Journal articles: 'Renal Transplant'

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Rodin, Gary, Karen Voshart, Daniel Cattran, Phillip Halloran, Carl Cardella, and Stanley Fenton. "Cadaveric Renal Transplant Failure: The Short-Term Sequelae." International Journal of Psychiatry in Medicine 15, no. 4 (December 1986): 357–64. http://dx.doi.org/10.2190/j0w3-x04w-7j6c-vq20.

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Quality of life was evaluated in 103 patients initially when each was placed on the waiting list for a cadaveric transplant. Patients who were not transplanted were reassessed six months after being placed on the waiting list. Patients who received a transplant were reassessed six months after the surgery. Cadaveric transplantation was performed in sixty-three patients by the time of follow-up. The mortality rate of 12.7 percent in transplanted patients after six months was more than twice that in patients who remained on the waiting list without a transplant, but this difference was not statistically significant. There was a graft failure rate of 23.6 percent among transplanted patients who survived six months. Graft failures were associated with some deterioration in subsequent physical activity ( F = 5.4, p < 0.03) but not in psychosocial functioning. Successful cadaveric transplants were associated with a marked and significant improvement in psychosocial well-being ( F = 10.5, p < 0.002) after six months even though physical activity did not increase. These findings suggest that 1) a successful cadaveric transplant is associated with an improved quality of life, 2) the graft failure rate of 23 percent with cadaveric transplantation is still appreciable but 3) graft failure is not necessarily associated in the short term with deterioration in psychosocial well-being.

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Dreher, Paulette Cutruzzula, Jessica M. Fazendin, Kelly Lurz, Daniel C. Edwards, Stephen Guy, and Melanie Amster. "Painful angiomyxoid tumor in a failed renal allograft presenting as post-transplant lymphoproliferative disorder." Journal of Nephropathology 9, no. 2 (September 10, 2019): e20-e20. http://dx.doi.org/10.34172/jnp.2020.20.

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Introduction: There exist few reports of de novo tumors involving an allograft kidney, and to the best of our knowledge there are only two previous reports of angiomyxoma Case Presentation: A 53-year-old Caucasian male with end-stage renal disease (ESRD) on hemodialysis (HD) secondary to malakoplakia with three failed prior renal transplants presented for repeat transplant evaluation. Imaging demonstrated a mass of the transplanted kidney suggestive of posttransplant lymphoproliferative disease (PTLPD). A biopsy was obtained revealing a predominance of myxoid material. The patient became increasingly symptomatic from the mass and underwent a palliative right transplant nephrectomy. Final pathology revealed angiomyxoid tumor. Conclusions: Angiomyxomas are asymptomatic, appear as PTLD on imaging and should be considered in the differential diagnosis of masses occurring in renal transplant allografts.

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Self, Michael, Ernest Dunn, John Cox, and Karl Brinker. "Managing Breast Cancer in the Renal Transplant Patient: A Unique Dilemma." American Surgeon 72, no. 2 (February 2006): 150–53. http://dx.doi.org/10.1177/000313480607200211.

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Improvements in immunosuppression have increased patient and graft survival in transplant recipients. As a result, there is greater risk of neoplastic processes such as breast cancer. Treatment in this population is complicated by the necessary immunosuppression, vascular accesses, and transplant grafts. General surgeons may expect to encounter more of these complex patients in the community setting. We sought to evaluate the surgical treatment of breast cancer in patients with renal transplants. Hospital and private physician records were queried to identify patients who developed breast cancer after a renal or pancreatic/renal transplantation. These charts were reviewed for demographics, type of breast cancer and treatment, location of dialysis access, and complications. From June 1, 1994, to May 31, 2004, 14 patients were identified. Eight patients had functioning transplants. All patients underwent operative interventions. Ten patients underwent adjuvant treatment. Three had functioning transplants and chose not to risk the graft with cessation of immunotherapy. However, no patient with functioning transplants who underwent chemotherapy developed organ failure. Breast cancer after transplantation poses a unique dilemma. The threat of transplanted organ failure is a major concern to these patients and often supersedes adjuvant therapies.

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Williams, Shelly, Amy Braden, Brahm Vasudev, Jeanne Palmer, and Eric Cohen. "Renal Transplantation for End-Stage Renal Disease Following Bone Marrow Transplantation: A 10-Year Outcomes Review." Blood 114, no. 22 (November 20, 2009): 4294. http://dx.doi.org/10.1182/blood.v114.22.4294.4294.

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Abstract Abstract 4294 Background The incidence of hematopoietic stem cell transplantations (HSCTs) in the US is increasing dramatically each year. Nephrotoxic agents used in these patients often lead to kidney injury that can be severe and progress to end-stage renal disease (ESRD) requiring long term dialysis or kidney transplant. Kidney transplantation is the best method of renal replacement therapy and maintenance immunosuppression is the mainstay to prevent graft rejection. Immune tolerance is of substantial interest because it obviates the need for long-term immunosuppression. Methods We performed a retrospective analysis of nine patients that developed ESRD after HSCT at the Medical College of Wisconsin. Chart review was performed to obtain demographic information and details of the transplants, patient and transplant outcomes, and various renal and HSCT related parameters. Results A total of nine patients were reviewed. Patient age at the time of HSCT ranged from 25-40 years. ESRD was caused by bone marrow transplant nephropathy (BMT-Np) in seven patients, HUS/TTP in one patient, and anti-TBM nephritis in one patient. Six patients received their kidney from a living related donor (LRD), whereas two patients received living unrelated renal transplants (LURRTx), and one recipient received a deceased donor transplant. Three of the six LRD recipients had same-donor renal and hematopoietic stem cell (HSC) transplants and did not require post-transplant maintenance immunosuppression. Of the two LURRTx recipients, no maintenance immunosuppression was required for the patient receiving same-donor organs. The deceased donor transplant recipient continues to be on immunosuppression. Follow-up ranges from 12-23 years post HSCT and 3-12 years post-renal transplant. Seven of the nine patients have functioning bone marrow and kidney transplants. Their serum creatinine ranges from 0.77 to 1.7 mg/dL. One patient died 24 months post-renal transplant from metastatic vaginal squamous cell cancer and had a functioning bone marrow and kidney at the time of death. Another patient was lost to follow-up and died of unknown cause, although her renal function 34 months post transplant was excellent off maintenance immunosupression. Conclusions Based on our case series, we conclude that the long-term outcome of renal allografts in patients who have received a renal transplant after HSCT is excellent. The overall requirement for immunosuppressive medications in this population is reduced. Disclosures: No relevant conflicts of interest to declare.

