Acute esophageal necrosis following kidney transplantation

We are reporting a case of spontaneous acute esophageal necrosis “black esophagus” of unclear etiology in a kidney transplant recipient. A patient with end-stage renal disease due to IgA nephropathy received a deceased-donor kidney transplant. The surgical procedure was uneventful, without hemodynamic instability. He was started on alemtuzumab for immunosuppression induction followed by maintenance immunosuppression with intravenous methylprednisolone for 3 days, then oral prednisone, mycophenolate mofetil and tacrolimus (a target level between 8 and 10ng/ml) daily. On postoperative day (POD) 3, the patient started to develop significant gastro-intestinal symptoms: epigastric pain, dysphagia, odynophagia, eructation, pyrosis, nausea, and regurgitation of food contents. He was diagnosed with esophageal necrosis by upper endoscopy on postoperative day 4. We describe a successful treatment with supportive therapy and complete recovery despite receiving immunosuppressive therapy. To our knowledge, this case is one of the few reported cases of esophageal necrosis in kidney transplant recipients and the first case that was not associated with clinical risk factors.

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Case Report: Transmission of Dengue Virus from a Deceased Donor to a Kidney Transplant Recipient Previously Infected by Dengue Virus

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0137 ◽

2021 ◽

Author(s):

Arnaud Lecadieu ◽

Laura Teysseyre ◽

Kevin Larsen ◽

Charles Vidal ◽

Margot Caron ◽

...

Keyword(s):

Virus Infection ◽

Dengue Virus ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Deceased Donor ◽

Severe Dengue ◽

Reunion Island ◽

Dengue Virus Infection ◽

First Case ◽

Réunion Island

Since 2018, a dengue epidemic has been ongoing in the French overseas department of Reunion Island, in the Indian Ocean, with more than 25,000 serologically confirmed cases. Currently, three dengue serotypes have been identified in Réunion Island (DENV-1, DENV-2, and DENV-3) progressing in the form of epidemic outbreaks. This arbovirus is mainly transmitted by mosquitoes of the genus Aedes and may be responsible for serious clinical forms. To date, very few cases of kidney transplant–related dengue virus infection have been described. Here we report the first case of severe dengue virus infection related to kidney transplantation from a patient previously infected with dengue. Testing for dengue fever with PCR search in donor’s urine may help complete the pretransplant assessment in areas where this disease occurs.

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Acute Esophageal Necrosis in an Immunosuppressed Kidney Transplant Recipient: A Case Report

Transplantation Proceedings ◽

10.1016/j.transproceed.2018.07.002 ◽

2018 ◽

Vol 50 (10) ◽

pp. 3968-3972 ◽

Cited By ~ 4

Author(s):

D. Mealiea ◽

D. Greenhouse ◽

M. Velez ◽

P. Moses ◽

C.E. Marroquin

Keyword(s):

Case Report ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Acute Esophageal Necrosis ◽

Esophageal Necrosis

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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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Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽

10.1136/bmjopen-2020-047263 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047263

Author(s):

Andrea Gibbons ◽

Janet Bayfield ◽

Marco Cinnirella ◽

Heather Draper ◽

Rachel J Johnson ◽

...

Keyword(s):

Kidney Transplant ◽

Outcome Measures ◽

Deceased Donor ◽

Patient Reported Outcome Measures ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Structured Interviews ◽

Cross Sectional ◽

Post Transplant ◽

Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

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Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor

Case Reports in Nephrology ◽

10.1155/2015/821346 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Amudha Palanisamy ◽

Paul Persad ◽

Patrick P. Koty ◽

Laurie L. Douglas ◽

Robert J. Stratta ◽

...

Keyword(s):

Kidney Transplant ◽

Hematologic Malignancy ◽

Deceased Donor ◽

Myeloid Sarcoma ◽

Kidney Transplant Recipients ◽

Systemic Involvement ◽

Transplant Patients ◽

Single Donor ◽

Allograft Nephrectomy ◽

One Year

We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescencein situhybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.

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Increased phosphorylation of the renal Na+-Cl−cotransporter in male kidney transplant recipient patients with hypertension: a prospective cohort

AJP Renal Physiology ◽

10.1152/ajprenal.00326.2015 ◽

2015 ◽

Vol 309 (10) ◽

pp. F836-F842 ◽

Cited By ~ 17

Author(s):

Lorena Rojas-Vega ◽

Aldo R. Jiménez-Vega ◽

Silvana Bazúa-Valenti ◽

Isidora Arroyo-Garza ◽

José Victor Jiménez ◽

...

