Modern lymphatic dissection techniques for preventing post renal transplant lymphocele

Background and Aims: Development of a lymphocele is a well-known complication following kidney transplant. Among causative factors, recipient iliac lymphatics dissection plays an important role. Electrothermal bipolar sealing devices (LigaSureTM) have been shown to decrease lymphatic leakage in a number of instances. The aim of this study was to investigate whether the use of this device decreases post-operative lymphatic complications in kidney transplant.Materials and methods: 48 patients admitted for renal transplant were included in the study. They were randomly assigned to either conventional ligation or LigaSureTM during lymphatic dissection.Results: One patient in the LigaSureTM arm and 5 patients in the conventional ligation arm developed lymphocele (p=0.04). Lymphatic drainage volumes were 99.8 ± 39.87 ml in the LigaSure arm and 131.46 ± 54.2 ml in the conventional ligation arm (p=0.02)Conclusion: Electrothermal bipolar sealing devices exhibit safety and efficiency when used in renal transplant lymphatic dissection. In the present study, this technique proved to be superior to conventional ligation in terms of post-operative lymphatic complications.

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Human BK Polyomavirus Nephropathy (BKVN) In Non- Kidney-Transplant Patients

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.258 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S118-S118

Author(s):

Y Chen Wongworawat ◽

C Zuppan

Keyword(s):

Renal Transplant ◽

Kidney Transplant ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Transplant Patients ◽

Bk Polyomavirus ◽

Pathologic Features ◽

Renal Biopsies ◽

Renal Transplant Patients

Abstract Introduction/Objective Human BK polyomavirus nephropathy (BKVN) occurs in up to 10% of renal transplant recipients, and can result in graft loss. Transplant biopsy is the gold standard to diagnose BKVN, and SV40 immunohistochemical (IHC) staining is helpful in confirming the diagnosis. BKVN is uncommon outside the setting of renal transplantation. To understand more about its occurrence in other contexts, we reviewed our renal biopsies files for cases of BKVN. Methods Our renal biopsy files for the past 20 years were reviewed for all cases with a diagnosis of BKVN or polyoma virus infection, and the clinical characteristics of the affected patients noted. Results Evidence of BKVN was found in 44 renal biopsies, of which 39 (86%) were renal transplant patients. Of the remaining five patients (14%), two had undergone heart transplantation, one lung transplantation, one was undergoing chemotherapy for acute lymphoblastic leukemia, and one patient had active HIV infection. All patients had elevated serum creatinine, and four out of five patients had documented BK viremia. Four of the five biopsies showed typical tubular injury with viral nuclear cytopathic changes (inclusions). In the lung transplant patient, the biopsy showed advanced chronic tubulointerstitial injury without distinct viral inclusions, but SV40 staining confirmed the presence of BK virus antigen. Conclusion The BKVN is distinctly uncommon outside the context of kidney transplantation. In our series, 14% of patients with BKVN were not kidney transplant recipients, but all were immune compromised in some fashion. The pathologic features of BKVN appear similar, regardless of whether the host is a renal transplant recipient or not. Although uncommon, it is important to consider the possibility of BKVN in non-renal transplant patients with persistent or progressive renal dysfunction.

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Transplantation: Polyomavirus Nephropathy and the Risk of Specific Immunosuppression Regimens

The Scientific World JOURNAL ◽

10.1100/tsw.2006.93 ◽

2006 ◽

Vol 6 ◽

pp. 412-528 ◽

Cited By ~ 1

Author(s):

Christine Wu ◽

Parmjeet Randhawa ◽

Jerry McCauley

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Kidney Transplant ◽

Transplant Patient ◽

Graft Loss ◽

Bk Virus ◽

Therapeutic Monitoring ◽

Kidney Transplant Patient ◽

Bk Polyomavirus ◽

Specific Immunosuppression

BK virus is ubiquitously present in the latent state in humans, and awareness of the importance of BK polyomavirus is emerging among the kidney transplant community. First discovered in 1971 in the urine of a renal transplant recipient, BK virus nephropathy (BKVN) has come to be recognized as a significant cause of genitourinary disease and potential graft loss in the kidney transplant patient. In this review, we discuss the risk factors, available methods of diagnosis and therapeutic monitoring, and current approaches to therapy of BKVN.