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Sidhu, Joginder, Surbhi Bansal, and Hasrat Sidhu. "Incidence and Neurological Complications in Renal Transplant Patients." Asian Pacific Journal of Health Sciences 2, no. 1 (January 2015): 69–72. http://dx.doi.org/10.21276/apjhs.2015.2.1.11.

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Polytimi, Leonardou, Gioldasi Sofia, and Pappas Paris. "Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment." Journal of Transplantation 2011 (2011): 1–7. http://dx.doi.org/10.1155/2011/219109.

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Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS).Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery.Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure.Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

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McGregor, Tom, Jennifer Bjazevic, Premal Patel, and Joshua Koulack. "Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community." Canadian Urological Association Journal 10, no. 1-2 (January 14, 2016): 7. http://dx.doi.org/10.5489/cuaj.3256.

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Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada.Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected.Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds.Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients.

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Subodh, K. Regmi, Jiang Song, and A. Warlick Christopher. "De-Novo Genitourinary Neoplasms in Transplant Recipients: The Present and Future." Cancer Medicine Journal 3, no. 1 (June 30, 2020): 10–22. http://dx.doi.org/10.46619/cmj.2020.3-1016.

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The risk of genitourinary cancers following transplantation is increased following majority of solid organ transplants but is best described following renal transplantation. Increasing average age of the transplant recipient as well as increases in post- transplant survival increases the risk of these malignancies. The risk of Kidney cancer is the highest following most solid organ transplants, whereas prostate cancer risk is lower than the general population in multiple large population-based studies. The etiology of increased risk of cancer following transplant is multifactorial with the predominant influence of immunosuppression and direct toxicity of immunosuppressants, however, the significance of end stage disease particularly in the causation of renal cancer in renal transplant recipients is undeniable. Modifications in immunosuppression regimens as well as changes in the standard treatment principles of some cancers may require changes in the management of some post-transplant malignancies. Standard screening guidelines have not been established but screening for renal tumors in renal transplant recipients is the only widely studied entity. Further work is needed to prepare the urologic oncological community with this once rare population group and standardized recommendations need to be established for screening and for the use of new age cancer therapeutics like immunotherapy.

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Rao, Nitesh N., Chris Wilkinson, Mark Morton, Greg D. Bennett, Graeme R. Russ, Patrick T. Coates, and Shilpa Jesudason. "Successful pregnancy in a recipient of an ABO-incompatible renal allograft." Obstetric Medicine 12, no. 1 (March 7, 2018): 42–44. http://dx.doi.org/10.1177/1753495x17745390.

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Kidney transplantation restores fertility in patients with end-stage renal disease, with many successful pregnancies after kidney transplantation being reported. However, there are little data regarding pregnancy in women transplanted under modern-era desensitisation protocols that utilise rituximab, plasma exchange and intravenous immunoglobulin, including ABO-incompatible transplants. Pregnancies in ABO-incompatible recipients can pose new challenges from an immunological perspective. Here, we report a case of successful pregnancy using in vitro fertilisation, in a renal transplant recipient who underwent desensitisation two years prior, that included use of rituximab and plasma exchange to receive an ABO-incompatible transplant from her husband and subsequent father of the baby. We believe this was the first case of successful pregnancy after ABO-incompatible kidney transplantation in Australia and New Zealand. This case also highlights the difficulties faced in conception following transplantation and demonstrates that in vitro fertilisation utilising ovulation induction can be successfully utilised for conception in this cohort. This recipient also had gestational diabetes, worsening renal function and preterm delivery which are important complications often seen in pregnancies of solid organ transplant recipients.

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Premaratne, Sobath, Jonathan Hopkins, Martin Duddy, Ket Sang Tai, Mark Kay, Radu Rogoveanu, Phil Nicholl, and Alok Tiwari. "Abdominal Aortic Aneurysm Repair in Renal and Liver Transplant Recipients." Vascular and Endovascular Surgery 54, no. 1 (October 10, 2019): 51–57. http://dx.doi.org/10.1177/1538574419880673.

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Background: Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. Methods: A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. Conclusion: Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.

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Blagojevic-Lazic, Radmila, Dragana Radivojevic, Vladan Andrejevic, Zoran Dzamic, Miodrag Acimovic, Drago Milutinovic, Ljubomir Djurasic, and Jovan Hadzi-Djokic. "Malignant disease in renal transplant recipients: Our experience." Acta chirurgica Iugoslavica 59, no. 1 (2012): 49–51. http://dx.doi.org/10.2298/aci1201049b.

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Kidney transplantation is a treatment of choice for patient with end stage renal disease. Chronic renal failure is characterized with weak cellular and humoral immunity. In our paper we present our experience with presence of malignancy in renal transplant patients. Urology clinic in Belgrade transplanted 411 patients over the period of 16 years. Living donor transplantation was performed for 272 and cadaveric kidney transplant for 139 patients. In the postoperative follow up, malignancies were diagnosed in 7 of the transplanted patients. Three patients developed basal cell skin carcinoma, one was diagnosed with adenocarcinoma of the transplanted kidney, one developed transitional cell carcinoma of the bladder and testicular tumors were diagnosed in two patients. Postoperative immunosuppressive therapy usually double or triple when patients are in the immunological high risk group. Incidence of malignancy according to big health centers is around 1 in every 1000 transplanted patients. It is also noted the rise of incidence of malignancies in transplanted patient in over 50%.

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Chon, W. James, Pradeep V. Kadambi, Chang Xu, Yolanda T. Becker, Piotr Witkowski, Kenneth Pursell, Brenna Kane, and Michelle A. Josephson. "Use of Leflunomide in Renal Transplant Recipients with Ganciclovir-Resistant/Refractory Cytomegalovirus Infection: A Case Series from the University of Chicago." Case Reports in Nephrology and Dialysis 5, no. 1 (April 1, 2015): 96–105. http://dx.doi.org/10.1159/000381470.

