Immunosuppression for Renal Transplant Patients and Common Medical Problems in Renal Transplantation

2010 ◽  
pp. 857-863 ◽  
Author(s):  
Naim Issa ◽  
William E. Braun
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Medical Problems ◽  
Transplant Patients ◽  
Renal Transplant Patients

Mycophenolate mofetil, an inhibitor of inosine monophosphate dehydrogenase, causes a paradoxical elevation of GTP in erythrocytes of renal transplant patients

2004 ◽  
Vol 107 (1) ◽  
pp. 63-68 ◽  
Author(s):  
David GOLDSMITH ◽  
Elizabeth A. CARREY ◽  
Stephen EDBURY ◽  
Ryszard T. SMOLENSKI ◽  
Piotr. JAGODZINSKI ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Plasma Metabolites ◽  
Renal Transplant Recipients ◽  
Inosine Monophosphate Dehydrogenase ◽  
Inosine Monophosphate ◽  
Transplant Patients ◽  
Renal Transplant Patients ◽  
Monophosphate Dehydrogenase

The immunosuppressant MMF (mycophenolate mofetil) has increasingly replaced AZA (azathioprine) in renal transplantation. MMF is a prodrug of MPA (mycophenolic acid), which inhibits lymphocyte IMPDH (inosine monophosphate dehydrogenase), thereby drastically decreasing GTP concentrations essential to lymphocyte proliferation in vitro and in vivo. Erythrocyte GTP concentrations are commonly elevated in severe renal disease, but normalize following successful engraftment. Consequently, elevated GTP in renal transplant recipients might signal impending loss of immunosuppression and graft failure. In the present study, we compared erythrocyte nucleotides and plasma metabolites in two groups of 25 patients after renal transplantation, both receiving prednisolone and cyclosporin A, but one group receiving MMF and the other AZA. No patients had recent allograft biopsy evidence of rejection. Erythrocyte GTP concentrations at MMF commencement were 50.4±23.4 μmol/l. An increase occurred during the first 3 months after transplant when MMF was used de novo, stabilizing at 146.7±62.9 μmol/l after 4 months. This was significantly higher (P=2.5×10−6) than erythrocyte GTP (40.4±15.9 μmol/l) in the AZA group, which was essentially unchanged from values immediately after successful transplantation. The effect of MMF on erythrocyte GTP levels was reversible, since GTP levels fell when MMF therapy was terminated. The results demonstrate paradoxically high GTP concentrations in erythrocytes of renal transplant patients receiving MMF. MPA may stabilize reticulocyte IMPDH, allowing the protein to persist during erythropoiesis. This behaviour is in marked contrast with the decrease in GTP levels seen in white blood cells of patients on chronic MMF therapy.

Transplantations: Implications of the Renal Transplantation Process for Rehabilitation Counselors

1993 ◽  
Vol 24 (1) ◽  
pp. 34-37
Author(s):  
Rick Houser ◽  
Varda Konstam
Keyword(s):  
Renal Transplantation ◽  
Chronic Illness ◽  
Renal Transplant ◽  
Functional Limitations ◽  
Rehabilitation Counselors ◽  
Rehabilitation Counselor ◽  
Transplant Patients ◽  
The Family ◽  
Renal Transplant Patients

Renal transplantation is one of the most common forms of transplantation performed today. The rehabilitation counselor may provide an important role in the rehabilitation of persons that have gone through renal transplantation. For example, the rehabilitation counselor can provide information on the effects of experiencing a chronic illness and provide information on the changes in the family as a result of the chronic illness. However, if the rehabilitation counselor is to be helpful to renal transplant patients they must be knowledgeable about the renal transplantation process. In this article we address the renal transplantation process including: the medical aspects, functional limitations, psychological implications and finally vocational implications as they relate to the rehabilitation counselor.