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Studying Risk Factors Association with Osteoporosis in Post Kidney Transplantation Patients

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i1.1807 ◽

2020 ◽

Vol 11 (1) ◽

pp. 200-206

Author(s):

Angham Ahmed Hasan ◽

Munaf H. Zalzala ◽

Abbas Al-Temimi

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Renal Transplant ◽

Kidney Transplant ◽

Female Gender ◽

Extensive Study ◽

High Rate ◽

T Score ◽

Transplant Patients ◽

Medical City

Osteoporosis that associate with kidney transplantation is an important cause of ‎morbidity to ‎the patients that warranted extensive study about possible causes of ‎osteoporosis in order to ‎implement several steps to reduce this risk. The current work aimed to investigate possible association between post kidney ‎transplant ‎immunosuppression therapy type and developing the ‎osteoporosis and evaluate the bone mass by using dual X-ray absorptiometry (DXA) post-renalal transplant. A case-control, conducted in kidney transplant center – medical city complex for ‎one year period (‎from October ‎‏2018‏‎ till April 2019), Seventy - five kidney ‎transplant patients were participated in the present study ‎including (21 females & ‎‎54 males). All ‎patients were examined for their bone density using DEXA scan (T – score) and ‎those with cut – point ≤- 2.5 were diagnosed as having osteoporosis (lumber and ‎hip bones were examined). The prevalence of osteoporosis and osteopenia was significantly higher in ‎transplant patients compared to control for bone lumber and hip bone (for ‎lumber bones: 33.3% vs 2.7%l for hip bones: 60% vs. 14.7%). T score was ‎significantly lower in the transplant patients compared to control for both lumber ‎‎(-1.9‎±0.8 vs. -1.1‎±0.7) and hip bones (-2.3‎±0.9 vs -1.3‎±0.8).‎ In logistic regression analysis; only gender and BMI were the predictors of ‎osteoporosis for spinal bone, while; the BMI and calcium were the predictors ‎of osteoporosis for hip bones. In ‏conclusion, Osteoporosis in post-renal transplant patients have a high rate of ‎osteoporosis compared to the general population, post-renal transplant drugs (Cyclosporine, MMF, etc.) did not increase the ‎risk of osteoporosis, and body mass index and female gender were risk factors for osteoporosis

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CD56+CD57+ infiltrates as the most predominant subset of intragraft natural killer cells in renal transplant biopsies with antibody-mediated rejection

Scientific Reports ◽

10.1038/s41598-019-52864-5 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Hey Rim Jung ◽

Mi Joung Kim ◽

Yu-Mee Wee ◽

Jee Yeon Kim ◽

Monica Young Choi ◽

...

Keyword(s):

Renal Transplant ◽

Nk Cells ◽

Natural Killer ◽

Kidney Transplant ◽

Graft Failure ◽

Nk Cell ◽

Cell Infiltration ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Antibody Mediated Rejection

Abstract Little is known about the characteristics and clinical implications of specific subsets of intragraft natural killer (NK) cells in kidney transplant recipients. We analyzed 39 for-cause renal transplant biopsies performed at our center from May 2015 to July 2017. According to histopathologic reports, 8 patients (20.5%) had no rejection (NR), 11 (28.2%) had T cell-mediated rejections (TCMR) only, and 20 (51.3%) had antibody-mediated rejection (ABMR). NK cells were defined as CD3–CD56+ lymphocytes that are positive for CD57, CD49b, NKG2A, or KIR. The density of NK cells was significantly higher in the ABMR group (2.57 ± 2.58/mm2) than in the NR (0.12 ± 0.22/mm2) or the TCMR (0.25 ± 0.34/mm2) group (P = 0.002). Notably, CD56+CD57+ infiltrates (2.16 ± 1.89) were the most frequently observed compared with CD56+CD49b+ (0.05 ± 0.13), CD56+NKG2A+ (0.21 ± 0.69), and CD56+KIR+ (0.15 ± 0.42) cells in the ABMR group (P < 0.001). Death-censored graft failure was significantly higher in patients with NK cell infiltration than those without (Log-rank test, P = 0.025). In conclusion, CD56+CD57+ infiltrates are a major subset of NK cells in kidney transplant recipients with ABMR and NK cell infiltration is significantly associated with graft failure post-transplant.