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Introduction: Although antiviral prophylaxis for cytomegalovirus (CMV) is widely used, CMV infection remains common in renal transplant recipients with adverse consequences. Methods: We report 5 cases of renal transplant recipients with resistant CMV infection who were successfully managed with leflunomide at the University of Chicago Medical Center. Results: Five renal transplant recipients (2 simultaneous pancreas/kidney transplants, 3 deceased donor kidney transplants) were diagnosed with GCV-resistant CMV infection from 2003 to 2011. Of the 4 patients who had resistance genotype testing, 3 showed a UL97 mutation and 1 patient had a clinically resistant CMV infection. All patients received CMV prophylaxis with valganciclovir for 3 months. The number of days from the date of transplant to viremia ranged from 38 to 458 days (median 219). All 5 patients received other antiviral agents (e.g. ganciclovir, foscarnet), and in 4 patients, viremia was cleared before leflunomide was initiated as consolidation (or maintenance) therapy. Conclusion: Leflunomide was well tolerated and successful in preventing recurrence of viremia in renal transplant recipients with resistant CMV infection. The beneficial effect of leflunomide in this setting warrants further investigation.

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&NA;. "Renal transplant research." Inpharma Weekly &NA;, no. 980 (April 1995): 10. http://dx.doi.org/10.2165/00128413-199509800-00017.

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Hobart, Michael G., Stevan B. Streem, and Inderbir S. Gill. "RENAL TRANSPLANT COMPLICATIONS." Urologic Clinics of North America 27, no. 4 (November 2000): 787–98. http://dx.doi.org/10.1016/s0094-0143(05)70126-9.

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Yazıcı, Bülent. "Renal Transplant Scintigraphy." Nuclear Medicine Seminars 5, no. 3 (December 9, 2019): 189–98. http://dx.doi.org/10.4274/nts.galenos.2019.0027.

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Doehn, C., P. Fornara, C. Tiemer, L. Fricke, and D. Jocham. "Renal transplant lithiasis." Transplantation Proceedings 34, no. 6 (September 2002): 2222–23. http://dx.doi.org/10.1016/s0041-1345(02)03211-6.

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PERCHIK, JOEL E., BRUCE R. BAUMGARTNER, and MICHAEL E. BERNARDINO. "Renal Transplant Rejection." Investigative Radiology 26, no. 5 (May 1991): 422–26. http://dx.doi.org/10.1097/00004424-199105000-00007.

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Baumqartner, B. R., and S. Carlock. "RENAL TRANSPLANT BIOPSY." Investigative Radiology 27, no. 12 (December 1992): 1094. http://dx.doi.org/10.1097/00004424-199212000-00083.

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Neil, Desley A. H. "Renal transplant pathology." Diagnostic Histopathology 16, no. 7 (July 2010): 345–48. http://dx.doi.org/10.1016/j.mpdhp.2010.03.017.

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GILKS, W. R., S. M. GORE, and B. A. BRADLEY. "RENAL TRANSPLANT REJECTION." Transplantation 50, no. 1 (July 1990): 141–45. http://dx.doi.org/10.1097/00007890-199007000-00026.

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Kung, Pen-Chen, Mei Chang Yeh, Ming-Kuen Lai, and Hsueh–Erh Liu. "Renal Transplant Recipients." Journal of Nursing Research 25, no. 5 (October 2017): 392–97. http://dx.doi.org/10.1097/jnr.0000000000000181.

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Bunzendahl, H., U. Frei, H. Grosse, and R. Pichlmayr. "Renal transplant recipients." World Journal of Urology 6, no. 2 (August 1988): 66–69. http://dx.doi.org/10.1007/bf00326617.

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Weber, Therese M., and Mark E. Lockhart. "Renal transplant complications." Abdominal Imaging 38, no. 5 (June 22, 2013): 1144–54. http://dx.doi.org/10.1007/s00261-013-0005-9.

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Akbar, Ruhina, Naeem Kauser, and Naveed Hussain. "RENAL TRANSPLANT RECIPIENTS." Professional Medical Journal 22, no. 05 (May 10, 2015): 590–95. http://dx.doi.org/10.29309/tpmj/2015.22.05.1272.

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Introduction: Good glycemic control and lipid modification are potentiallyimportant intervention for improving outcome after kidney transplantation. Objective: Todetermine the frequency of dyslipidemia and its types in renal transplant recipients (RTRs),and to observe impact of hyperglycemia on their lipid profile. Design: Case control study.Period: June 2011 to May 2012. Setting: Kidney Dialysis Department of Jinnah HospitalLahore, Urology Department of Mayo Hospital Lahore and Pathology Department AllamaIqbal Medical College Lahore. Patients and Methods: A total of 40 RTR were included in thestudy. An equal number of sex and age matched healthy subjects were considered as controlgroup. The patients were on regular post transplant follow up in Kidney Dialysis Department ofJinnah Hospital Lahore and Urology Department of Mayo Hospital Lahore and had no clinicalor laboratory evidence of graft rejection, post-transplant diabetes mellitus, hypertension or intercurrent infection. Total cholesterol (TC), triglyceride (TG), High density Lipoprotein-Cholesterol(HDL-C), and Glycohemoglobin A1c (HbA1c) were estimated in all subjects. These subjectswere divided into Diabetic and non-diabetic groups, according to level of HbA1c. Results:The mean age of the RTR was 34.5± 9.02 years and the mean duration of transplant was36.70 ± 38.07 months. RTRs showed significantly high mean levels of TG (p< 0.002), TC (p<0.00), LDL-C (p< 0.01), and HDL-C (p< 0.05) as compared to the control subjects. ElevatedTC, TG, LDL-C and low HDL was observed in 32.5%, 72.5%, 52.5%, and 60% of total RTR,respectively. The mean levels of TC, TG and HDL-C were increased in Diabetic transplant groupas compared to non-diabetic RTR. Percentage of elevated TC, TG, LDL-C and decreased HDLin diabetic group of RTR versus non diabetic RTR was 43.7% Vs 25% , 81.2% Vs 66.6%, , 62.5%Vs 44.4%, and 50% Vs 66.6% respectively. There was a positive relationship between HbA1cand lipid profile (TC, TG, and LDL – C) in both Diabetic and Non Diabetic Group. A statisticallysignificant correlation of the mean HbA1c levels with TG level was observed in Diabetic RTR.Conclusion: Dyslipidemia in our RTRs was observed as elevated levels of TC, TG and LDL-C. Indiabetic RTR, a statistically significant positive correlation of the HbA1c levels with TG level wasobserved. More rigorous glycemic control and lipid modification will reduce the development ofmicrovascular complications.

