Treatment of Kaposi's sarcoma after solid organ transplantation.

PURPOSE This retrospective review of all patients who developed Kaposi's sarcoma (KS) after solid organ transplantation at a single institution was undertaken to define the clinical presentation of this malignancy in the setting of iatrogenic immunodeficiency, and to determine the most appropriate treatment for patients in this clinical setting. MATERIALS AND METHODS The records of 2,099 patients who underwent heart, lung, liver, or kidney transplantation at The Toronto Hospital between January 1, 1981 and June 30, 1995, were reviewed. Twelve patients were identified who developed biopsy-proven KS in the posttransplantation period. Five patients who had disseminated KS who had not responded to either reduction or withdrawal of immunosuppression or to local radiotherapy were treated with combination chemotherapy consisting of doxorubicin 20 to 30 mg/m2, bleomycin 10 mg/m2, and vincristine 2 mg (ABV) administered intravenously every 3 weeks. RESULTS Eight of 12 patients were male and nine were of Italian origin. KS was limited to a localized area of the skin for only six patients, all after kidney transplantation. Visceral KS was present in three patients. Four of five patients responded to ABV chemotherapy (two complete and two partial remissions). The fifth patient responded to second-line etoposide and cisplatin. The median duration of response was in excess of 13 months (range, 8+ to 45+ months). Toxicity was limited to grade 1 neurotoxicity and grade 1 skin toxicity. CONCLUSION KS is an uncommon but recognized complication of solid organ transplantation. Combination chemotherapy is a safe and effective treatment for patients with disseminated or visceral KS that fails to respond to changes in immunosuppression.

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RELATIONSHIP OF HHV8 REPLICATION AND KAPOSI'S SARCOMA AFTER SOLID ORGAN TRANSPLANTATION

Transplantation Journal ◽

10.1097/00007890-199904270-00022 ◽

1999 ◽

Vol 67 (8) ◽

pp. 1200-1201 ◽

Cited By ~ 37

Author(s):

Julio C. Mendez ◽

Gary W. Procop ◽

Mark J. Espy ◽

Thomas F. Smith ◽

Christopher G. A. McGregor ◽

...

Keyword(s):

Organ Transplantation ◽

Kaposi's Sarcoma ◽

Solid Organ Transplantation ◽

Kaposi’S Sarcoma ◽

Solid Organ ◽

Relationship Of

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HLA and Kaposi's sarcoma in solid organ transplantation

Human Immunology ◽

10.1016/0198-8859(90)90069-2 ◽

1990 ◽

Vol 29 (1) ◽

pp. 56-63 ◽

Cited By ~ 26

Author(s):

Mathew E. Brunson ◽

Kamala Balakrishnan ◽

Israel Penn

Keyword(s):

Organ Transplantation ◽

Kaposi's Sarcoma ◽

Solid Organ Transplantation ◽

Kaposi’S Sarcoma ◽

Solid Organ

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Ethical issues in Kidney Transplantation and “An” Islamic perspective

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i2.51530 ◽

2021 ◽

Vol 20 (2) ◽

pp. 241-249

Author(s):

Mohammad Yousuf Rathor ◽

Azarisman SM Shah ◽

Nur Raziana Bt Rozi ◽

Che Rosle Draman ◽

Wan Ahmad Syahril

Keyword(s):

Kidney Transplantation ◽

Organ Donation ◽

Organ Transplantation ◽

Islamic Law ◽

Ethical Issues ◽

Human Life ◽

Medical Science ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Living Kidney Donor

Kidney transplantation (KT) is currently the most realistic treatment option for patients with end-stage renal disease (ESRD) as it enables them to live longer and provides better quality of life post-transplantation. Before the 1960s, all these patients would die as there was no treatment available. It is the commonest solid organ transplantation carried out in the world at the moment. Organs are harvested from living or cadaveric donors, with living kidney donor organs generally functioning better and for longer periods of time compared to the latter. Issues surrounding organ transplantation in general and kidney transplantation in particular, are fraught with ethical dilemmas due to the shortage of organs, the logistics behind the acquisition of organs, use of living donors including minors and the black market that has sprouted thereof. Entwined in this quagmire are the legal, social and psychological consequences for the individuals involved and the society at large. It is further compounded by religious concerns, which have a significant influence on the society’s acceptance of the practice of organ donation. The practice of organ transplantation is generally accepted by most Islamic scholars as it is concordant to the objectives of Islamic Law (maqasid al Sharī’ah) which prioritize the preservation of human life. However, resistances do arise from some jurists and even physicians of the same Islamic faith despite a fatwas decreeing that organ and tissue transplantations are permissible in Islam under certain conditions. The take-up of organ-donation is still largely poor especially among Muslims. This article therefore hopes to explore the various moral and ethical issues surrounding KT as well as the Islamic viewpoints emanating from it. We hope that this knowledge and understanding will benefit both health-care personnel and the public in general. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.241-249

