Clinical Management of Kidney Transplant Recipients

Author(s):  
James A. Onigkeit

Kidney transplant is common. More than 19,000 kidney transplants were performed in the United States in 2017. About two-thirds were deceased donor transplants, and about one-third were living donor transplants. The clinical management of a kidney transplant recipient begins in the operating room. Posttransplant complications can be divided into 2 categories: surgical and medical.

2018 ◽  
Vol 19 (1) ◽  
pp. 269-276 ◽  
Author(s):  
Courtenay M. Holscher ◽  
Xun Luo ◽  
Allan B. Massie ◽  
Tanjala S. Purnell ◽  
Jacqueline M. Garonzik Wang ◽  
...  

2014 ◽  
Vol 98 ◽  
pp. 525
Author(s):  
J. Stephen ◽  
T. Anderson-Haag ◽  
S. Gustafson ◽  
J. Snyder ◽  
A. Israni ◽  
...  

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Masahiro Tomonari ◽  
Mariko Shimada ◽  
Yasuyuki Nakada ◽  
Izumi Yamamoto ◽  
Munenari Itoh ◽  
...  

Abstract Background Sebaceous carcinoma is a rare but progressive malignant skin cancer, and the incidence is approximately five times higher in post-transplant patients than in people who have not received kidney transplants. Sebaceous carcinoma is sometimes found concurrently with visceral cancers and a genetic abnormality, Muir–Torre syndrome. We report the case of a female kidney transplant recipient with sebaceous carcinoma concurrent with colon cancer 10 years after transplantation. Case presentation A 43-year-old woman was admitted due to a rapidly progressive tumor on her head. Histologically, the tumor was diagnosed as sebaceous carcinoma. We diagnosed her with Muir–Torre syndrome based on the following evidence: 1) high prevalence of microsatellite instability in gene locus assay, 2) absence of mismatch repair proteins in the sebaceous carcinoma on immunohistochemical analysis, and 3) a genetic mutation of 1226_1227delAG in the MSH2 exon 7 in the lesion detected by DNA sequencing analysis. Several reports have shown an association between immunosuppressive agents and latent Muir–Torre syndrome progression. Therefore, the progression of colon cancer in this case originated from her genetic mutation for Muir–Torre syndrome and long-term use of immunosuppressive agents. Conclusion This case report not only highlights the importance of adequate diagnosis and therapy for Muir–Torre syndrome, but also suggests the further prevention of the development of malignant tumors in kidney transplant recipients. Physicians should be mindful that sebaceous carcinoma in kidney transplant recipients is highly concurrent with Muir–Torre syndrome.


2014 ◽  
Vol 40 (6) ◽  
pp. 546-553 ◽  
Author(s):  
Jenise Stephen ◽  
Teresa L. Anderson-Haag ◽  
Sally Gustafson ◽  
Jon J. Snyder ◽  
Bertram L. Kasiske ◽  
...  

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pierre-Guillaume Deliège ◽  
Justine Bastien ◽  
Laetitia Mokri ◽  
Charlotte Guyot-Colosio ◽  
Carl Arndt ◽  
...  

Abstract Background To report the first case of belatacept-associated multidrug-resistant Cytomegalovirus retinitis in a kidney transplant recipient. Case presentation A 76-year-old African male renal allograft recipient was admitted for acute visual loss of the right eye. Ophthalmological examination of the right eye showed anterior uveitis and vitritis associated with large paravascular haemorrhages and yellow necrotic borders, involving the posterior pole but not the fovea. Both Cytomegalovirus DNA in plasma and aqueous humor were positive. The patient had had several episodes of Cytomegalovirus reactivation subsequent to the introduction of belatacept. His cytomegalovirus was multi-drug resistant, and was treated with maribarir, intravitreal and systemic injections of foscarnet, and anti-Cytomegalovirus human immunoglobulin. In parallel, belatacept was stopped and switched to tacrolimus. Cytomegalovirus DNA became undetectable and there was partial improvement of visual acuity at the last ophthalmologic examination, 18 months after the initial diagnosis of Cytomegalovirus retinitis. Conclusion Cytomegalovirus retinitis is an uncommon opportunistic infection in kidney transplant recipients. Cytomegalovirus retinitis is a serious infection because of the risk of blindness and the occurrence of associated life-threatening opportunistic infections. In view of the recent literature, kidney transplant recipients treated by belatacept immunosuppression may be at increased risk for Cytomegalovirus disease, notably Cytomegalovirus retinitis. The occurrence of Cytomegalovirus retinitis may help improve the selection of patients converted to belatacept.


2018 ◽  
Vol 48 (6) ◽  
pp. 472-481 ◽  
Author(s):  
Ahmed A. Awan ◽  
Jingbo Niu ◽  
Jenny S. Pan ◽  
Kevin F. Erickson ◽  
Sreedhar Mandayam ◽  
...  

Background: Death with graft function remains an important cause of graft loss among kidney transplant recipients (KTRs). Little is known about the trend of specific causes of death in KTRs in recent years. Methods: We analyzed United States Renal Data System data (1996–2014) to determine 1- and 10-year all-cause and cause-specific mortality in adult KTRs who died with a functioning allograft. We also studied 1- and 10-year trends in the various causes of mortality. Results: Of 210,327 KTRs who received their first kidney transplant from 1996 to 2014, 3.2% died within 1 year after transplant. Cardiovascular deaths constituted the majority (24.7%), followed by infectious (15.2%) and malignant (2.9%) causes; 40.1% of deaths had no reported cause. Using 1996 as the referent year, all-cause as well as cardiovascular mortality declined, whereas mortality due to malignancy did not. For analyses of 10-year mortality, we studied 94,384 patients who received a first kidney transplant from 1996 to 2005. Of those, 22.1% died over 10 years and the causative patterns of their causes of death were similar to those associated with 1-year mortality. Conclusions: Despite the downtrend in mortality over the last 2 decades, a significant percentage of KTRs die in 10-years with a functioning graft, and cardiovascular mortality remains the leading cause of death. These data also highlight the need for diligent collection of mortality data in KTRs.


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