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Merdin, Alparslan, Seray Karagoz, Fatma Avci, Huseyin Kocak, Ayhan Dinckan, and Gultekin Suleymanlar. "Prevalence of Anemia in Renal Transplant Patients in Turkey." Turkish Nephrology Dialysis Transplantation 23, no. 2 (May 6, 2014): 142–44. http://dx.doi.org/10.5262/tndt.2014.1002.11.

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Goldooz, Matin, Anne Kennedy, and Jeffrey Campsen. "Tacrolimus-induced Segmental Renal Artery Vasoconstriction in the Setting of Nicardipine Administration after Renal Transplantation." American Journal of Sonography 1 (July 23, 2018): 12. http://dx.doi.org/10.25259/ajs-27-2018.

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Immediate postoperative complications in renal transplants include renal artery thrombosis and dissection both of which carry significant risk for loss of the graft. We present an unusual case in which apparent devascularization of the upper pole of the transplant kidney was due to reversible vasospasm as a result of a drug interaction. Tacrolimus, a calcineurin inhibitor, is used for post-transplant immunosuppression. The antihypertensive medication nicardipine impairs liver metabolism of tactolimus and, in this case, the combination of drugs resulted in supratherapeutic levels of tacrolimus causing acute nephrotoxicity as well as profound vasoconstriction which was most pronounced in the upper pole branch renal artery and simulated devascularization of almost half of the transplant kidney. This case highlights the fact that not all abnormal post-transplant Doppler findings are due to surgical technique or embolic events and illustrates the importance of drug interactions in this group of patients with complex medical conditions.

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Merhametsiz, Özgür, Tolga Yıldırım, Ebru Gök Oğuz, Zafer Ercan, Özlem Yayar, Rahmi Yılmaz, Yunus Erdem, Dilek Ertoy Baydar, Başol Canbakan, and Deniz Aylı. "Evaluation of Renal Biopsies for BK Virus Nephropathy in Non-Renal Transplant Immunosuppressed Patients." Turkish Nephrology Dialysis Transplantation 25, no. 2 (May 12, 2016): 162–67. http://dx.doi.org/10.5262/tndt.2016.1002.07.

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Aydın, Ünal, Muhammed Bayram, Safa Göde, Mugisha Kyaruzi, and Onur Şen. "Open surgical repair of an abdominal aortic aneurysm in a renal transplant recipient." Turkish Journal of Vascular Surgery 30, no. 2 (January 18, 2021): 156–58. http://dx.doi.org/10.9739/tjvs.2021.864.

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Abdominal aortic aneurysm (AAA) surgical repair in renal transplant recipients requires alternative techniques for the protection of the transplanted kidney against ischemia and reperfusion injury. In this report, we present a renal transplant recipient who underwent open surgical repair of an AAA. After aortic cross-clamping, cold Custodiol® solution was infused to the renal artery. Postoperative renal ultrasound showed normal parenchymal echo pattern, and biochemical markers of renal functions were found at normal levels.

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Tuvell, Nancy, and Kathryn Sorrell. "Traumatic Renal Transplant Subcapsular Hematoma: Diagnosis by Duplex Ultrasound." Journal for Vascular Ultrasound 29, no. 1 (March 2005): 39–41. http://dx.doi.org/10.1177/154431670502900106.

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Introduction Subcapsular renal hematomas result from a hemorrhage within the kidney that is contained by its fibrous capsule. In some cases, enlarging or acute hematomas may compress the renal parenchyma and result in ischemia or impaired renal function. In the renal transplant recipient or a patient with a solitary kidney, this situation requires immediate identification and aggressive intervention to preserve renal function. Patient A 54-year-old renal transplant recipient was seen in our vascular laboratory with complaints of severe pain over his transplanted kidney, hematuria, and an elevated creatinine level. His recent history was significant for a minor automobile accident in which his seatbelt engaged over the site of his transplant in the right iliac fossa. Findings Gray-scale imaging revealed a reniform collection surrounding the lateral surface of the kidney, displacing and compressing the renal parenchyma. Resistive indices were elevated at 1.0 throughout the transplant. At the hilum of the kidney, color Doppler documented a high-velocity flow jet in the main renal vein with a continuous Doppler flow pattern. On the basis of these findings, the patient was taken to the operating room for emergent evacuation of the hematoma. A follow-up duplex ultrasonography on the first postoperative day revealed a significant decrease in the size of the hematoma. The resistive indices and the renal vein flow returned to normal. Conclusion Duplex ultrasonography provided an accurate diagnosis of the subcapsular hematoma and its hemodynamic impact on the transplanted kidney.

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Latzko, Michael, Sakshi Jasra, Sana Akbar, Harry Sun, and Sadanand Palekar. "Laparoscopic Splenectomy to Salvage Renal Transplants from Severe Acute Antibody-Mediated Rejection." Case Reports in Transplantation 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/253173.

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Purpose. Acute antibody-mediated rejection, a complication of cross match positive and sensitized renal transplants, occurs despite the use of standard desensitization protocols. Rescue therapy consists of plasmapheresis and intravenous immunoglobulin (IVIg). In patients with preformed donor specific antibodies, rejection can be aggressive. We report here a case in which laparoscopic splenectomy was added to the standard rescue regimen.Case Report and Results. A 40-year-old Hispanic female with end stage renal disease had been receiving hemodialysis. The patient had numerous class 1 unacceptable antigens. She was scheduled to undergo an incompatible 1-1-1 mismatch living related donor kidney transplant. Preoperatively, the patient received plasmapheresis, IVIG, and thymoglobulin. There was good graft function until postoperative day 5. At that point, worsening renal function was noted. Renal biopsy was consistent with AMR. The patient became anuric and dialysis was initiated. To salvage the transplant, the patient underwent laparoscopic splenectomy. Postoperatively, renal function improved. Two years after transplant, the patient continues to have excellent graft function.Conclusion. In a small but significant number of renal transplants, antibody production occurs at a rate that traditional treatments are unable to reduce effectively. Based on our experience, the addition of splenectomy to standard rescue therapy can salvage renal transplants.