P0126RENAL TRANSPLANT PATIENTS UNDER CALCINEURIN INHIBITOR THERAPY RAPIDLY ACQUIRE AN ABERRANT LYSOSOMAL LESION IN PROXIMAL TUBULAR CELLS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Benjamin Vervaet ◽  
Nika Kojc ◽  
Cynthia Nast ◽  
Gerd Schreurs ◽  
Patrick D'Haese ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Allograft ◽  
Calcineurin Inhibitor ◽  
Deceased Donor ◽  
Inhibitor Therapy ◽  
Transplant Patients ◽  
Protocol Biopsies ◽  
Proximal Tubular ◽  
Renal Transplant Patients

Abstract Background and Aims Calcineurin inhibitor therapy has changed the field of (renal) transplantation by considerably prolonging graft survival. Yet, all immunosuppressive calcineurin inhibitors are nephrotoxic that eventually contribute to complete scarring of the renal allograft. In renal biopsy analysis many histopathological features have been considered indicative of CNI nephrotoxicity, i.e. striped fibrosis, vascular hyalinosis, isometric tubular vacuolization, glomerulosclerosis, cellular infiltration and tubular atrophy, however, all are rather aspecific and can be secondary to many other causes. During the course of evaluating the specificity of a recently discovered proximal epithelial lysosomal lesion (i.e. multiple enlarged (>1,2µm) dysmorphic lysosomes containing dispersed electron dense non-membrane bound aggregates) in patients with Chronic Interstitial Nephropathy in Agricultural Communities (CINAC), we observed it to be present in renal transplant patients treated with cyclosporine or tacrolimus. Here, we test the hypothesis whether this lysosomal lesion is acquired during CNI therapy. Method A retrospective transmission electron microscopic analysis was performed to evaluate the presence of the typical lysosomal lesion on the following biopsies from renal transplant patients: 20 deceased donor implantation biopsies; 5 living donor implantation biopsies. For another 10 additional deceased donor renal allograft recipients, we evaluated implantation as well as protocol biopsies taken after 6 and 12 months of CNI treatment that started immediately after transplantation. Also included were 24 indication biopsies of CNI treated renal transplants. Results Of the total set of implantation biopsies (n=35), 2 (6%) were positive for the aberrant lysosomal phenotype on EM, whereas in the protocol and indication biopsies prevalence of the lesion was considerably higher ranging between 56% (protocol) and 80% (indication) of cases. Conclusion CNI therapy is associated with the fairly rapid appearance of a particular proximal tubular lysosomal phenotype observable on EM, that was not (or rarely) present at implantation. Whether this lesion is related to CNI toxicity and indicative for the outcome for the graft and/or patient survival after renal transplantation has to be investigated in a prospective trial.

scholarly journals VALGANCICLOVIR INDUCED THROMBOCYTOPENIA: A CASE REPORT

2017 ◽  
Vol 10 (7) ◽  
pp. 3 ◽  
Author(s):  
Amita D ◽  
Balaji O ◽  
Navin Patil
Keyword(s):  
Case Report ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Adverse Effects ◽  
Transplant Patient ◽  
Hematological Toxicity ◽  
Severe Immunosuppression ◽  
Platelet Counts ◽  
Transplant Patients ◽  
Renal Transplant Patients

Triple immunosuppression is very pivotal in maintaining the graft in case of renal transplantation. But because of severe immunosuppression, always there is chance of severe adverse effects. Hematological toxicity is usually very common but dreaded in case of renal transplant patients. Here, we report a case of valganciclovir-induced drop in platelet counts in a postrenal transplant patient.

scholarly journals Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Anil Kapoor ◽  
Jason Akerman ◽  
Emily Wong ◽  
Gaurav Vasisth ◽  
Fadil Hassan ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Controlled Trial ◽  
Ureteral Stent ◽  
Flexible Cystoscopy ◽  
Stent Removal ◽  
Transplant Patients ◽  
Renal Transplant Patients ◽  
Tract Infections ◽  
Retrieval Device

Introduction: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. Methods: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. Results: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively; p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. Conclusions: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

Posttransplant Lymphoproliferative Disorders (PTLD) After Renal Transplantation: Focus on HLA Antigens