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COVID-19 in Renal Transplant Recipients: Case Series and a Brief Review of Current Evidence

Nephron ◽

10.1159/000512329 ◽

2020 ◽

pp. 1-7

Author(s):

Muhammed Ahmed Elhadedy ◽

Yazin Marie ◽

Ahmed Halawa

Keyword(s):

Renal Transplant ◽

Kidney Transplant ◽

Therapy Monitoring ◽

Intensive Therapy ◽

Current Evidence ◽

Intensive Care Treatment ◽

Renal Transplant Recipients ◽

Supportive Treatment ◽

Transplant Recipients ◽

Kidney Transplant Recipients

By April 26, 2020, infections related to coronavirus disease 2019 (COVID-19) affected people from 210 countries and caused 203,818 reported deaths worldwide. A few studies discussed the outcome of COVID-19 in kidney transplant recipients. This short series demonstrates our experience in managing COVID-19 disease in renal transplant patients in the absence of strong evidence. We report 8 cases of kidney transplant recipients infected with COVID-19 (median age = 48.5 years; range = 21–71 years), including 4 males and 4 females. The most frequently associated comorbidity was hypertension. The most common presenting features were fever and cough. The main radiological investigation was a portable chest X-ray. Other common features included lymphopenia, high C-reactive protein, and a very high ferritin level. Overall, 1 patient was managed as an outpatient, the remaining 7 required hospital admission, 1 of them referred to the intensive therapy unit. Management included supportive treatment (intravenous fluid therapy, monitoring renal function, and symptomatic treatment with or without ward-based oxygen therapy depending on oxygen saturation) and discontinuation of the antiproliferative immunosuppressive drugs. Seven patients recovered and discharged home to self-isolate. One patient required intensive care treatment and mechanical ventilation. Supportive treatment could be sufficient for the management or to be tried first. We also found that short hospital stay with self-isolation on discharge reduces the burden on the health service and protect the staff and the public.

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Vitamin K for kidney transplant organ recipients: investigating vessel stiffness (ViKTORIES): study rationale and protocol of a randomised controlled trial

Open Heart ◽

10.1136/openhrt-2019-001070 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001070

Author(s):

Jennifer Susan Lees ◽

Kenneth Mangion ◽

Elaine Rutherford ◽

Miles D Witham ◽

Rosemary Woodward ◽

...

Keyword(s):

Cardiovascular Risk ◽

Renal Transplant ◽

Kidney Transplant ◽

Vitamin K ◽

Controlled Trial ◽

Aortic Distensibility ◽

Vascular Stiffness ◽

Matrix Gla Protein ◽

Renal Transplant Recipients ◽

Transplant Organ

BackgroundRenal transplant recipients (RTRs) exhibit increased vascular stiffness and calcification; these parameters are associated with increased cardiovascular risk. Activity of endogenous calcification inhibitors such as matrix gla protein (MGP) is dependent on vitamin K. RTRs commonly have subclinical vitamin K deficiency. The Vitamin K in kidney Transplant Organ Recipients: Investigating vEssel Stiffness (ViKTORIES) study assesses whether vitamin K supplementation reduces vascular stiffness and calcification in a diverse population of RTR.Methods and analysisViKTORIES (ISRCTN22012044) is a single-centre, phase II, parallel-group, randomised, double-blind, placebo-controlled trial of the effect of vitamin K supplementation in 90 prevalent RTR. Participants are eligible if they have a functioning renal transplant for >1 year. Those on warfarin, with atrial fibrillation, estimated glomerular filtration rate <15 mL/min/1.73 m2 or contraindications to MRI are excluded. Treatment is with vitamin K (menadiol diphosphate) 5 mg three times per week for 1 year or matching placebo. All participants have primary and secondary endpoint measures at 0 and 12 months. The primary endpoint is ascending aortic distensibility on cardiac MR imaging. Secondary endpoints include vascular calcification (coronary artery calcium score by CT), cardiac structure and function on MR, carotid-femoral pulse wave velocity, serum uncarboxylated MGP, transplant function, proteinuria and quality of life. The study is powered to detect 1.0×10–3 mm Hg-1 improvement in ascending aortic distensibility in the vitamin K group relative to placebo at 12 months. Analyses will be conducted as between-group differences at 12 months by intention to treat.DiscussionThis trial may identify a novel, inexpensive and low-risk treatment to improve surrogate markers of cardiovascular risk in RTR.

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Donor-Specific Anti-HLA Antibodies at the Time of Kidney Transplant Biopsy Associates With Late Graft Failure in Pediatric Renal Transplant Recipients.

Transplantation Journal ◽

10.1097/00007890-201407151-01682 ◽

2014 ◽

Vol 98 ◽

pp. 504

Author(s):

A. Fichtner ◽

B. Hoecker ◽

S. Rieger ◽

R. Waldherr ◽

G. Opelz ◽

...

Keyword(s):

Renal Transplant ◽

Kidney Transplant ◽

Graft Failure ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Hla Antibodies ◽

Pediatric Renal Transplant ◽

Pediatric Renal Transplant Recipients ◽

Transplant Biopsy

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P1612CAN THE URINARY NITRATE TO CREATININE RATIO BE USED AS A MARKER FOR KIDNEY TRANSPLANT REJECTION?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1612 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Cited By ~ 1

Author(s):

Amy Riddell ◽

John Kirkwood ◽

Miranda Smallwood ◽

Paul Winyard ◽

Bridget Knight ◽

...

