scholarly journals Favorable Outcome of COVID-19 Pneumonia in a Kidney Transplant Recipient Treated with Tocilizumab

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Adnane Guella ◽  
Osman Elfadil ◽  
Ghisson Abdulrazaq ◽  
Sahla Osman ◽  
Mohammed Munir Khan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Patient ◽  
Clinical Course ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Immunosuppressive Medications ◽  
Therapeutic Guidelines ◽  
The Subject

The presentation of COVID-19 pneumonia in kidney transplant recipients is similar to that of the general population. However, in the former, it may have a worse clinical course. We report a kidney transplant patient affected by COVID-19 pneumonia whose condition worsened 9 days after the initial presentation. As no therapeutic guidelines on the subject are currently available, here we share our approach in the management of the immunosuppressive medications and the antiviral therapy and compare them to the scarce available data. We also expose the use of tocilizumab in our patient with excellent results.

scholarly journals 530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S332-S332
Author(s):  
Anna Hardesty ◽  
Aakriti Pandita ◽  
Yiyun Shi ◽  
Kendra Vieira ◽  
Ralph Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Case Control Study ◽  
Clinical Course ◽  
Case Series ◽  
Case Fatality ◽  
Case Control ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: review of 1589 patients

2018 ◽  
Vol 275 (5) ◽  
pp. 1183-1188 ◽  
Author(s):  
Gwanghui Ryu ◽  
Min Young Seo ◽  
Kyung Eun Lee ◽  
Hyo Yeol Kim ◽  
Hun-Jong Dhong ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Course ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Herpes Zoster in Kidney Transplant Recipients: A Series of Three Cases

2020 ◽  
Vol 10 (3) ◽  
pp. 139-146 ◽  
Author(s):  
Ramy M. Hanna ◽  
Farid Abd-El-Malak ◽  
Ammar Alnaser ◽  
Rumi Cader ◽  
Julie M. Yabu
Keyword(s):  
Herpes Zoster ◽  
Kidney Transplant ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Varicella Zoster ◽  
Organ Rejection ◽  
Increased Risk ◽  
Disseminated Disease

Kidney transplant recipients require lifelong immunosuppression to prevent organ rejection. The need for this intervention, however, leads to decreased cellular immunity and, in turn, increased risk of developing herpes zoster (HZ) from reactivation of latent varicella zoster virus. HZ commonly presents as a painful rash in a dermatome presentation followed by post-herpetic neuralgia. In immunosuppressed individuals, the presentation can be atypical and vary in severity depending on degree of immunosuppression and host immune response. We present the clinical course of 3 kidney transplant recipients who developed HZ after transplantation at different times post-transplant with varying clinical manifestations. The balance between maintaining immunosuppression and preventing or subsequently treating disseminated disease is discussed.

scholarly journals Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients

2020 ◽  
Vol 78 (2) ◽  
pp. 281-286 ◽  
Author(s):  
Alireza Abrishami ◽  
Shiva Samavat ◽  
Behdad Behnam ◽  
Mehran Arab-Ahmadi ◽  
Mohsen Nafar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Course ◽  
Imaging Features ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Symptom Experience Associated With Immunosuppressive Medications in Chinese Kidney Transplant Recipients

2015 ◽  
Vol 47 (5) ◽  
pp. 425-434 ◽  
Author(s):  
Sha Teng ◽  
Shuping Zhang ◽  
Wenxin Zhang ◽  
Xiaohong Lin ◽  
Yabin Shang ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Symptom Experience ◽  
Kidney Transplant Recipients ◽  
Immunosuppressive Medications

scholarly journals Muir–Torre syndrome: sebaceous carcinoma concurrent with colon cancer in a kidney transplant recipient; a case report

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Masahiro Tomonari ◽  
Mariko Shimada ◽  
Yasuyuki Nakada ◽  
Izumi Yamamoto ◽  
Munenari Itoh ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Case Report ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Immunosuppressive Agents ◽  
Genetic Mutation ◽  
Sebaceous Carcinoma ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

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.

scholarly journals Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

2019 ◽  
Vol 13 (11) ◽  
Author(s):  
Axel Cayetano-Alcaraz ◽  
Juan Sebastian Rodriguez-Alvarez ◽  
Mario Vilatobá-Chapa ◽  
Josefina Alberú-Gómez ◽  
Bernardo Gabilondo-Pliego ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Kidney Transplant Patients ◽  
Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

scholarly journals Sepsis-like histoplasmosis in a kidney transplant patient

2018 ◽  
Vol 40 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Ana Raquel Fernandes ◽  
Laila Almeida Viana ◽  
Juliana Busato Mansur ◽  
Mariana de Moraes Françoso ◽  
Daniel Wagner de Castro Lima Santos ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Skin Biopsy ◽  
Kidney Transplant ◽  
Liposomal Amphotericin ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Fungus Infection ◽  
Immunosuppressed Patients ◽  
Severe Manifestation

Abstract Histoplasmosis is a fungus infection that mainly affects immunosuppressed patients. The authors present a case of a kidney transplant recipient who developed sepsis-like histoplasmosis, na atypical but severe manifestation of the disease. The fungus was found in blood and in a skin biopsy, and the treatment with liposomal amphotericin resulted in hepatotoxicity.

scholarly journals The outcome of pregnancy in a kidney transplant patient: A case report and review of the literature

2017 ◽  
Vol 74 (8) ◽  
pp. 778-781 ◽  
Author(s):  
Andreja Glisic ◽  
Nevena Divac ◽  
Miroslava Gojnic-Dugalic ◽  
Biljana Kastratovic-Kotlica ◽  
Neven Vavic ◽  
...  
Keyword(s):  
Case Report ◽  
Kidney Transplant ◽  
Clinical Signs ◽  
Kidney Transplant Patient ◽  
Kidney Transplant Recipients ◽  
Organ Rejection ◽  
Immunosuppressive Medications ◽  
Healthy Female ◽  
Gestational Week

Introduction. The possibility of a term pregnancy with favorable maternal and neonatal outcome is one of the greatest advances in kidney transplantation, though concerns still exist regarding the safety of the mother, fetus, and graft. The use of immunosuppressive medications during pregnancy is related to possible fetal adverse effects. Case report. We report a course of a pregnancy in a patient with a kidney transplant. The patient was treated with immunosuppressive therapy (tacrolimus, azathioprine, and prednisolone) during the pregnancy. The outcome of the pregnancy was without maternal and neonatal complications. Serum creatinine levels were stable and no acute organ rejection occurred during pregnancy. Significant elevation of the Ddimer and coagulant factors II, VII, IX and X were noticed during the third trimester. This could be partially attributed to azathioprine, which was a part of the immunosuppressive regimen. On the other hand, there were no radiological or clinical signs of thromboembolism, but low-molecularweight heparin prophylaxis was immediately initiated. Cesarean section was performed at the 39th gestational week and a healthy female infant was delivered with a birth weight of 3,150 g and Apgar score 9. Conclusion. Pregnancies of kidney transplant recipients are high-risk and require a multidisciplinary approach. Careful clinical follow-up is a prerequisite for favorable outcome.

scholarly journals Belatacept associated - cytomegalovirus retinitis in a kidney transplant recipient: a case report and review of the literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pierre-Guillaume Deliège ◽  
Justine Bastien ◽  
Laetitia Mokri ◽  
Charlotte Guyot-Colosio ◽  
Carl Arndt ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Cytomegalovirus Retinitis ◽  
Renal Allograft Recipient ◽  
Ophthalmological Examination ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
The Right

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.

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