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Opportunistic Infections in Renal Transplantation
—A Case Series
 [PDF]

Rita Sampaio, José Palla Garcia, Leonídio Dias, La Salete Martins, José Ramón Vizcaíno
Open Journal of Pathology (OJPathology) , 2017, DOI: 10.4236/ojpathology.2017.71002
Abstract: Background: Porto’s Hospital Centre is one of the most active Portuguese hospitals in renal transplantation (performed since 1983). Although increasingly rare, opportunistic infections in transplanted patients are associated with high mortality rate in kidney transplantation and remain a major diagnostic challenge. Methods: We investigated 2041 cases of hospital admissions (from 2004 to 2012), any time after kidney transplantation. We described the infection location, the diagnostic techniques used and the mortality after the infection. Results: We found 82 cases of opportunistic infection caused by Herpes virus (Zoster and simplex), Cytomegalovirus, Polyomavirus, Aspergilus, Alternaria, Mucorales, Candida, Mycobacterium tuberculosis, Cryptococcus and Pneumocystis. Conclusions: In this article we highlight the important role of histology/cytology in the diagnostic process of these infections. In many cases prompt diagnosis and treatment are necessary to avoid life-threatening complications and may greatly improve prognosis.
Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature
Polytimi Leonardou, Sofia Gioldasi, George Zavos, Paris Pappas
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-59
Abstract: Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.The incidence of mycotic aneurysm formation following renal transplantation is < 1%. A non-mycotic etiology for aneurysm formation in the same setting has also been recorded [1-3]. An aneurysm may be asymptomatic, being an incidental finding during imaging evaluation for other reasons, yet it can occasionally cause fever and anemia, iliac fossa discomfort, renal dysfunction and graft loss or even precipitate a lethal hemorrhage due to acute rupture [4]. Early recognition of this entity based on a high index of suspicion and use of early diagnostic procedures is vital for its successful management. Therapeutic options include aneurysmectomy, proximal and distal ligation of the arterial trunk, medical treatment and percutaneous embolization, although the choice of prompt treatment strategy is still a subject of debate, requiring further delineation.We report the cases of five patients suffering from this life-threatening complication and present the therapeutic procedures used and their long-term outcomes together with a literature review on this topic.The first case is a 42-year-old Caucasian man, who was on hemodialysis after rejec
Pediatric Renal Transplantation
B. Saeed
International Journal of Organ Transplantation Medicine , 2012,
Abstract: Although the number of children with end-stage renal disease (ESRD) in need for renal transplantationis small compared with adults, the problem associated with renal transplant in childrenare numerous, varied, and often peculiar. Pre-emptive transplantation has recently beengrowing in popularity as it avoids many of the associated long-term complications of ESRDand dialysis. Changes in immunosuppression to more potent agents over the years will haveaffected transplant outcome; there is also evidence that tacrolimus is more effective than cyclosporine.This review will discuss the short- and long-term complications such as acute andchronic rejection, hypertension, infections, and malignancies as well as factors related to longtermgraft function.Chronic allograft nephropathy is the leading cause of renal allograft loss in pediatric renal transplantrecipients. It is likely that it reflects a combination of both immune and nonimmune injuryoccurring cumulatively over time so that the ultimate solution will rely on several approaches.Transplant and patient survival have shown a steady increase over the years. The major causesof death after transplantation are cardiovascular disease, infection and malignancy. Transplantationin special circumstances such as children with abnormal urinary tracts and children withdiseases that have the potential to recur after transplantation will also be discussed in this review.Non-compliance with therapeutic regimen is a difficult problem to deal with and affectspatients and families at all ages, but particularly so at adolescence. Growth may be severelyimpaired in children with ESRD which may result in major consequences on quality of lifeand self-esteem; a better height attainment at transplantation is recognized as one of the mostimportant factors in final height achievement.Although pediatric kidney transplantation is active in some parts of many developing countries,it is still inactive in many others and mostly relying on living donors. The lacking deceasedprograms in most of these countries is one of the main issues to be addressed to adequatelyrespond to organ shortage.In conclusion, transplantation is currently the best option for children with ESRD. Although improvementin immunosuppression demonstrated excellent results and has led to greater 1-yeargraft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectiouscomplications remain a problem
Organ transplantation from deceased donors with cancer: is it safe?
