Remarkable 107-year-old kidney with a 49-year of long-term allograph survival through continuous azathioprine monotherapy.

BACKGROUND: The main goal of kidney allograft transplantation is to improve survival in patients with end-stage kidney failure. Herein, we report a 49-year long-term allograft survival with non-identical human leukocyte antigens (HLA). The purpose of this study was to report the successful clinical outcome of 49 years of transplant survival in a 79-year-old patient with a 107-year-old kidney undergoing continued immunosuppressive monotherapy. MATERIAL AND METHODS: The patient was evaluated clinically and immunologically with HLA typing and anti-HLA antibodies before transplantation. Post-transplant, the patient's clinical and immunological survival were monitored for 49 years. The state of the chimerism was assessed using the polymerase chain reaction to amplify 24 short tandem repeats using a DNA thermocycler and DNA analyzer. RESULTS: The patient and donor were haploidentical and the patient was treated with azathioprine monotherapy. Donor-specific antibodies were detected only for the HLA-DPB1* 03:01 mismatch. This patient developed multiple skin tumors 26 years after transplant, which were successfully treated with topical therapy or surgical removal. The patient developed an intestinal adenocarcinoma 43 years after kidney transplantation, which was surgically removal; six years later, adenocarcinoma was diagnosed in a finger, followed by axillar and hepatic metastases. After 49 years of graft survival of a kidney of 107 years old in a patient with 79 years of age, the patient's health worsened with severe dehydration, anemia, and bacterial infection. The patient was hospitalized with a serum creatinine level of 3.45 mg/dL, urea level of 188 mg/dL, and estimated glomerular filtration rate of 22 mL/1.72 m2; septicemia developed and was treated with antibiotics. The patient had poor clinical progress, was intubated, and later died due to septic shock. CONCLUSIONS: To the best of our knowledge, this is the first case of a 107-year-old kidney, transplanted into a recipient who was treated with azathioprine monotherapy for 49 years.

Effects of Bacterial Urinary Tract Infection on Clinical Outcome and Survival of Kidney Transplant Patients.

BACKGROUND: There is no consensus on whether the development of urinary tract infections (UTIs) leads to high mortality or graft loss in kidney transplant patients. A high incidence of multidrug resistant (MDR) infections was observed worldwide and is associated with these complications. The aim of this study was to analyze the effects of UTIs on the clinical outcome and survival in kidney transplant patients. METHODS: This retrospective study evaluated 601 kidney transplant patients who were categorized as follows: group 1 (G1) patients without a UTI, group 2 (G2) patients with a UTI, and group 3 (G3) recipients with a recurrent UTI. Patients were followed up for at least 1 year after transplantation. Graft survival, risk of graft loss, and risk of developing a UTI were analyzed by the Kaplan-Meier method, Cox regression, and logistic regression methods, respectively. Differences with P < .05 were considered statistically significant. RESULTS: The proportion of rejection episodes was higher in G3 (32.35%) than in G1 (20.89%) and G2 (21.88%) (P < .001). The graft survival after the 10-year follow-up was better in G1 (73.29%) than in G3 (61.62%) (P = .019). UTI recurrent episodes increased the risk of graft loss >2.5-fold. Women and those who received a kidney from a deceased donor (DD) were at risk of at least 1 UTI event during follow-up. A greater proportion of MDR infections was observed in G3 than in G2 (P < .001). CONCLUSIONS: The risk factors for developing a UTI were female sex, receiving a DD kidney, susceptibility to other infections, episodes of rejection, and delayed graft function. Moreover, a UTI, especially a recurrent UTI, was an important risk factor for allograft loss.

Malignancy Diseases in Kidney Transplantation, Clinical Outcomes, Patient, and Allograft Survival: A Case-Control Study.

BACKGROUND: Malignancy is a well-known complication in patients after kidney transplantation (KT), but its effect on posttransplant outcomes, allograft, and patient survival remains unexplored. The aim of this study is to report the impact of the comorbidity on clinical outcome, function, and failure of an allograft kidney. METHODS: This case-control study included 101 KT patients. Twenty-six patients who developed cancer (CA) were assigned to the case group and 75 to the control group. Statistical analysis was performed using logistic regression models, and graft survival was analyzed using the Kaplan-Meier curve. RESULTS: Non-melanoma skin CA was the most common malignancy, accounting for almost 60% of cases, followed by stomach CA, prostate CA, and lymphoproliferative diseases (7.70% each). Difference in graft and patient survival was not significant between the two groups (P > .05). A tumor in nonfunctioning in the first nonfunctioning KT was identified in 1 KT patient with a second allograft and by anatomopathological was detect Fuhrman grade II renal cell carcinoma. This KT patient was in good clinical condition with serum creatinine level of 1.5 mg/dL. CONCLUSIONS: No association was observed between CA development and risk factors, including family history and smoking habit, and no differences in allograft and patient survival were found. Nevertheless, in our data, CA in KT patients occurred early after transplantation. Renal cell carcinoma in allograft failure was identified in a patient; that suggested that nephrectomy of kidney failure must be performed to avoid patient allosensitization and neoplasia. Thus, we suggest continuous screening of malignancy diseases for KT patients.

