Thrombotic Microangiopathy Associated with Pazopanib  in a Kidney Transplant Recipient

Thrombotic microangiopathy (TMA) is characterised by abnormalities in the walls of arterioles and capillaries, precipitated by hereditary or acquired characteristics, and culminating in microvascular thrombosis because of dysregulated complement activity. A number of drugs can precipitate TMA, including vascular endothelial growth factor (VEGF) inhibitors, because of their effects on endothelial repair. Pazopanib is a VEGF inhibitor used for the treatment of renal cell carcinoma (RCC); it is uncommonly associated with TMA. A 52-year-old male, 5 years post his second kidney transplant secondary to immunoglobulin (Ig) A nephropathy, presented with hypertension, fluid overload, and worsening graft function (peak creatinine 275 µmol/L, baseline 130–160 µmol/L) and nephrotic range proteinuria 2 months after commencing pazopanib for metastatic RCC. His maintenance immunosuppression included ciclosporin, mycophenolate, and prednisolone. Haematological parameters were unremarkable. Allograft biopsy demonstrated glomerular and arteriolar changes consistent with chronic active TMA, with overlying fea-tures of borderline cellular rejection. He was treated with intravenous methylprednisolone 250 mg for 3 days and commenced on irbesartan 75 mg daily. Drug-induced TMA from pazopanib was suspected, particularly given the documented association with other tyrosine kinase inhibitors (TKIs). In consultation with his medical oncologist, pazopanib was ceased, and an alternate TKI cabozantinib was commenced. Serum creatinine remained <200 µmol/L 3 months after admission. This is the first reported biopsy-proven case of TMA attributed to pazopanib in a kidney transplant recipient. With increasing clinical indications for and availability of TKIs, clinicians need to be aware of their association with TMA events in kidney transplant recipients, who are already susceptible to TMA due to abnormal vasculature, infectious triggers, ischaemia-reperfusion injury, and use of calcineurin inhibitor.

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Successful treatment of BK virus associated-nephropathy in a human immunodeficiency virus-positive kidney transplant recipient

International Journal of STD & AIDS ◽

10.1177/0956462419900853 ◽

2020 ◽

Vol 31 (4) ◽

pp. 387-391 ◽

Cited By ~ 1

Author(s):

Gaetano Alfano ◽

Francesco Fontana ◽

Giovanni Guaraldi ◽

Gianni Cappelli ◽

Cristina Mussini

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Successful Treatment ◽

Kidney Transplant Recipient ◽

Graft Loss ◽

Graft Function ◽

Opportunistic Pathogen ◽

Bk Virus ◽

Kidney Transplant Recipients ◽

Post Transplantation

BK virus (BKV) is an opportunistic pathogen in those with impaired immunity. Viral replication is generally asymptomatic but is able to induce cytopathic alterations in renal cells. If BKV infection is left untreated, it leads to BKV-associated nephropathy (BKVAN) and graft loss. There is scarce experience in the management of BKV infection in kidney transplant recipients living with HIV. We report the successful treatment of BKVAN in an HIV-positive kidney transplant recipient who experienced BKV replication in the immediate post-transplantation period. A change in therapy from calcineurin inhibitor to sirolimus, steroid withdrawal and a short course of an immunomodulatory agent (leflunomide) controlled BKV viremia in the absence of drug side-effects or impairment of graft function.

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Long-Term Care of the Pediatric Kidney Transplant Recipient

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.16891020 ◽

2021 ◽

pp. CJN.16891020

Author(s):

Hilda E. Fernandez ◽

Bethany J. Foster

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Graft Failure ◽

Graft Function ◽

Failure Rates ◽

Care Providers ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Term Care

Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize transition to adult-oriented transplant care and long-term outcomes.

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

BMC Nephrology ◽

10.1186/s12882-019-1592-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 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.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.5794 ◽

2019 ◽

Vol 13 (11) ◽

Cited By ~ 1

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.

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BK virus-related thrombotic microangiopathy in a kidney transplant recipient

Indian Journal of Transplantation ◽

10.1016/j.ijt.2015.10.008 ◽

2015 ◽

Vol 9 (4) ◽

pp. 155-158

Author(s):

Cengiz Bulut ◽

Ebru Gok Oguz ◽

Basol Canbakan ◽

Deniz Ayli

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Thrombotic Microangiopathy ◽

Kidney Transplant Recipient ◽

Bk Virus

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Comparison of norepinephrine and dopamine in kidney transplant recipient on renal graft function

European Journal of Anaesthesiology ◽

10.1097/00003643-201106001-00445 ◽

2011 ◽

Vol 28 ◽

pp. 139-140 ◽

Cited By ~ 1

Author(s):

C. Feng ◽

B. Liu ◽

M. Piao

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Renal Graft

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

BMC Ophthalmology ◽

10.1186/s12886-020-01741-1 ◽

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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Belatacept Conversion in an HIV-Positive Kidney Transplant Recipient With Prolonged Delayed Graft Function

American Journal of Transplantation ◽

10.1111/ajt.13923 ◽

2016 ◽

Vol 16 (11) ◽

pp. 3278-3281 ◽

Cited By ~ 13

Author(s):

Z. Ebcioglu ◽

C. Liu ◽

R. Shapiro ◽

M. Rana ◽

F. Salem ◽

...

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Delayed Graft Function ◽

Hiv Positive

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Clinical Management of Kidney Transplant Recipients

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0073 ◽

2019 ◽

pp. 457-459

Author(s):

James A. Onigkeit

Keyword(s):

United States ◽

Transplant Recipient ◽

Kidney Transplant ◽

Clinical Management ◽

Living Donor ◽

Kidney Transplant Recipient ◽

Deceased Donor ◽

The United States ◽

Transplant Recipients ◽

Kidney Transplant Recipients

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.

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