Nalesnik MA,Ison MG
Open Access Surgery , 2011,
Abstract: Michael A Nalesnik1, Michael G Ison21Division of Transplantation and Hepatic Pathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburg, PA, USA; 2Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: The availability of donor organs continues to be insufficient to meet the needs of patients actively waiting for transplant. Consequently, there is continuing pressure to increase the donor organ pool while simultaneously assuring safety for the recipient population. The complication of donor malignancy transmission has been documented almost from the beginning of transplantation, and continues to be a concern today. The anecdotal nature of case reports and compiled series ensures that clinical decisions related to organ use from donors with malignancy will of necessity continue to be made on the basis of low-level evidence. Despite this limitation, the literature indicates that not all donor neoplasms have the same risk for transmission to the recipient, and it is necessary to consider the specific malignancy affecting the donor, as well as the condition of the recipient, before a decision is made to transplant or discard a given organ. Published cases suggest that certain forms of neoplasia, such as melanoma, choriocarcinoma, sarcoma, small cell carcinoma, or metastatic carcinomas serve as strong contraindications to organ donation. In contrast, considerable experience exists to suggest that certain tumors of the central nervous system, small subclinical prostate carcinomas, or small renal cell carcinomas resected prior to transplant, among other tumors, should not in themselves disqualify an individual from donating organs in the appropriate circumstance. This review presents the case for considering organ transplantation in the setting of certain donor malignancies and discusses factors to be weighed in such decisions. Additionally, donors with a history of cancer are considered, and features that may aid in reaching a conclusion for or against transplantation of organs from these patients are presented.Keywords: organ transplantation, donor organs, malignancy, complications
Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation  [cached]
Akbarzadehpasha Abazar,Oliaei Farshid,Asrari Mohammad Reza,Alizadeh-Navaei Reza
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Long-term immunosuppressive therapy after renal transplantation increases the risk of developing malignancy. The aim of this study was to determine the demographic parameters and immunosupression protocol in kidney transplant recipients with and without malignancy. This case-control study was undertaken on 12 renal transplant recipients with malignancy and 48 with-out malignancy at The Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Data including age, gender, number of anti-rejection therapies and immunosupression regimen were recorded and analyzed with SPSS and Mann-Whitney Fisher′s exact t-test. P value < 0.05 was considered significant. The prevalence of malignancy in 380 renal allograft recipients was 3.15% during six years of follow-up. The malignancies noted after renal transplantation included: Kaposi′s sarcoma (n = 5), lymphoma (n = 3), cutaneous basal cell carcinoma (n = 2), cutaneous squamous cell carcinoma (n = 1) and brain tumor (n = 1). Age of patients at the time of trans-plantation, duration of immunosupression treatment and number of anti-rejection therapies were not significantly different in patients with and without malignancy (P > 0.05). Males were signi-ficantly more affected with malignancy compared to females (P < 0.05). Our study shows that there was no significant correlation between age at transplantation, duration of immunosupression treatment and number of anti-rejection therapies and occurrence of post-renal transplantation malignancy; however, the prevalence of malignancy was significantly higher in male patients. The most common malignancy seen was Kaposi′s sarcoma followed by lymphoma.