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Pluvio, Corrado, Emanuela dePascale, Maria Pluvio, Matilde Carone, Mauro Giordano, Livio Luzi, Francesco Sabella, and Pietro Castellino. "RENAL HEMODYNAMICS IN RENAL TRANSPLANT RECIPIENTS." Transplantation 61, no. 5 (March 1996): 733–38. http://dx.doi.org/10.1097/00007890-199603150-00011.

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Carr, Roxane R., Eric M. Yoshida, Stephen W. Chung, and Nilufar Partovi. "Primary Induction with Mycophenolate Mofetil and Corticosteroids in a Liver Transplant Recipient with Hepatorenal Syndrome." Annals of Pharmacotherapy 32, no. 1 (January 1998): 45–48. http://dx.doi.org/10.1345/aph.17059.

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OBJECTIVE To report the use of mycophenolate mofetil for primary induction in a liver transplant recipient to avoid the nephrotoxicity of cyclosporine/tacrolimus. CASE SUMMARY: A 47-year-old white man in hepatic coma with anuric hepatorenal syndrome received a liver transplant, and was given mycophenolate mofetil and corticosteroids as primary induction immunosuppression with the addition of low-dose cyclosporine 13 days later. His renal function improved and he remains rejection-free after 13 months of follow-up. CONCLUSIONS This case suggests that mycophenolate mofetil may be used as a primary induction agent in liver transplant recipients with renal failure to avoid the additional nephrotoxicity of the standard immunosuppressants, cyclosporine and tacrolimus. Low-dose cyclosporine/tacrolimus may be introduced later as the renal function improves. OBJETIVO Se reporta el uso de micofenolato mofetíl como indución primaria en un recipiente con transplante hepático con el propósito de evitar la nefrotoxicidad debido a ciclosporina y tacrolimus. RESUMEN DEL CASO Un hombre de 47 años de edad en coma hepático y con síndrome hepáticorenal anúrico recibió un transplante de hígado y tratamiento con micofenolato mofetíl y corticosteroides como inducción inmunosupresiva primaria más la adición subsecuente de dosis bajas de ciclosporina después de 13 días. La función renal se mejoró y el paciente permaneció sin síntomas de rechazo después de 4 meses de observacions continuas. CONCLUSIONES La presentación de este caso sugiere que micofenolato mofétil puede ser usado como un agente inductivo primario en recipientes de transplantes hepáticos e insuficiencia renal con el fín de evitar la nefrotoxicidad adicional debido a los medicamentos inmunosupresivos estandar de ciclosporina y tacrolimus. Dosis bajas de ciclosporina y tacrolimus pueden ser añadidas en el futuro después de una mejoría en la función renal.

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Lowe, Marcus, Robert Maidstone, Kay Poulton, Judith Worthington, Hannah J. Durrington, David W. Ray, David van Dellen, Argiris Asderakis, John Blaikley, and Titus Augustine. "Monthly variance in UK renal transplantation activity: a national retrospective cohort study." BMJ Open 9, no. 9 (September 2019): e028786. http://dx.doi.org/10.1136/bmjopen-2018-028786.

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ObjectiveTo identify whether renal transplant activity varies in a reproducible manner across the year.DesignRetrospective cohort study using NHS Blood and Transplant data.SettingAll renal transplant centres in the UK.ParticipantsA total of 24 270 patients who underwent renal transplantation between 2005 and 2014.Primary outcomeMonthly transplant activity was analysed to see if transplant activity showed variation during the year.Secondary outcomeThe number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates.ResultsAnalysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity.ConclusionUK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system.

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Ayorinde, John OO, Dominic M. Summers, Laura Pankhurst, Emma Laing, Alison J. Deary, Karla Hemming, Edward CF Wilson, Victoria Bardsley, Desley A. Neil, and Gavin J. Pettigrew. "PreImplantation Trial of Histopathology In renal Allografts (PITHIA): a stepped-wedge cluster randomised controlled trial protocol." BMJ Open 9, no. 1 (January 2019): e026166. http://dx.doi.org/10.1136/bmjopen-2018-026166.

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IntroductionMost potential kidney transplant donors in the UK are aged over 60 years, yet increasing donor age is associated with poorer graft survival and function. Urgent preimplantation kidney biopsy can identify chronic injury, and may aid selection of better ‘quality’ kidneys from this group. However, the impact of biopsy on transplant numbers remains unproven. The PreImplantation Trial of Histopathology In renal Allografts (PITHIA) study will assess whether the introduction of a national, 24 hours, digital histopathology service increases the number, and improves outcomes, of kidneys transplanted in the UK from older deceased donors.Methods and analysisPITHIA is an open, multicentre, stepped-wedge cluster randomised study, involving all UK adult kidney transplant centres. At 4-monthly intervals, a group of 4–5 randomly selected clusters (transplant centres) will be given access to remote, urgent, digital histopathology (total intervention period, 24 months). The trial has two primary end points: it is powered for an 11% increase in the proportion of primary kidney offers from deceased donors aged over 60 years that are transplanted, and a 6 mL/min increase in the estimated glomerular filtration rate of recipients at 12 months post-transplant. This would equate to an additional 120 kidney transplants performed in the UK annually. Trial outcome data will be collected centrally via the UK Transplant Registry held by NHS Blood and Transplant (NHSBT) and will be analysed using mixed effects models allowing for clustering within centres and adjusting for secular trends. An accompanying economic evaluation will estimate the cost-effectiveness of the service to the National Health Service.Ethics and disseminationThe study has been given favourable ethical opinion by the Cambridge South Research Ethics Committee and is approved by the Health Research Authority. We will present our findings at key transplant meetings, publish results within 4 years of the trial commencing and support volunteers at renal patient groups to disseminate the trial outcome.Trial registrationnumberISRCTN11708741; Pre-results.

