Relevance of Proteinuria in Kidney Transplant Recipients and Allograft Outcomes.

BACKGROUND: The onset of proteinuria in renal allograft recipients is frequently associated with an increased risk for both graft failure and mortality. We investigated the risk associated with post-transplant proteinuria and its time-dynamics in a select group treated for biopsy proven antibody-mediated rejection (ABMR). METHODS: Eighty-five patients who underwent transplantation were enrolled in our study and followed up from transplantation until October 31, 2020, death, or the date of the return to dialysis. We created two main groups: the ABMR group (n = 19) and an ABMR-negative control group with stable kidney function (n = 52) without donor-specific antibodies (DSA) and a subgroup with DSAs but stable graft function (n = 14) without ABMR. Differences in patient, donor, and transplant graft characteristics between the groups were assessed by Fisher's exact test for categorical variables. Death-censored graft loss was evaluated with the help of Kaplan-Meier analysis using log risk statistics. RESULTS: Proteinuria decreased after treatment in the ABMR group (P < .0009). Pre-treatment every 10 mg/mmol increase in proteinuria was associated with a 7% increase in the risk for graft failure in the ABMR group. The estimated 3-year graft survival was 87.5% in the ABMR group, compared to 93% in the group without ABMR but with pre-formed DSA, and 100% in the DSA negative subgroup (log-rank probe P < .0666). CONCLUSION: Proteinuria is an independent predictor for graft failure, can be lowered by treatment for ABMR but ABMR is associated with lower graft survival in our study population.

Hemorrhagic Pneumonia in a Kidney Transplant Recipient Caused by Stenotrophomonas Maltophilia Infection: A Case Report.

Pneumonia is a common nosocomial complication in transplant patients. Stenotrophomonas maltophilia is recognized as a common cause and is typically seen in immunocompromised and critically ill patients. S. maltophilia, a nonfermenting gram-negative rod, ranks as the third most common nosocomial pathogen, following Pseudomonas aeruginosa and Acinetobacter. The bacteria are frequently found in environmental sources and are prevalent in healthcare facilities, including in tap water faucets, shower outlets, air-cooling systems, intravenous fluids, catheters, dialysis machines, and oxygen humidifiers. This bacterium possesses the ability to rapidly form biofilms, enabling it to colonize new surfaces in less than 24 hours. While S. maltophilia generally exhibits low virulence, there remains uncertainty among many clinicians regarding whether it is merely a colonizer or the primary cause of infection. Although S. maltophilia infections are rare in immunocompetent individuals, the species is increasingly recognized as an opportunistic pathogen in vulnerable populations such as those with cystic fibrosis, cancer, and other conditions leading to immunosuppression. S. maltophilia now recognized as a causative agent in various clinical syndromes, primarily affecting the lungs and bloodstream. We present a case of S. maltophilia-associated lung infection in a kidney transplant recipient, emphasizing the significance of underlying diseases and associated signs and symptoms.

Effect of education on sun-safe behaviour in kidney transplant recipients.

BACKGROUND: Organ transplant recipients (OTR) are more likely to develop skin cancer than the general population. One of the main components of the exposome that triggers the development of skin tumours is solar ultraviolet (UV) radiation. To reduce the incidence of harmful consequences of sun exposure, sun protection education is needed for patients taking long-term immunosuppressive drugs. METHODS: In a previous study, we assessed the sun-safe behaviour of 221 OTR using a questionnaire before and after transplantation and personally educated the patients about proper sun protection. After the education, there were no further reminder presentations. Presently, the sun protection and sun seeking habits of the available 176 of these patients were questioned to assess the long-term effect of the previous sun protection education. RESULTS: Two-four years after the education, more patients wore hats and protected their skin with long-sleeved clothing than before the education. In terms of sun seeking habits, both occupational and recreational sun exposure decreased significantly. Significantly fewer people went on holiday after transplantation, but those who went on holiday spent significantly less time in the sun. CONCLUSION: The long-term positive effects of education can be seen both in the patients' sun protection and in their sun seeking habits. However, the long-term goal is to maintain these results and thereby reduce the likelihood of skin tumours and consequently the associated tumour death.