Impact of the immunotherapy induction on allograft outcome and survival in kidney transplant patients with donor-specific antibodies to HLA-DQB1.

BACKGROUND: The presence of donor-specific antibodies (DSAs) against HLA-DQB1 is considered a significant barrier to good outcome and allograft survival in kidney transplantation (KT). This study aimed to assess the impact of induction immunotherapy on the outcome and allograft survival in KT patients with HLA-DQB1-DSA. METHODOLOGY: Thirty-two patients who had undergone KT and found to be positive for HLA-DQB1-DSA were monitored at least one to 10 years. They were allocated into two groups of patients: G1 received induction immunotherapy (n = 14 patients; 43.75%), and G2 did not (n = 18 patients; 56.25%). RESULTS: In G1, 6 (42.86%) patients experienced rejection episodes (RE), 2 (14.29%) due to antibody-mediated rejection (ABMR) and 4 (28.57%) due to T-cell-mediated rejection (TCMR). In G2, 13 (72.22%) patients experienced RE, 3 (16.67%) due to ABMR, and 10 (55.56%) due to TCMR. Graft loss occurred in 4 patients from G1, 2 (14.29%) due to ABMR and 2 (14.29%) due to non-immunological causes. In G2, 9 (50.00%) patients lost their grafts, 2 (11.11%) due to TCMR, 2 (11.11%) due to ABMR, and 5 (27.78%) due to non-immunological causes. The graft survival rate was 64.29% in G1 and 45.83% in G2. Glomerulitis and peritubular capillaritis were observed in 3 and C4d-positive patients with/or without induction who lost their grafts by ABMR by HLA-DQ DSA. Two patients from G2 lost their graft by TCMR due to interstitial lymphocytic infiltrate (i1), foci of mild tubulitis (t2), interstitial edema, moderate interstitial fibrosis and tubular atrophy. Better graft survival rates were shown in patients from G1 who received induction immunotherapy. CONCLUSION: Our study suggests that patients with an immunological profile of HLA-DQ+ DSA+ treated by immunotherapy induction have a decreased risk of ABMR and increased allograft survival, and the presence of anti-HLA-DQB1 DSA+ detected before and after KT were associated with ABMR episodes and failure.

Effect of Glomerulopathy Recurrence in the Outcome and Graft Survival of Kidney Transplanted Patients.

BACKGROUND: Recurrent glomerulopathy (GP) after kidney transplantation is a complication of kidney transplantation that could negatively affect kidney function and graft survival. This study aimed to evaluate the outcome, graft survival, and GP recurrence and its predictive factors in kidney-transplanted patients. METHODS: Patients were divided into 2 groups: G1 (with GP; n = 95) and G2 (with other causes of end-stage renal disease; n = 373). Graft survival analyses were performed using the Kaplan-Meier for living donor (LD) and deceased donor (DD). Cox proportional hazards regression were used to investigate the predictors for graft loss and for GP recurrence. RESULTS: Disease recurrence was observed in 9 patients who received a kidney from an LD, of which 4 lost their grafts. In patients who received a kidney from a DD, recurrence was also observed in 9 patients, of which 3 lost their grafts. No statistically significant differences in graft survival between G1 and G2 in relation to LD and DD were noted (P = .299 and .434, respectively). However, differences in graft survival were found when GP subtypes and GP recurrence were analyzed. The predictors of graft loss were delayed graft function (hazard ratio [HR] = 2.226, P = .002), rejection episodes (HR = 1.904, P = .017), and recurrence or transplant GP (HR = 3.243, P = .006). The predictors of disease recurrence or transplant GP were age (HR = 0.945, P = .028) and cold ischemia time (HR = 1.117, P = .003). CONCLUSION: Kidney transplantation could be a reasonable treatment for GP with end-stage renal disease. Despite the disease recurrence, which is a significant cause of graft loss in transplant recipients, graft survival remains satisfactory.

Linfoistiocitose hematofagocítica em transplante renal: relato de caso e revisäo da literatura / Histiocytosis-non-Langerhans-cell in kidney transplantation: case report and literature review

A linfoistiocitose hematogocítica (LH) constitui uma síndrome clínico-patológica associada à febre pancitopenia severa, disfunçäo hepática e distúrbio da coagulaçäo, com hematofagocitose no nível da medula óssea e órgäos linfóides. Ocorre em pacientes imunossuprimidos, sendo induzida por infecçöes bacterianas, viróticas, fúngicas e parasitárias, bem como neoplasias, especialmente os linfomas de células T. Este trabalho relata o primeiro caso do nosso conhecimento de LH em transplante renal no Brasil, discutindo-se a etiologia, fisiopatogenia, manifestaçoös clínicas e tratamento da doença.