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Begum NAS, Kashem TS, Nobi F, Arefin SUZ, Rashid HU. Experiences of performing ABO-incompatible kidney transplantation in Bangladesh. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:111-118. [PMID: 35919197 PMCID: PMC9296974 DOI: 10.4285/kjt.22.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The number of end-stage renal disease (ESRD) patients is increasing in Bangladesh. Currently, living kidney donation is the only viable option for transplantation in Bangladesh, and it is further restricted by ABO compatibility issues. We have performed ABO-incompatible kidney transplantations (ABOi KTs) in Bangladesh since 2018. This study examines our experiences with seven cases of ABOi KT. Methods The desensitization protocol included low-dose rituximab (100 mg/body) followed by plasma exchange (PEX), which was followed by a 5-g dose of intravenous immunoglobulin. Immunosuppression was undertaken using tacrolimus (0.1 mg/kg/day), mycophenolate mofetil (1,500 mg/day), and prednisolone (0.5 mg/kg/day). All patients received basiliximab for induction therapy. Results The median baseline anti-ABO antibody titer was 164 (range, 132–1128). Transplantation was performed at a titer of ≤18. Our patients attended three to five PEX sessions before transplantation. Graft survival was 100% in the seven cases over a mean period of 22 months. The mean creatinine level was 204.6±47.4 µmol/L. Two patients were suspected of having developed acute rejection and received intravenous methylprednisolone, resulting in improved kidney function. One patient required posttransplant hemodialysis due to delayed graft function and subsequently improved. Infection was the most common complication experienced by ABOi KT patients. Two patients developed severe cytomegalovirus pneumonia and died with functioning grafts. Conclusions ABOi KT in Bangladesh will substantially expand the living kidney donor pool and bring hope to a large number of ESRD patients without ABO-compatible donors. However, the high cost and risk of acute rejection and infection remain major concerns.
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Affiliation(s)
- Nura Afza Salma Begum
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Tasnuva Sarah Kashem
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Farnaz Nobi
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Shakib Uz-Zaman Arefin
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
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Damázio LODA, Lins EM, Ferraz ÁAB, Bezerra CDM, Carvalho Neto FACB, de Oliveira LLR, da Costa MCS, Santos PMC. Padrões tomográficos de agentes etiológicos da pneumonia durante o primeiro ano após transplante renal. Radiol Bras 2022; 55:84-89. [PMID: 35414733 PMCID: PMC8993179 DOI: 10.1590/0100-3984.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objetivo Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. Materiais e Métodos Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. Resultados Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. Conclusão Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.
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Affiliation(s)
- Luiz Otávio de Andrade Damázio
- Instituto de Medicina Integral Professor Fernando
Figueira (IMIP), Recife, PE, Brasil
- Faculdade Pernambucana de Saúde (FPS), Recife,
PE, Brasil
| | - Esdras Marques Lins
- Instituto de Medicina Integral Professor Fernando
Figueira (IMIP), Recife, PE, Brasil
- Faculdade Pernambucana de Saúde (FPS), Recife,
PE, Brasil
- Universidade Federal de Pernambuco (UFPE), Recife, PE,
Brasil
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Hiramitsu T, Tomosugi T, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Adult Living-Donor Kidney Transplantation, Donor Age, and Donor-Recipient Age. Kidney Int Rep 2021; 6:3026-3034. [PMID: 34901571 PMCID: PMC8640566 DOI: 10.1016/j.ekir.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Owing to organ shortage, the number of kidney transplantation (KT) involving older adult living donors is increasing. We aimed to investigate the effects of living-donor age and donor-recipient age differences on KT outcomes. METHODS This single-center, retrospective cohort study involved 853 adult LDKTs performed between January 2008 and December 2018. Recipients were stratified into the following 5 groups based on donor age and donor-recipient age difference: donor age, 30 to 49 years and age difference, -10 to 15 years; donor age, 50 to 69 years and age difference, -10 to 15 years; donor age, 50 to 69 years and age difference, 15 to 40 years; donor age, 70 to 89 years and age difference, -10 to 15 years; and donor age, 70 to 89 years and age difference, 15 to 40 years (groups 1, 2, 3, 4, and 5, respectively). As a primary outcome, the risk of graft loss was investigated. The secondary outcomes were postoperative estimated glomerular filtration rates (eGFRs) and mortality rates of recipients. RESULTS Group 4, representing KT between older adult donors and older adult recipients, had the highest graft loss risk and mortality. The eGFRs of the recipients from donors aged 70 to 89 years (groups 4 and 5) were significantly lower than those from donors in the other groups. Although the differences in the eGFR between groups 4 and 5 were not significant, the eGFR of group 4 was lower than that of group 5 at 6 months post-KT. CONCLUSION LDKTs from older adult donors to older adult recipients resulted in the worst graft survival and mortality rates.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
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Mangalgi S, Madan K, Das CJ, Singh G, Sati H, Kanwar Yadav R, Xess I, Singh S, Bhowmik D, Agarwal SK, Bagchi S. Pulmonary infections after renal transplantation: a prospective study from a tropical country. Transpl Int 2021; 34:525-534. [PMID: 33423313 DOI: 10.1111/tri.13817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023]
Abstract
Pulmonary infection is a leading cause of morbidity and mortality in renal transplant recipients. In a prospective study, we characterized their epidemiology in a tropical country with high infectious disease burden. Adult renal transplant recipients presenting with pulmonary infections from 2015 to 2017 were evaluated using a specific diagnostic algorithm. 102 pulmonary infections occurred in 88 patients. 32.3% infections presented in the first year, 31.4% between 1 and 5, and 36.3% beyond 5 years after transplantation. Microbiological diagnosis was established in 69.6%, and 102 microorganisms were identified. Bacterial infection (29.4%) was most common followed by tuberculosis (23.5%), fungal (20.6%), Pneumocystis jiroveci (10.8%), viral (8.8%), and nocardial (6.9%) infections. Tuberculosis(TB) and bacterial infections presented throughout the post-transplant period, while Pneumocystis (72.7%), cytomegalovirus (87.5%) and nocardia (85.7%) predominantly presented after >12 months. Fungal infections had a bimodal presentation, between 2 and 6 months (33.3%) and after 12 months (66.7%). Four patients had multi-drug resistant(MDR) TB. In 16.7% cases, plain radiograph was normal and infection was diagnosed by a computed tomography imaging. Mortality due to pulmonary infections was 22.7%. On multivariate Cox regression analysis, use of ATG (HR-2.39, 95% CI: 1.20-4.78, P = 0.013), fungal infection (HR-2.14, 95% CI: 1.19-3.84, P = 0.011) and need for mechanical ventilation (9.68, 95% CI: 1.34-69.82, P = 0.024) were significant predictors of mortality in our patients. To conclude, community-acquired and endemic pulmonary infections predominate with no specific timeline and opportunistic infections usually present late. Nocardiosis and MDR-TB are emerging challenges.
