scholarly journals Nocardia infection in renal transplant recipient: diagnostic and therapeutic considerations

1993 ◽  
Vol 35 (5) ◽  
pp. 417-421 ◽  
Author(s):  
L.T. Santamaria Saber ◽  
J.F.C. Figueiredo ◽  
S.B. Santos ◽  
C.E. Levy ◽  
M.A. Reis ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Present Report ◽  
Pulmonary Involvement ◽  
University Hospital ◽  
Renal Transplant Recipients ◽  
Cns Involvement ◽  
Diagnostic Difficulties ◽  
Therapeutic Measures ◽  
The University ◽  
Therapeutic Considerations

In the present report the authors discuss the diagnostic difficulties, therapeutic measures and the clinical course of Nocardia infection which occurred among renal transplant recipients at the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (UH-FRP), from 1968 to 1991. Among 500 individuals submitted to renal transplant, 9 patients developed Nocardiosis at varying times after transplant (two months to over two years). All the patients had pulmonary involvement and their most common symptoms were fever, cough and pleural pain. Dissemination of the process is common and three patients presented cutaneous abscesses, four CNS involvement and one had pericarditis due to Nocardia. The diagnostic is quite difficult since there is no specific clinical picture, concomitant infections are frequent and the microorganism presents slow growth in culture (ranging from four to forty days, in our experience). In this report, three cases were only diagnosed by necropsy. The treatment of choice is a combination of Sulfamethoxazole and Trimethoprim (SMX-TMP). In the present series, overall mortality was 77% (7 cases) and in five of the patients who died the diagnosis was late. All the patients who had CNS involvement died.

scholarly journals MO920TRANSITION FROM GENERIC TO BRAND TACROLIMUS IN TUNISIAN RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Dorra Amor ◽  
Sahtout Wissal ◽  
A Ellouz ◽  
Ameni Abderrahman ◽  
Awatef Azzabi ◽  
...  
Keyword(s):  
Renal Transplant ◽  
University Hospital ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Blood Concentrations ◽  
Transplant Patients ◽  
Trough Blood ◽  
Bioequivalence Testing ◽  
Adult Volunteers

Abstract Background and Aims Due to unavailability of the generic tacrolimus, commonly used in renal transplant patients in Tunisia, all renal transplant switched to the Brand. No previous studies have assessed the pharmacokinetic differences of this generic tacrolimus compared to the brand. The aim of the present study was to evaluate the effect of this switch on the tacrolimus dose (D) and on the dose-adjusted tacrolimus trough blood concentrations (C0/D) in Tunisian renal transplant recipients. Method For the 255 renal transplant monitored in biochemestry department of Sahloul University hospital, 808tacrolimus trough concentration (C0) were collected from october 2018 to February 2020 and were divided to 406 C0 determination before switch and 402 after switch. The dose and the post-transplantation period was recorded for each C0. Results The generic tacrolimus doses used were significantly higher compared to the brand: 0,12 mg/kg [0,02-0,6] vs 0,11 mg/kg [0,02-0,22] p<0,001 and this was reported in different post graft periods: 0,17 [0,03-0,22] vs 0,13 [0,06-0,22] p<0,001in the 3 first months after the transplantation and 0,11 [0,02-0,48] vs 0,08 [0,02-0,22] p<0,001 above.The C0/D were significantly lowe runder the the generic tacrolimus compared to the brand 48,34ng/ml per mg/kg/day [11,58-210,00] vs77,35ng/ml per mg/kg/day[19,38-221,67]; p<0,001 and this was reported in different post graft periods: 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 in the 3 first months after the transplantation and 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 above. Dose needed to reach target tacrolimus C0 seems to be higher with the generic tacrolimus compared to the brand. Conclusion Approval of a generic is dependent on bioequivalence testing in healthy adult volunteers after a single dose, however studies on renal graft recipient populations after chronic use are needed to assed bioequivalence in this special population.

scholarly journals 531. COVID-19 infection outcome in African American Renal Transplant recipients: Detroit Medical Center experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S332-S333
Author(s):  
Angela Beatriz V Cruz ◽  
Claudia Jarrin Tejada ◽  
Mareena Zachariah ◽  
Shakir Hussein ◽  
Elizabeth Wilpula ◽  
...  
Keyword(s):  
African American ◽  
Renal Transplant ◽  
Medical Center ◽  
Deceased Donor ◽  
University Hospital ◽  
Lower Mortality ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Laboratory Findings ◽  
Obstructive Sleep