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Donor-Derived Cell-Free DNA in Kidney Transplantation: Origins, Present and a Look to the Future

Medicina ◽

10.3390/medicina57050482 ◽

2021 ◽

Vol 57 (5) ◽

pp. 482

Author(s):

Sam Kant ◽

Daniel C. Brennan

Keyword(s):

Kidney Transplantation ◽

Organ Transplantation ◽

Allograft Rejection ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Future Prospects ◽

Cell Free Dna ◽

Medical Specialties ◽

Free Dna ◽

The Future

Since its first detection in 1948, donor-derived cell-free DNA (dd-cfDNA) has been employed for a myriad of indications in various medical specialties. It has had a far-reaching impact in solid organ transplantation, with the most widespread utilization in kidney transplantation for the surveillance and detection of allograft rejection. The purpose of this review is to track the arc of this revolutionary test—from origins to current use—along with examining challenges and future prospects though the lens of transplant nephrology.

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The Use of IVIG for Solid Organ Transplantation: An Evidence Based Practice Guideline

Blood ◽

10.1182/blood.v112.11.4666.4666 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4666-4666

Author(s):

Nadine Shehata ◽

Heather Ann Hume ◽

Valerie Palda ◽

Ralph Meyer ◽

Patricia Campbell ◽

...

Keyword(s):

Kidney Transplantation ◽

Organ Transplantation ◽

Practice Guideline ◽

Graft Rejection ◽

Solid Organ Transplantation ◽

Evidence Based ◽

Solid Organ ◽

Blood Products ◽

Limited Data

Abstract Background Utilization of intravenous immune globulin (IVIG) is increasing in Canada and worldwide despite few and no new labeled indications. In 2007, Canadian Blood Services in collaboration with the National Advisory Committee on Blood and Blood Products convened a panel of solid organ transplantation (SOT) experts (kidney, heart, lung, and liver) and methodologists to develop an evidence-based practice guideline for the use of IVIG in patients undergoing SOT. The objectives of this guideline are to examine the evidence for the use of IVIG in patients who are candidates for SOT and are sensitized to HLA or ABO antigens, to provide guidance for Canadian practitioners involved in the care of these patients and transfusion medicine specialists on the use of IVIG. Methods: The panel identified clinical areas of SOT that would benefit from treatment with IVIG and generated key clinical questions. A systematic, expert and bibliography literature search up to July 2008 was conducted to ensure all relevant publications were included. The panel generated recommendations based on the evidence. The levels of evidence and grading of recommendations were adapted from the Canadian Task Force on Preventative Health Care. To validate conclusions and recommendations, the practice guideline will be sent to physicians involved in solid organ transplantation in Canada and a patient representative. Recommendations from practitioner feedback will be incorporated, and the guideline will be disseminated to all physicians involved in the care of patients receiving solid organ transplantation in Canada to aid implementation of the guideline. The National Advisory Committee of Blood and Blood Products in Canada will subsequently assess the performance of the guideline and will renew the guideline at timely intervals. Results and Conclusions: The research questions developed by the panel were: Is there evidence that the use of IVIG reduces morbidity and mortality for patients undergoing SOT who are sensitized (HLA or ABO) in the perioperative setting and are sensitized experiencing acute graft rejection or experiencing chronic graft rejection? 791 citations were retrieved, and panel members identified 3 additional citations. 51 reports and a systematic review were used for this guideline. These reports were limited by inconsistent definitions of sensitization, inconsistent reporting of the type and titre of the antibody, the assays used to detect HLA antibodies, the response criteria and dosing schedules for IVIG. Thus, a consensus process was used to account for the poor evidence. The use of IVIG was associated with decreased sensitization and acceptable morbidity and mortality in living donor kidney transplantation. IVIG has been used with several other modalities for ABO-incompatible kidney transplantation and it was difficult from the existing literature to separate outcomes based on a single modality. There was also limited data on the perioperative use of IVIG in renal transplantation. IVIG was shown to be effective in combination with plasmapheresis for acute antibody mediated rejection of the kidney; however the role of IVIG was not clear for other forms of rejection. There were also several methodological limitations in the literature assessing IVIG for cardiac transplantation and only limited data were available to assess the use of IVIG for lung or liver transplantation. Future studies are needed to define the role of IVIG in solid organ transplantation and should capture the following elements: impact on antibody (specificity and titres), transplant rates, time to transplantation, graft function, graft survival, and rejection (cellular and antibody mediated).