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Kord, Ali, Enrico Benedetti, and James T. Bui. "Posttransplant Intrarenal Lymphangiectasia." Case Reports in Transplantation 2020 (July 21, 2020): 1–3. http://dx.doi.org/10.1155/2020/8824833.

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Renal lymphangiectasia is an extremely rare benign condition in the setting of transplanted kidneys. We describe a 50-year-old female with a past medical history of lupus nephritis and renal transplants who presented with right lower quadrant pain and was found to have intrarenal lymphangiectasia on imaging and laboratory tests. The patient was treated with percutaneous drainage initially and then wide peritoneal fenestration and omentoplasty. An extremely rare adult case with intrarenal lymphangiectasia thirteen months after kidney transplant was described in this study. Imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), plays a key role in the diagnosis of renal lymphangiectasia.

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Stechman, M. J., N. Charlwood, D. W. R. Gray, and A. Handa. "Administration of 75 mg of aspirin daily for 28 days is sufficient prophylaxis against renal transplant vein thrombosis." Phlebology: The Journal of Venous Disease 22, no. 2 (April 1, 2007): 83–85. http://dx.doi.org/10.1258/026835507780346187.

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Introduction: Early postoperative renal transplant vein thrombosis results in graft loss. We evaluate the effect of administering aspirin 75 mg daily for 28 days following transplantation. Methods: Prospectively collected data on the outcome of all transplants undertaken in our unit in the five-year period from January 1997 to January 2002 were reviewed, and in cases of graft failure before three months the cause was defined. Results: In the study period, a total of 401 transplants were undertaken (311 cadaveric and 90 living related). There was one case of renal transplant vein thrombosis (0.25%). This represents a significant reduction on the unit's historical incidence of 5.8%, P<0.001. Conclusion: Aspirin 75 mg daily is adequate to virtually abolish renal transplant vein thrombosis and has a role in thromboprophylaxis in other situations where heparin is contraindicated.

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RAKUSIN, ARIE, LEONARD P. CONNOLLY, and S. T. TREVES. "Intraperitoneal Renal Transplant Mobility The Transposed Transplant." Clinical Nuclear Medicine 24, no. 7 (July 1999): 530–31. http://dx.doi.org/10.1097/00003072-199907000-00017.

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MEIER-KRIESCHE, HERWIG-ULF, AKINLOLU O. OJO, FRIEDRICH K. PORT, JULIE A. ARNDORFER, DIANE M. CIBRIK, and BRUCE KAPLAN. "Survival Improvement among Patients with End-Stage Renal Disease: Trends over Time for Transplant Recipients and Wait-Listed Patients." Journal of the American Society of Nephrology 12, no. 6 (June 2001): 1293–96. http://dx.doi.org/10.1681/asn.v1261293.

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Abstract. Both transplant and dialysis outcomes have improved over recent years. In addition, transplantation has been shown to confer a survival benefit over maintenance dialysis. The study presented here addresses the question of whether the survival benefit of transplantation over maintenance dialysis has changed in the most recent eras. This study was based on data collected by the United States Renal Transplant Scientific Registry and the United States Renal Data System. The study sample consisted of 104,000 patients placed on the renal transplant waiting list between 1988 and 1996, of which 73,707 subsequently received renal transplants. The annualized adjusted mortality rates per 1000 patient-years were calculated by calendar year of placement on the renal transplant waiting list and for kidney transplant recipients. The resulting data were plotted, and linear curve fitting was used to estimate the slope of the change of the adjusted mortality rates by year during the period studied, 1988 to 1996. Overall annual adjusted death rates in the wait-listed patients and transplant recipients per 1000 patient-years decreased for both groups throughout the study period. From 1989 to 1996, the relative risk (RR) for patient death had decreased by 30% for transplant recipients and 23% for wait-listed patients (RR = 0.70 and 0.77; P < 0.0001 each). Slope analysis of the cause-specific mortality rates for cardiovascular disease and infection showed nearly equivalent, linear decreases for both groups. Mortality rates have improved overall and by categories of major cause of death for both renal transplant recipients and patients on the renal transplant waiting list. These favorable trends most likely represent equal advances in transplantation, dialysis, and general medical care.

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Toapanta, Néstor, Irina B. Torres, Joana Sellarés, Betty Chamoun, Daniel Serón, and Francesc Moreso. "Kidney transplantation and COVID-19 renal and patient prognosis." Clinical Kidney Journal 14, Supplement_1 (March 1, 2021): i21—i29. http://dx.doi.org/10.1093/ckj/sfab030.

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Abstract Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.

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Burns, Tania, Anna McGovern, Emma Van Hardeveld, Julie Haynes, Julie Reynolds, Kerry Dole, Kim Pickering, Paul Robertson, and Tarryn Isard. "“I’m a renal transplant coordinator”." Transplant Journal of Australasia 28, Number 1 (April 30, 2019): 20–26. http://dx.doi.org/10.33235/tja.28.1.20-26.

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The advance of renal replacement therapy options for people with end-stage kidney disease has given rise to the development of specialist renal nurses including the renal transplant coordinator. The renal transplant coordinator role requires a high level of specialist knowledge in renal and transplantation nursing plus a commitment to following through with people in the long term. To find out just what renal transplant coordinators in Australia do, an interview was conducted with renal transplant coordinators from each Australian state and territory. Their stories relate to transplanting units; referring centres; and, adult, paediatric, state-wide and national renal services. They demonstrate the diversity that exists within the role of the renal transplant coordinator.

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Bernstein, L. H., P. J. Russell, and J. M. Horenstein. "Urinary adenylate kinase activity as a predictor of renal allograft crises." Clinical Chemistry 31, no. 7 (July 1, 1985): 1151–54. http://dx.doi.org/10.1093/clinchem/31.7.1151.

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Abstract We examined data on adenylate kinase (EC 2.7.4.3) activity and other clinical chemical values from patients with renal transplants by analysis of variance and discriminant analysis, using various combinations of variables in an attempt to find a predictor of transplant rejection. Some typical data are presented. We conclude that the combination of urinary adenylate kinase and creatinine clearance is the best predictor for identifying patients with transient or destructive renal transplant crises.