Keyword(s):

Nitric Oxide ◽

Renal Transplant ◽

Kidney Transplant ◽

Nitrate Concentration ◽

Clinical Care ◽

Transplant Rejection ◽

Creatinine Ratio ◽

Unequal Variance ◽

Renal Transplant Rejection ◽

Over Time

Abstract Background and Aims Early identification and treatment of kidney transplant rejection episodes is vital to limit loss of function and prolong the life of the transplanted kidney and recipient. Current practice depends on detecting a creatinine rise. A biomarker to diagnose transplant rejection, either at an earlier time point, or to inform earlier decision making to biopsy, could be transformative. Urinary nitrate concentration is elevated in renal transplant rejection. Nitrate is a nitric oxide (NO) oxidation product. Transplant rejection upregulates NO synthesis via inducible nitric oxide synthase leading to elevations in urinary nitrate concentration. Historically, assays for measurement of inorganic nitrate in biological fluids have been too time consuming to be useful in a clinical setting. We have recently validated a urinary nitrate concentration assay which could provide results in a clinically relevant timeframe. Our aim was to determine whether urinary nitrate concentration is a useful tool to predict renal transplant rejection in the context of contemporary clinical practice. Method We conducted a prospective observational study, recruiting renal transplant participants over an 18 month period. We made no alterations to the patients’ clinical care including medications, immunosuppression, diet and frequency of visits. We collected urine samples from every clinical attendance including routine attendances, unscheduled attendances for acute clinical indications, and on the day of attendance for biopsy, for those who underwent biopsy. We measured the urinary nitrate to creatinine ratio (uNCR) between patient groups including routine attendances, biopsy proven rejection and biopsy proven “no rejection”. uNCR was examined over time for those with transplant rejection. Groups were compared using a 2 tail t-test of unequal variance, for statistical significance. Results A total of 2656 samples were collected. uNCR during biopsy proven rejection, median 49 µmol/mmol, IQR 23-61, was not significantly different from that of routine samples, median 55 µmol/mmol, IQR 37-82 (p=0.56), or biopsy proven “no rejection”, median 39 µmol/mmol, IQR 21-89, (P=0.77). Overall uNCR was highly variable; median 52 µmol/mmol, IQR 31-81, with no diagnostic threshold for kidney transplant rejection. Furthermore, within-patient uNCR was highly variable over time, and thus it was not possible to produce individualised patient thresholds to identify rejection. Conclusion The urinary nitrate to creatinine ratio is not a useful biomarker for renal transplant rejection.

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Correlation between clinical outcome and tissue inflammatory response in kidney transplant recipients with cryptococcosis

Pathogens and Disease ◽

10.1093/femspd/ftaa054 ◽

2020 ◽

Vol 78 (7) ◽

Author(s):

Angela S Nishikaku ◽

Marcel V Soldá ◽

Giannina Ricci ◽

Vinicius Ponzio ◽

Carla Pagliari ◽

...

Keyword(s):

Renal Transplant ◽

Kidney Transplant ◽

Transforming Growth Factor ◽

Granulomatous Inflammation ◽

Protective Role ◽

Tissue Response ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Tissue Samples

ABSTRACT Cryptococcosis is the second most common invasive fungal infection reported in renal transplant recipients. Tissue granulomatous inflammation is necessary to contain Cryptococcus infection. This study aims to analyze the granuloma patterns and in situ expression of regulatory T (Treg) immune response in tissue samples from 12 renal transplant recipients with cryptococcosis. Fungal isolates were molecularly identified as Cryptococcus neoformans species complex. A detailed characterization of granulomas in tissue samples from 12 kidney transplant recipients with cryptococcosis was described by checking six lung and six skin biopsies by conventional histology and for immunohistochemical detection of CD4 and Treg markers: forkhead box P3 (FoxP3), interleukin (IL)-10 and transforming-growth factor (TGF)-β. Granulomas were classified as compact, loose or mixed. Patients with mixed (n = 4) and compact (n = 3) granulomatous inflammation patterns were associated with a better prognosis and presented a higher number of CD4+FoxP3+T cells compared to the group of patients with loose granulomas. In counterpart, three out of five patients with loose granulomas died with cryptococcosis. We suggest that Treg may have a protective role in the tissue response to Cryptococcus infection given its association with compact and mixed granulomas in patients with better clinical outcomes.

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