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5074-5074
Author(s):  
Charlotte Strandhave ◽  
Kaj Anker Jørgensen ◽  
Knud Bendix ◽  
Bente Jespersen ◽  
Robert Schou Pedersen ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
T Cell ◽  
Skin Cancer ◽  
Renal Transplant ◽  
Conflicts Of Interest ◽  
Hla Antigens ◽  
Cox Regression Analysis ◽  
Transplant Patients ◽  
Increased Risk ◽  
Renal Transplant Patients

Abstract Abstract 5074 Background: PTLD is a lymphoid proliferation that develops as a consequence of immunosuppression. It represents monoclonal B-cell, or rarely T-cell, proliferations, occurring in a setting of decreased T-cell immune surveillance. It has been shown that HLA-B mismatching is associated with increased risk of skin cancer in recipients of renal transplants. An association between skin cancer related to human papillomavirus and HLA-A11 has also been established in this group of patients. Bakker et al has shown that HLA-B mismatching is a risk marker of PTLD. More specifically, Subklewe et al found that HLA-B18 and HLA-B21 were associated with increased risk of PTLD, whereas mismatch at HLA-A03 and HLA-DR7 level reduced the risk of PTLD. We therefore hypothesized that mismatch of certain HLA alleles may be risk predictors of PTLD after renal transplantation. Methods: According to the national renal transplantation database of the Danish Society of Nephrology, 872 renal transplantations in 793 patients were performed at Aarhus University Hospital between 1990 and 2005. A total of 11 cases of PTLD were retrospectively identified through the National Danish Pathology database and individually reviewed by an experienced hematopathologist (KB). PTLD patients were investigated according to transplantation procedure, clinicopathological patient characteristics, type of lymphoma, outcome and HLA haplotype of both donor and recipient. Results: Univariate Cox regression analysis showed no positive correlation between risk of PTLD and number of HLA-B mismatches, or with HLA-A or HLA-DR mismatches. Conversely, we found a decreased risk with one/two HLA-B mismatches compared to no mismatches (p<0.01). With regard to specific alleles, HLA-B37 showed a trend towards an association with PTLD (OR = 8.62; 95% CI 1.70–43.6; P<0.04), whereas the same association was significantly stronger for HLA-DR6 (OR= 30.7; 95% CI 4.97–189.8; p<0.005). Unlike earlier reports, no association with HLA-B18 and HLA-B21 mismatches was observed. Conclusions: Our data suggest not only that the risk of developing PTLD is unaffected by an increasing number of HLA-B mismatches, but that a low number of such mismatches may even protect against PTLD developement. In our analysis, we found a moderate correlation between PTLD and HLA-B37, and a stronger one with HLA-DR6. The latter observation has never been previously reported. Further analyses with larger cohorts of renal transplant patients are needed to clarify the role of HLA antigens as risk markers for PTLD in order to establish whether a pre-emptive PTLD monitoring of renal transplant patients expressing certain haplotypes/haplotype mismatches is justified. Disclosures: No relevant conflicts of interest to declare.

Perioperative management of renal transplant patients undergoing total joint arthroplasty

2019 ◽  
Vol 29 (9) ◽  
pp. 270-275
Author(s):  
Benjamin Devoy ◽  
Khaled M. Yaghmour ◽  
Emanuele Chisari ◽  
Stephen M. McDonnell ◽  
Wasim Khan
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Total Joint Arthroplasty ◽  
Perioperative Management ◽  
Joint Arthroplasty ◽  
The Body ◽  
Management Guidelines ◽  
Transplant Patients ◽  
High Incidence ◽  
Renal Transplant Patients

The success of renal transplantation depends on lifelong immunosuppression. This can lead to a high incidence of avascular necrosis of major joints in the body for which arthroplasty is the treatment of choice. The risk of surgical complications is high in these patients, and there is no current set of cohesive perioperative management guidelines. In this review, we discuss the perioperative management of renal transplant patients undergoing elective total joint arthroplasty.

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