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Seale, H., D. E. Dwyer, J. R. Chapman, and C. R. MacIntyre. "Cytomegalovirus Disease Amongst Renal Transplant Recipients in Australia and New Zealand." Virology: Research and Treatment 1 (January 2008): VRT.S920. http://dx.doi.org/10.4137/vrt.s920.

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Cytomegalovirus (CMV) is a significant pathogen causing disease in renal transplant patients. The highest incidence of CMV disease occurs during the first 3 months post-transplant and is most problematic in CMV-naïve transplant recipients. In this study, we conducted a retrospective review of two databases, the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the National Hospital Morbidity Database, from the Australian Institute of Health and Welfare (AIHW), to examine CMV in renal transplant recipients. The first source looked at CMV serostatus at the time of transplantation and the second recorded hospital admissions for recipients with invasive CMV disease. From the ANZDATA registry, we obtained information from 13,530 renal transplants recipients from 1980 to 2004. Of these recipients, 7808 had a known CMV serostatus, of which 65.7% (5134/7808) had a positive sero antibody status and 34.2% (2674/7808) had a negative sero antibody status. In univariate analysis, factors significantly associated with renal rejection were being male, recipient age <50 years, being diabetic, being diagnosed with cancer at some point and having a positive EBV status. Positive CMV serostatus was not a contributing factor. Between 1993 and 2001 there were 1445 renal transplant recipients hospitalized in Australia with a diagnosis of CMV disease, of which 38% (554/1445) had CMV disease as a principal diagnoses. The average annual rate of admissions with any diagnosis was 3871 episodes per 100,000 people living with a functioning graft. Preventative strategies for CMV in renal transplant recipients should be a priority. New vaccines for CMV may soon be available and renal transplant recipients would be a suitable target group for vaccination.

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Sakhuja, Ankit, R. Scott Wright, Jesse D. Schold, James T. McCarthy, Amy W. Williams, Hatem Amer, and Robert C. Albright. "National Impact of Maintenance Dialysis or Renal Transplantation on Outcomes Following ST Elevation Myocardial Infarction." American Journal of Nephrology 44, no. 5 (2016): 329–38. http://dx.doi.org/10.1159/000450834.

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Background: Though cardiovascular disease is an important cause of mortality in patients with end-stage renal disease, epidemiology of ST-elevation myocardial infarction (STEMI) is less well described in this population. Methods: This study included STEMI hospitalizations in patients aged ≥20 using Nationwide Inpatient Sample Database from 2006 to 2010. Primary outcomes were incidence and trends of STEMI hospitalizations based on renal function status. We also looked at utilization of revascularization procedures, all-cause-hospital mortality and predictors of mortality. Results: Of the estimated 882,447 STEMI hospitalizations, 11,383 were on maintenance dialysis and 1,076 had renal transplants. The incidence of STEMI was over 7 times in patients on maintenance dialysis and 1.73 times in renal transplant recipients compared to the general population. This incidence has however declined in those on maintenance dialysis (p for trend <0.001) to a greater extent than the general population and patients with renal transplant. Utilization of revascularization procedures was lowest in patients on maintenance dialysis (51.6 vs. 73.3% in renal transplant recipients and 77.0% in general population; p < 0.001) and mortality was highest (21.6 vs. 10.9 vs. 6.8%; p < 0.001). Being on maintenance dialysis or having a renal transplant were both independent predictors of mortality in patients hospitalized with STEMI. There was a differential effect of cardiac catheterization on odds of mortality with lesser impact in patients on maintenance dialysis. Conclusions: STEMI hospitalizations are more common in patients on maintenance dialysis and with renal transplants. The utilization of revascularizations procedures remains low and mortality high in these patients.

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Ghonge, Nitin P., Nidhi Goyal, Sandeep Vohra, and Veena Chowdhury. "Renal transplant evaluation: multimodality imaging of post-transplant complications." British Journal of Radiology 94, no. 1124 (August 1, 2021): 20201253. http://dx.doi.org/10.1259/bjr.20201253.

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With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive “one-stop” modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist”s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.

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Robert, Maxime, Pierre Sarkis, François Iborra, Georges Mourad, and Jacques Guiter. "Serial Renal Transplant Surgery: Technical Reflections Concerning Third Transplants." Urologia Internationalis 55, no. 2 (1995): 84–87. http://dx.doi.org/10.1159/000282757.

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Davins, Meritxell, Secundino Llagostera, Rocio Jimenez, Antonio Rosales, Josep Maria Romero, and Joan Manuel Diaz. "Aortofemoral Bypass to Bridge End-Stage Renal Disease Patients with Severe Iliac Calcification to Kidney Transplantation." Vascular 17, no. 5 (January 1, 2009): 269–72. http://dx.doi.org/10.2310/6670.2009.00044.

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Patients undergoing hemodialysis have a lower survival rate than those who receive a kidney transplant. Mortality among hemodialysis patients is approximately 14.5% compared with 1.5% for transplant recipients. One of the exclusion criteria for renal transplant is severe iliac artery calcification. We performed an aortofemoral bypass in these patients to make them eligible for renal transplantation. Eleven patients were selected to receive an aortofemoral bypass. All had severe calcification of iliac arteries. Eight patients required a bypass from the thoracic aorta and two from the infrarenal level. Revascularization was successful in 10 patients. Patency was 100%. Surgery could not be performed in one owing to severe calcification of the femoral artery. One patient died owing to gastrointestinal bleeding. Two patients developed complications; one needed a splenectomy, and the other developed meningitis and paralytic ileus. To date, four patients have received transplants, and the viability of the transplanted kidney is good in all cases. Renal transplantation is the only method known to improve survival and quality of life for hemodialysis patients. We consider that if patients with severe iliac calcification are well informed of the morbidity and mortality risk of an aortic bypass, this intervention can be justified in this setting.

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BAID, SEEMA, MANUEL PASCUAL, WINFRED W. WILLIAMS, NINA TOLKOFF-RUBIN, STEPHEN M. JOHNSON, BERNARD COLLINS, RAYMOND T. CHUNG, FRANCIS L. DELMONICO, A. BENEDICT COSIMI, and ROBERT B. COLVIN. "Renal Thrombotic Microangiopathy Associated with Anticardiolipin Antibodies in Hepatitis C-Positive Renal Allograft Recipients." Journal of the American Society of Nephrology 10, no. 1 (January 1999): 146–53. http://dx.doi.org/10.1681/asn.v101146.

