Kidney transplantation

Equine Anti-Thymocyte Globulin (ATGAM) administration in patient with previous rabbit Anti-Thymocyte Globulin (Thymoglobulin) induced serum sickness: A case report

Published on: 23rd March, 2018

OCLC Number/Unique Identifier: 7666273824

Thymoglobulin is a rabbit-derived anti-thymocyte antibody directed at T-cells and commonly used for induction immunosuppression therapy in solid organ transplantation, especially in immunologically high risk kidney transplant recipients. Despite its frequent use and efficacy, the heterologous makeup of thymoglobulin can induce the immune system resulting in serum sickness which typically presents with rash, fever, fatigue, and poly-arthralgia in the weeks following drug exposure. ATGAM is another anti-thymocyte antibody, targeting the same epitopes, but differs from thymoglobulin by the animal in which the preparations are generated (equine vs. rabbit). Herein, we present a case of a patient with a known history of thymoglobulin-induced serum sickness, who presented with evidence of acute cellular and vascular rejection at their 12-month post-operative visit. Given their immunologically high risk status, they were successfully treated with ATGAM with improvement in their rejection and kidney function. To the author’s knowledge, this is the first case report of successful administration of ATGAM in a patient with a documented history of thymoglobulin induced serum sickness, demonstrating a possible treatment option for acute rejection in patients with reactions to thymoglobulin. 
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Urine Leak Following Kidney Transplantation: An Evidence-based Management Plan

Published on: 2nd October, 2018

OCLC Number/Unique Identifier: 7869210591

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.
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The value of routine ultrasound at discharge to identify patients at risk of developing symptomatic lymphoceles after kidney transplantation: A case-cohort study

Published on: 9th July, 2019

OCLC Number/Unique Identifier: 8199192017

Introduction: Ultrasound examination is frequently used to evaluate the graft after renal transplantation and to detect possible lymphoceles. The first ultrasound scan in our hospital is normally performed on the day of discharge. We questioned whether perirenal fluid collections detected by ultrasound examination at discharge are predictive for future symptomatic lymphoceles. Methods: All ultrasound reports of all renal transplant recipients treated in our hospital between January 2010 and December 2017 were collected and screened for abnormalities such as fluid collections. Patients that developed a symptomatic lymphocele were compared with a control group from the same cohort. Sensitivity and specificity of ultrasound examination to detect symptomatic lymphoceles were calculated for the primary and consecutive ultrasounds tests. Results: There were no significant differences at baseline characteristics between the Symptomatic lymphocele group and control group, with the exception of mean age at kidney transplantation (47 ± 17 years in the control group vs. 56 ± 13 years in the symptomatic lymphocele group, p=0.02). The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%. Conclusion: Routinely use of ultrasound testing on the day of discharge does detect perirenal fluid collections, but is not predictive for development of symptomatic lymphoceles in the future.
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Specific meningoencephalitis in patients with transplanted kidney

Published on: 17th June, 2020

OCLC Number/Unique Identifier: 8628628844

We described a case of specific (tuberculous) encephalitis in a patient after kidney transplantation. Immunosuppressive therapy, continuously required in post-tranplant period, may cause various complications, such as infections. Specific meningoencephalitis is an infection that is rarely diagnosed and more common in immunocompromised patients. Case report: A 30-year-old man had kidney transplantation (kidney donor was his father). He previously was two years on chronic hemodialysis treatment because of end-stagerenal disease based on diabetic nephropathy. He has diabetes type 1. The early post-transplant period duly passed with satisfactory clinical and laboratory parameters of renal function. Two months after transplantation, he presented with febrile condition, signs of septicemia and dehydration with significant neurological deficit and expressed meningeal signs. In cerebrospinal fluid we found lymphocytosis, elevated proteins and positive micobacterium tuberculosis antibodies (Hexagon method) and we suspected to specific etiology of meningitis. Performed computed tomography (CT) scan of the brain with contrast confirmed the expected finding. Due to the poor prognosis of infections of the central nervous system (CNS) in immunocompromised patients, only prompt diagnosis can improve survival in this group of patients. The therapeutic protocol after kidney transplantation include the prophylactic use of antituberculous drug (Isoniazid 300 mg) during the 9 months.
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Impact of a multidisciplinary pre-dialysis program on renal treatment modalities choice

Published on: 5th May, 2021

OCLC Number/Unique Identifier: 9124546591

In Portugal, around 2500 patients with end-stage chronic kidney disease (CKD stage 5) start a renal replacement therapy (RRT) for the first time each year [1]. They have four main treatment options: kidney transplantation (TX); haemodialysis (HD); peritoneal dialysis (PD) and conservative treatment (CT). RRT selection is quite complex due to the specificities of each option and to their profound effect on patient’s quality of life. Patients must play a decisive role in the choice of treatment modality and select the option that best suits to their values and needs.
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