Abstract Background Transplant recipients are more vulnerable to infections including COVID-19, given their co-morbidities and chronic immunosuppression. Most preliminary care series report rapid clinical progression and higher mortality compared to the general population. Methods Retrospective study at Harper University Hospital - Detroit Medical Center. Twenty-five renal transplant recipients (RTR) presenting consecutively with COVID-19 symptoms and positive NP swab PCR for SARS-CoV2 between 03/01/2020 - 05/01/2020 were included. Data on demographics, clinical presentation, laboratory findings, management and outcomes were collected. Results All 25 patients were hospitalized. Patients had a median age of 56, all African American and deceased donor transplant recipients. Most had hypertension (96%), about half (52%) had diabetes, 64% had pulmonary disease including obstructive sleep apnea, COPD and pulmonary hypertension. Most common presenting symptom was dyspnea (64%), followed by fever and cough (56%) and diarrhea (56%). One-half of patients had multifocal opacities on initial chest x-ray (52%). Immunosuppression with tacrolimus and low dose prednisone was continued, while mycophenolate mofetil was held on admission. Following institution guidelines, hydroxychloroquine was given to 32%, while 48% received both hydroxychloroquine and steroids. Prophylactic anticoagulation was given to 80% of patients and therapeutic coagulation to 8%. Oxygen supplementation given to 60% of patients and one patient required intubation. Three patients (12%) required transfer to the intensive care unit, one expired. At follow-up, treatment with mycophenolate was reintroduced based on resolution of symptoms and laboratory parameters. Conclusion COVID-19 infected RTR in this small cohort had lower mortality of 4% (n=1) compared to State-wide mortality of 10%. Despite multiple co-morbidities and chronic immunosuppression, our patient cohort had excellent prognosis and lower mortality compared to other series. Exact reasons for this optimal outcome are explored. Disclosures All Authors: No reported disclosures

scholarly journals Use of Leflunomide in Renal Transplant Recipients with Ganciclovir-Resistant/Refractory Cytomegalovirus Infection: A Case Series from the University of Chicago

2015 ◽  
Vol 5 (1) ◽  
pp. 96-105 ◽  
Author(s):  
W. James Chon ◽  
Pradeep V. Kadambi ◽  
Chang Xu ◽  
Yolanda T. Becker ◽  
Piotr Witkowski ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Medical Center ◽  
Case Series ◽  
Deceased Donor ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
University Of Chicago ◽  
Kidney Transplants ◽  
Cmv Infection ◽  
The University

Introduction: Although antiviral prophylaxis for cytomegalovirus (CMV) is widely used, CMV infection remains common in renal transplant recipients with adverse consequences. Methods: We report 5 cases of renal transplant recipients with resistant CMV infection who were successfully managed with leflunomide at the University of Chicago Medical Center. Results: Five renal transplant recipients (2 simultaneous pancreas/kidney transplants, 3 deceased donor kidney transplants) were diagnosed with GCV-resistant CMV infection from 2003 to 2011. Of the 4 patients who had resistance genotype testing, 3 showed a UL97 mutation and 1 patient had a clinically resistant CMV infection. All patients received CMV prophylaxis with valganciclovir for 3 months. The number of days from the date of transplant to viremia ranged from 38 to 458 days (median 219). All 5 patients received other antiviral agents (e.g. ganciclovir, foscarnet), and in 4 patients, viremia was cleared before leflunomide was initiated as consolidation (or maintenance) therapy. Conclusion: Leflunomide was well tolerated and successful in preventing recurrence of viremia in renal transplant recipients with resistant CMV infection. The beneficial effect of leflunomide in this setting warrants further investigation.

scholarly journals Pregnancy on a Rudimentary Unbroken Horn of a Pseudo-Unicornuate Uterus: A Case Report at The University Hospital of Angre Abidjan

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Uterine Wall ◽  
University Hospital ◽  
Fetal Mortality ◽  
Abdominal Pregnancy ◽  
Mortality And Morbidity ◽  
Unicornuate Uterus ◽  
Uterine Malformation ◽  
Diagnostic Difficulties ◽  
The University ◽  
Made In

The pseudo-unicornuate uterus which is a rare uterine malformation, that can be the site of a pregnancy. Pregnancies in the rudimentary horn usually result in a rupture due to a uterine wall not adapted to the level of the horn, but especially diagnostic difficulties. Their discovery is most often made in intraoperative, when an indication of laparotomy is made for hemoperitoneum in emergency. They are therefore responsible for high maternal-fetal mortality and morbidity. We report in this observation a case of pregnancy in a rudimentary unruptured horn, in a 28-year-old, 4th gesture 2nd parous, the discovery of which was made incidentally, during an indication of laparotomy posed for suspected abdominal pregnancy complicated by a surgical abdomen.

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