Etiology of renal failure and peritoneal dialysis complications in Isfahan  [PDF]
Soheila Mojdeh, Shirin Karimi, Ali Mehrabi, Soheila Bakhtiari
Health (Health) , 2013, DOI: 10.4236/health.2013.510229
Abstract:

Introduction: Worldwide specific diseases are jeopardizing people’s health in the world as well as in Iran. Chronic renal failure as a developed and irreversible failure is usually progressive. End Stage Renal Disease (ESRD) is a situation when renal function is not sufficient to preserve one’s life leading to acute uremia resulting in dialysis and/or kidney transplantation for the patients. Although dialysis methods bring about complications for the patients, peritoneal dialysis is relatively cost-effective and more convenient to survive. The present study aimed to investigate (the) Etiologic factor of renal failure and imposed complications of peritoneal dialysis in the patients of Isfahan Alzahra hospital. Materials and Methods: It was a cross-sectional descriptive study conducted on 67 patients in Isfahan Peritoneal Dialysis Center. The data from the patients were collected through a two-section questionnaire whose first section was allocated to demographic information and the second part was related to the disease and complications of peritoneal dialysis. The collected data were analyzed by SPSS version 18. Results: The findings showed that there were 39 (58%) males and 28 (42%) females. Mean age of the subjects was 48 (18.8) years old. Regarding marital status, 65% were married and 35% were single. Considering complications, 28 subjects (53.5%) had infectious complications while 24 subjects (46.2%) had non-infectious complications. The highest frequency in etiologic factor of renal failure was diabetes mellitus in 29 subjects (43.9%) and the lowest for polycystic kidney in 2 subjects (3%); in addition, hypertension was observed in 51 subjects (77.3%). Discussion: The most frequent and important complication of peritoneal dialysis catheters is infection, whic

Incidence of Malignancy after Living Kidney Transplantation: A Multicenter Study from Iran  [cached]
Behzad Einollahi, Zohreh Rostami, Mohammad Hossein Nourbala, Mahboob Lessan-Pezeshki, Naser Simforoosh, Eghlim Nemati, Vahid Pourfarziani, Fatemeh Beiraghdar, Mohsen Nafar, Fatemeh Pour-Reza-Gholi, Mitra Mahdavi Mazdeh, Manochehr Amini, Pedram Ahmadpour
Journal of Cancer , 2012,
Abstract: Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.
Organ transplantation from deceased donors with cancer: is it safe?
Nalesnik MA, Ison MG
Open Access Surgery , 2011, DOI: http://dx.doi.org/10.2147/OAS.S14720
Abstract: gan transplantation from deceased donors with cancer: is it safe? Review (2674) Total Article Views Authors: Nalesnik MA, Ison MG Published Date August 2011 Volume 2011:4 Pages 11 - 20 DOI: http://dx.doi.org/10.2147/OAS.S14720 Michael A Nalesnik1, Michael G Ison2 1Division of Transplantation and Hepatic Pathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburg, PA, USA; 2Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: The availability of donor organs continues to be insufficient to meet the needs of patients actively waiting for transplant. Consequently, there is continuing pressure to increase the donor organ pool while simultaneously assuring safety for the recipient population. The complication of donor malignancy transmission has been documented almost from the beginning of transplantation, and continues to be a concern today. The anecdotal nature of case reports and compiled series ensures that clinical decisions related to organ use from donors with malignancy will of necessity continue to be made on the basis of low-level evidence. Despite this limitation, the literature indicates that not all donor neoplasms have the same risk for transmission to the recipient, and it is necessary to consider the specific malignancy affecting the donor, as well as the condition of the recipient, before a decision is made to transplant or discard a given organ. Published cases suggest that certain forms of neoplasia, such as melanoma, choriocarcinoma, sarcoma, small cell carcinoma, or metastatic carcinomas serve as strong contraindications to organ donation. In contrast, considerable experience exists to suggest that certain tumors of the central nervous system, small subclinical prostate carcinomas, or small renal cell carcinomas resected prior to transplant, among other tumors, should not in themselves disqualify an individual from donating organs in the appropriate circumstance. This review presents the case for considering organ transplantation in the setting of certain donor malignancies and discusses factors to be weighed in such decisions. Additionally, donors with a history of cancer are considered, and features that may aid in reaching a conclusion for or against transplantation of organs from these patients are presented.
Malignancy in a cryptorchid testis with renal agenesis
Shatha Ali Al Hilli,Nabir Syed
Journal of Emergency Medicine, Trauma and Acute Care , 2012, DOI: 10.5339/jemtac.2012.6
Abstract: Malignancy in undescended testis is well documented. We present a rare case—of seminoma in an adult male found in an intra abdominal testis—that is associated with ipsilateral renal agenesis and absence of ipsilateral seminal vesicle.
Renal Transplantation in the Elderly
J. Jones,W. Bentas,S. W. Melchior
Transplantationsmedizin , 2008,
Abstract: The increasing number of elderly dialysis patients together with the constant lack of organs challenges us to inquire whether renal transplants in the elderly is acceptable at all and particularly whether there is a survival benefit as compared to dialysis in this population. Some representative studies are presented here overviewing this issue. Present data clearly suggest that renal transplantation provides a survival advantage in the elderly as compared to dialysis.
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