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Guillain-Barre Syndrome after Kidney Transplantation: a Case Report

Galen Medical Journal ◽

10.31661/gmj.v2i1.33 ◽

2013 ◽

Vol 2 (1) ◽

pp. 35-36

Author(s):

Mohsen Farazdaghi ◽

Anahita Zoghi ◽

Afshin Borhani Haghighi

Keyword(s):

Kidney Transplantation ◽

Organ Transplantation ◽

Solid Organ Transplantation ◽

Guillain Barre Syndrome ◽

Unusual Complication ◽

Solid Organ ◽

Hematopoietic Stem ◽

Guillain Barré Syndrome ◽

Associated Symptoms ◽

Guillain Barré

Background: Guillain-Barre Syndrome is an unusual complication of hematopoietic stem cell transplantation but it is extremely rare after solid organ transplantation such as kidney or liver transplantationCase report: A 48-year-old man, a case of kidney transplantation presented with generalized weakness in an ascending pattern. History and examination were compatible with the diagnosis of Guillain-Barre Syndrome (GBS) and paraclinical studies confirmed this diagnosis. He was treated for Guillain-Barre syndrome but no significant response was observed.Conclusion: Guillain–Barre´ syndrome rarely appears after organ transplantation but it should be considered in a patient presenting with its associated symptoms after transplantation.

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Vitamin D in Solid Organ Transplantation with Special Emphasis on Kidney Transplantation

Vitamins and the Immune System - Vitamins & Hormones ◽

10.1016/b978-0-12-386960-9.00019-8 ◽

2011 ◽

pp. 429-468 ◽

Cited By ~ 1

Author(s):

Ursula Thiem ◽

Kyra Borchhardt

Keyword(s):

Vitamin D ◽

Kidney Transplantation ◽

Organ Transplantation ◽

Solid Organ Transplantation ◽

Solid Organ

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Donor-derived TB after kidney transplantation: a case report

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0117 ◽

2021 ◽

Author(s):

Luiz Roberto de Sousa Ulisses ◽

Helen Souto Siqueira Cardoso ◽

Inara Creão Costa Alves ◽

Isabela Novais Medeiros ◽

Camilla Garcia de Oliveira ◽

...

Keyword(s):

Kidney Transplantation ◽

Case Report ◽

Organ Transplantation ◽

Fluid Collection ◽

Graft Function ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Mortality And Morbidity ◽

Contralateral Kidney ◽

Post Transplant

Abstract Introduction: Tuberculosis (TB) is a possible serious complication of solid organ transplantation, associated with high mortality and morbidity. Post-transplant TB has varied pathogenesis with many approaches to its prevention, which is the most important way to reduce its incidence. Treatment of TB in organ recipients is challenging because of drug toxicity and interaction with immunosuppressants. Case report: an 18-year-old woman that underwent kidney transplantation from a deceased donor and was discharged with fair renal function was readmitted at 37th postoperative day with fever. CT showed signs of miliary TB and fluid collection besides graft fistulization through the skin. The patient presented positive BAAR in the drained fluid and Koch's bacillus in the urine. She was treated with a four-drug regimen (rifampicin, isoniazid, pyrazinamide, and etambutol), with great response and preserved graft function. We were informed that the recipient of the contralateral kidney also presented post-transplant TB, implying in a donor-derived origin. Conclusion: TB is an important differential diagnosis for infectious complications in patients after solid-organ transplantation, especially in endemic regions. Its initial clinical presentation can be unspecific and it should be suspected in the presence of fever or formation of fluid collections. The suspicion of TB is the key to early diagnosis and satisfactory outcomes in post-transplant TB.

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