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Affiliation(s)
- Shreepriya Mangalgi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, New Delhi, India
| | - Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hemchandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kanwar Yadav
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Menon J, Hakeem AR, Rammohan A, Sundaramoorthy S, Kanagavelu RG, Reddy MS, Rela M. Living Donor Liver Transplantation During the COVID-19 Pandemic: A Serendipitous Silver Lining! Transplantation 2021; 105:e20-e21. [PMID: 33492114 DOI: 10.1097/tp.0000000000003574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jagadeesh Menon
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
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Korneffel K, Gehring B, Rospert D, Rees M, Ortiz J. BK Virus in Renal Transplant Patients Using Alemtuzumab for Induction Immunosuppression. EXP CLIN TRANSPLANT 2020; 18:557-563. [DOI: 10.6002/ect.2019.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The Inhibition of P-Selectin Reduced Severe Acute Lung Injury in Immunocompromised Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8430465. [PMID: 32377309 PMCID: PMC7196163 DOI: 10.1155/2020/8430465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 01/05/2023]
Abstract
In an immunocompetent host, excess infiltration of immune cells in the lung is a key factor in infection-induced severe acute lung injury. Kidney transplant patients are immunocompromised by the use of immunosuppressive drugs. Immune cell infiltration in the lung in a renal transplant recipient suffering from pulmonary infection is significantly less than that in an immunocompetent host; however, the extent of lung injury in renal transplant patients is more serious than that in immunocompetent hosts. Therefore, we explored the role of platelet activation in a Klebsiella pneumoniae-induced lung injury model with P-selectin gene knockout mice or wild-type mice. Our study suggested that the inhibition of platelets reduced severe acute lung injury and increased survival after acute lung infection in mice. In addition, P-selectin expression on the surface of platelets in mice increased after administration of immunosuppressive drugs, and the extent of lung injury induced by infection decreased in P-selectin gene knockout mice. In conclusion, p-selectin plays a key role in severe acute lung injury in immunocompromised mice by reducing platelet activation and inflammatory processes.
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Taoka R, Tanaka K, Sofue T, Abe Y, Naito H, Miyauchi Y, Matsuoka Y, Tajima M, Kato T, Tsunemori H, Ueda N, Nishiyama Y, Minamino T, Sugimoto M, Kakehi Y. Body Fat Area as a Predictive Marker of New-Onset Diabetes Mellitus After Kidney Transplantation. Transplant Proc 2019; 51:3281-3285. [PMID: 31635839 DOI: 10.1016/j.transproceed.2019.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND New-onset diabetes after kidney transplantation (NODAT) adversely affects patient survival. Excessive fat accumulation is generally considered a risk factor of NODAT. Body mass index (BMI) and abdominal circumference (AC) are frequently used to assess fat accumulation but cannot directly measure it. This study measured body fat area (BFA) via computed tomography and aimed to clarify whether preoperative BFA can predict the development of NODAT more accurately than BMI and AC. METHODS This retrospective study included 62 patients without diabetes mellitus who received living-donor kidney transplantation at our institute between July 2005 and April 2016. We investigated the association between preoperative BMI, AC, and BFA and the development of NODAT. RESULTS Eight patients (12.9%) developed NODAT during a mean follow-up period of 78.1 months. The preoperative BMI, AC, and BFA were markedly higher in NODAT patients than in patients without NODAT (P = .05, P = .02, P < .01, respectively). Correlation analyses revealed that BFA had a strong relationship with BMI (r = 0.68, P < .01) and AC (r = 0.77, P < .01). Receiver operating characteristic curve analyses demonstrated that BFA, compared to BMI and AC, had considerable predictive accuracy for the development of NODAT, with an area under the curve of 0.803 (sensitivity 75%, specificity 87%). CONCLUSIONS Preoperative BFA could be a predictive marker of NODAT in renal graft recipients. Our findings underline the importance of routine preoperative BFA measurements in clinical practice.
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Affiliation(s)
- Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Kenichi Tanaka
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yohei Abe
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hirohito Naito
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuyuki Miyauchi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Motofumi Tajima
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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