Keyword(s):

Blood Pressure ◽

Kidney Transplant ◽

Prospective Cohort ◽

Blood Pressure Monitoring ◽

Kidney Transplant Recipient ◽

Blood Levels ◽

Kidney Transplant Recipients ◽

Hypertensive Patients ◽

Urinary Exosomes ◽

Trough Blood

Evidence in rodents suggests that tacrolimus-induced posttransplant hypertension is due to upregulation of the thiazide-sensitive Na+-Cl−cotransporter NCC. Here, we analyzed whether a similar mechanism is involved in posttransplant hypertension in humans. From January 2013 to June 2014, all adult kidney transplant recipients receiving a kidney allograft were enrolled in a prospective cohort study. All patients received tacrolimus as part of the immunosuppressive therapy. Six months after surgery, we assessed general clinical and laboratory variables, tacrolimus trough blood levels, and ambulatory 24-h blood pressure monitoring. Urinary exosomes were extracted to perform Western blot analysis using total and phospho-NCC antibodies. A total of 52 patients, including 17 women and 35 men, were followed. At 6 mo after transplantation, of the 35 men, 17 developed hypertension and 18 remained normotensive, while high blood pressure was observed in only 3 of 17 women. The hypertensive patients were significantly older than the normotensive group; however, there were no significant differences in body weight, history of acute rejection, renal function, and tacrolimus trough levels. In urinary exosomes, hypertensive patients showed higher NCC expression (1.7 ± 0.19) than normotensive (1 ± 0.13) ( P = 0.0096). Also, NCC phosphorylation levels were significantly higher in the hypertensive patients (1.57 ± 0.16 vs. 1 ± 0.07; P = 0.0049). Our data show that there is a positive correlation between NCC expression/phosphorylation in urinary exosomes and the development of hypertension in posttransplant male patients treated with tacrolimus. Our results are consistent with the hypothesis that NCC activation plays a major role in tacrolimus-induced hypertension.

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Ureteric Trauma following Stent Removal in Kidney Transplant Recipient: A Unique Case of Prolonged Morbidity

Case Reports in Transplantation ◽

10.1155/2021/9959074 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Ahmad Mirza ◽

Imran Gani ◽

Andy Shi Huang ◽

Ravi Mallavarapu ◽

Laura Mulloy ◽

...

Keyword(s):

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Deceased Donor ◽

Filling Defect ◽

Percutaneous Nephrostomy ◽

Distal Ureter ◽

Noncontrast Ct ◽

Deceased Donor Kidney Transplant ◽

Stage Renal Disease ◽

End Stage

A 52-year-old African-American male patient with end-stage renal disease due to hypertension underwent deceased donor kidney transplant procedure with no immediate complications. The postprocedure complications, interventions, and course were abstracted by chart review. The ureteric stent was removed with flexible cystoscopy on postoperative day (POD) 24. 24 hours later, the patient presented with abdominal pain and inability to urinate. An urgent ultrasound and noncontrast CT scan showed grade 4 hydronephrosis of the transplanted kidney. A percutaneous nephrostomy stent was placed for urinary diversion. A large ureteric hematoma filling the lumen of the mid to distal ureter was identified on the nephrostogram and was evacuated. A follow-up nephrostogram on POD 44 revealed a distal ureter stricture and persistent well-formed midureter filling defect. A repeat nephrostogram performed at POD 72 was done with stricture dilatation, internalization of stents, and removal of a percutaneous nephrostomy tube. The patient was maintained on antibiotics for UTI prophylaxis throughout the course.

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Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03290321 ◽

2021 ◽

pp. CJN.03290321

Author(s):

Simon Ville ◽

Marine Lorent ◽

Clarisse Kerleau ◽

Anders Asberg ◽

Christophe Legendre ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Ischemia Reperfusion ◽

Multivariable Analysis ◽

Graft Function ◽

Deceased Donor ◽

Kidney Graft ◽

Kidney Transplant Recipients ◽

Heart Beating ◽

Deceased Donor Kidney Transplant

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

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