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Abstract. Hepatitis C virus (HCV) infection has been associated with de novo or recurrent membranoproliferative glomerulonephritis and acute transplant glomerulopathy in transplanted kidneys. Recently, anticardiolipin antibodies (ACA) have been linked with chronic HCV infection. A few reports have suggested an association between ACA and renal allograft thrombosis. This study examines the clinical and pathologic features of HCV-positive renal allograft recipients at our institution. From 1990 to 1996, 379 kidney transplants were performed. We identified 18 recipients (4.8%) with HCV-positive serology pretransplant. Determination of IgG and IgM ACA was performed by enzyme-linked immunosorbent assay, using pretransplant sera. Among the 18 patients, five patients presented with biopsy-proven de novo renal thrombotic microangiopathy (RTMA), occurring 5 to 120 d (median, 14 d) after transplant. No differences in pretransplant characteristics were observed between patients with (n = 5) or without (n = 13) RTMA. All five patients had a positive ACA test (either IgG or IgM titer > 2 SD above normal), compared with only one of 13 patients without RTMA. The mean value for IgG ACA was significantly higher in the RTMA patients than in patients without RTMA (22.9 ± 14.1 versus 6.9 ± 4.9 IgG phospholipid units, P = 0.02); however, there were no significant differences in IgM ACA titers. Rheumatoid factor and complement C4 levels were normal in pretransplant sera of patients with RTMA. Patients with RTMA had their cyclosporine withdrawn (four of five) or the dose was decreased (one of five), and one of five underwent plasmapheresis. Four of five patients died within 5 yr after transplant, compared with no deaths in the other 13 patients. Finally, as a control group, seven HCV-negative renal allograft recipients who presented with RTMA/hemolytic uremic syndrome during the same time period were found to have normal ACA values (IgG or IgM). RTMA associated with ACA in HCV-positive renal allograft recipients may represent a new clinical entity. The occurrence of this syndrome may have deleterious consequences for patient and graft survival.

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Quinn, Caroline S., Margaret R. Jorgenson, Jillian L. Descourouez, Brenda L. Muth, Brad C. Astor, and Didier A. Mandelbrot. "Management of Tumor Necrosis Factor α Inhibitor Therapy After Renal Transplantation: A Comparative Analysis and Associated Outcomes." Annals of Pharmacotherapy 53, no. 3 (September 20, 2018): 268–75. http://dx.doi.org/10.1177/1060028018802814.

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Background: Biologic agents inhibiting the tumor necrosis factor α pathway (TNFα-Is) are used to treat systemic inflammatory diseases. The best management of these agents after renal transplantation is unknown. Objective: Evaluate peritransplant use of TNFα-Is and associated outcomes. Methods: Retrospective, single-center study of adult renal-transplant-recipients (RTRs) transplanted between 1/1/1998-12/31/2017, who received TNFα-Is for inflammatory disease prior to transplant. Qualifying patients were divided into 2 cohorts: patients who resumed TNFα-Is after transplant and those who did not. Outcomes were evaluated. Results: A total of 5256 renal transplants occurred in the study window; 14 patients met inclusion criteria. Primary indication for TNFα-I was Crohn’s-disease (CD; 57.1%). Infliximab was utilized most frequently (50%). Seven RTRs resumed TNFα-I posttransplant; mean time to resumption of 10.6±4.35 months (median=6 months), 85.7% for CD. Immunosuppression was modified in 2 patients (28.6%) in response to restarting TNFα-I therapy. Seven RTRs did not resume TNFα-Is following transplant; the majority of these had rheumatic diseases. There was no significant difference in time to first bacterial or fungal infection, rejection, or patient survival between the 2 groups. Last measured estimated glomerular-filtration-rate was similar between groups (TNFα-I: 41 ± 14.2 vs 48.6 ± 8.6, P = 0.25). No patient had cytomegalovirus infection; however, 42.8% of each cohort had documented BK virus infection. Malignancy occurred more frequently in the cohort that resumed TNFα-Is (42.8% vs 14.3%, P = 0.24); however, this was not statistically significant. Conclusion and Relevance: TNFα-I therapy prior to renal-transplant is relatively uncommon. The decision to continue therapy after transplant must balance risks of infection and malignancy against inflammatory disease recurrence. A multidisciplinary treatment approach is necessary as use of TNFα-I affects immunosuppressive management and appears to affect transplant outcomes. Future studies are needed to further clarify the role of TNFα-I therapy use in RTRs with inflammatory disorders focusing on its correlation with both BK and malignancy.

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Smith, H. J., and S. J. Bakke. "MR Angiography of in Situ and Transplanted Renal Arteries." Acta Radiologica 34, no. 2 (March 1993): 150–55. http://dx.doi.org/10.1177/028418519303400210.

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Three-dimensional (3D) time-of-flight (TOF) MR angiography (MRA) was performed in 34 patients with suspected renal artery disease. In situ (i.e., nontransplanted) renal arteries were studied with MRA in 14 patients. Of these, 12 had conventional angiography for comparison. Twenty-four MRAs of transplanted renal arteries were obtained in 20 patients; 8 of these had angiography as well. Significant stenoses of in situ renal arteries were diagnosed with a sensitivity of 100% and a specificity of 95%. The stenoses were all proximal; 3D TOF MRA proved inadequate for depiction of peripheral renal arteries. MRA and angiography showed good agreement between findings in 7 of 8 patients with renal transplants. In one patient with a renal transplant, MRA showed a significant stenosis of the arterial anastomosis which appeared completely normal at i.a. DSA, indicating that findings at MRA still need to be confirmed by more established alternative methods.

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Arregui Garcia, Irati, Matilde Elía López, Aitziber Aguinaga Pérez, Joaquín Manrique Escola, and Carmen Ezpeleta Baquedano. "Cryptosporidiosis in immunosuppressed renal transplant patient." Revista Española de Quimioterapia 34, no. 2 (February 26, 2021): 164–66. http://dx.doi.org/10.37201/req/136.2020.

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Journal articles on the topic 'Renal Transplant'

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