the commonest etiological agents, 22 (46.8%), and were associated with 40% mortality. Cryptococcal meningitis was occurring in 19 (27.5%), with mortality in 31.6% of these. Other fungal infections were aspergillosis in two and mucormycosis in one. All patients with aspergillosis and mucormycosis had a fatal outcome. The second largest group on CNS complications comprised of patients with cerebrovascular accidents, which occurred in 13 patients (18.8%), and were associated with a mortality of 23%. Eight patients with ischemic stroke had survived. Two had hemorrhagic stroke and both had a fatal outcome. Three patients had subdural hematoma with 33.3% mortality. Four patients had toxic encephalopathy as a result of fulminant systemic sepsis with mortality in all. Other less common CNS complications included intracranial space occupying lesion in two, postoperative psychosis in two, and hypoglycemic coma in one. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. A total 61 (65.5%) patients, which comprises 7% of the total transplant recipients, presented with some complications involving the peripheral nervous system (PNS). The most common manifestations were tremor in 26.5%, followed by paresthesias in 18.3%, steroid-induced myopathy in 11.8%, ulnar neuropathy in 4.4, and femoral neuropathy in 2.2%. These complications were more common with tacrolimus.We conclude that complications involving the neurological system occur in 10.5% of all transplant patients with 8% involving CNS and 7% involving the PNS. The high mortality rates associated with CNS complications warrant early diagnosis and aggressive treatment in renal transplant recipients.

Critical Ovarian Hyperstimulation Syndrome After In Vitro Fertilization Treatment in a Renal Transplant Recipient: A Case Report

ObjectiveThe study sought to describe a case of critical ovarian hyperstimulation syndrome (OHSS) after in vitro fertilization treatment in a renal transplant recipient. PatientA 35-year-old woman with a 5-year history of renal transplantation underwent in vitro fertilization treatment with a midluteal pituitary downregulation regimen. ResultThere are only 7 cases published regarding successful pregnancies outcomes after in vitro fertilization treatment in renal transplant recipients. In the most of the case reports, there was no deterioration of graft function. However, our patient developed critical OHSS. After effective treatment, her serum creatinine level decreased from 668 μmol/L to baseline. ConclusionsOur case demonstrates that the highly specialized care and close cooperation of transplantation and perinatology teams are required when undergoing in vitro fertilization treatment in renal transplant recipients.

BK Virus Load Associated with Serum Levels of sCD30 in Renal Transplant Recipients.

Background. Rejection is the main drawback facing the renal transplant operations. Complicated and overlapping factors, mainly related to the immune system, are responsible for this rejection. Elevated serum levels of sCD30 were frequently recorded as an indicator for renal allograft rejection, while BV virus is considered as one of the most serious consequences for immunosuppressive treatment of renal transplant recipients (RTRs). Aims. This study aimed to determine the association of BK virus load with serum levels of sCD30 in RTRs suffering from nephropathy. Patients and Methods. A total of 50 RTRs with nephropathy and 30 age-matched apparently healthy individuals were recruited for this study. Serum samples were obtained from each participant. Real-time PCR was used to quantify BK virus load in RTRs serum, while ELISA technique was employed to estimate serum levels of sCD30. Results. Twenty-two percent of RTRs had detectable BKV with mean viral load of 1.094E + 06 ± 2.291E + 06. RTRs showed higher mean serum level of sCD30 (20.669 ± 18.713 U/mL) than that of controls (5.517 ± 5.304 U/mL) with significant difference. BK virus load had significant positive correlation with the serum levels of sCD30 in RTRs group. Conclusion. These results suggest that serum levels of sCD30 could be used as an indicator of BK viremia, and accordingly the immunosuppressive regime should be adjusted.

Neurological complications in renal transplant patients: A single-center experience

AimsTo evaluate the nature and incidence of neurologic complications in recipients of living donor renal transplantation. Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants and there is paucity of data regarding the same. The epidemiology of infective agents varies according to geographical locations. MethodsWe included 856 patients of live related renal transplantation at our institution between January 2002 and December 2009. All recipients who were found to have some clinical, laboratory, or radiological evidence of neurological involvement were considered. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were recorded. Occurrence of acute rejections, chronic allograft nephropathy (CAN), delayed graft function, and new onset diabetes after transplant (NODAT) were recorded. ResultsOf the total 856 renal transplant recipients, a total of 93 (10.8%) patients were found to have some clinical, laboratory, or radiological evidence of neurological involvement. A total of 69 (73.3%) developed CNS complications with a mortality rate of 37.7%. CNS infections occurred in 47 (5% of total) recipients and accounted for the largest group (68.1%). Fungi were the commonest etiological agents, 22 (46.8%), and were associated with 40% mortality. Cryptococcal meningitis was occurring in 19 (27.5%), with mortality in 31.6% of these. Other fungal infections were aspergillosis in two and mucormycosis in one. All patients with aspergillosis and mucormycosis had a fatal outcome. The second largest group on CNS complications comprised of patients with cerebrovascular accidents, which occurred in 13 patients (18.8%), and were associated with a mortality of 23%. Eight patients with ischemic stroke had survived. Two had hemorrhagic stroke and both had a fatal outcome. Three patients had subdural hematoma with 33.3% mortality. Four patients had toxic encephalopathy as a result of fulminant systemic sepsis with mortality in all. Other less common CNS complications included intracranial space occupying lesion in two, postoperative psychosis in two, and hypoglycemic coma in one. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. A total 61 (65.5%) patients, which comprises 7% of the total transplant recipients, presented with some complications involving the peripheral nervous system (PNS). The most common manifestations were tremor in 26.5%, followed by paresthesias in 18.3%, steroid-induced myopathy in 11.8%, ulnar neuropathy in 4.4, and femoral neuropathy in 2.2%. These complications were more common with tacrolimus. ConclusionWe conclude that complications involving the neurological system occur in 10.5% of all transplant patients with 8% involving CNS and 7% involving the PNS. The high mortality rates associated with CNS complications warrant early diagnosis and aggressive treatment in renal transplant recipients.