Left ventricular structure and function in long-term kidney transplantation: the influence of glucose metabolism and oxidative stress.

Impaired cardiac structure and function are fundamental components of cardiovascular disease, leading to morbidity, mortality, and graft loss after renal transplantation. The aim of this study was to describe and determine the factors involved in these cardiac abnormalities, paying special attention to the role of glucose metabolism and oxidative stress. We studied 54 long-term, nondiabetic recipients with no valvulopathy who underwent an echocardiographic examination and simultaneous biochemical determinations of lipid profile, hemoglobin A1c (HbA1c), and various oxidative stress parameters: malondialdehyde, superoxide dismutase, total glutathione, and isoprostanes. We calculated the left ventricular mass index (LVMI) and ejection fraction and the peak velocity of early rapid filling to peak velocity of atrial filling (E/A) ratio. Left ventricular hypertrophy (LVH), systolic dysfunction, and diastolic dysfunction (LVDD) were present in 25.9%, 5.6%, and 59.25% of the patients, respectively. The mean blood pressure (MBP) was higher and the hemoglobin lower among patients with LVH, which was related to the age of the patients. We observed a significant negative association of the E/A ratio-used as an index of LVDD-with HbA1c (r = -.448, P = .002) and age (r = -.57, P = .000) and a positive association with the level of total glutathione (r = .322, P = .029). Multiple regression analysis of the E/A ratio showed significance only for HbA1c but not for MBP or LVMI. These results suggested a possible causal influence of subclinical glucose metabolism impairment as detected by HbA1c on the presentation of LVDD via the impaired oxidative stress status, independent of blood pressure control or LVH grade.

Cytomegalovirus Infection Monitoring Based on Interferon Gamma Release Assay in Kidney Transplantation.

BACKGROUND: Cytomegalovirus (CMV) is the most common viral infection after kidney transplantation and is associated with significant morbidity and mortality. Recent studies showed that CMV-specific CD8+ T cells play the crucial role in protection against CMV. The Quantiferon-CMV (QF-CMV) is an interferon gamma (IFN-γ) release assay (IGRA test) that measures the IFN-γ response to a range of T-cell epitopes of CMV. In the present study, we analyzed the clinical utility of QF-CMV assay to predict CMV infection in kidney transplant recipients and evaluated if reactive result in QF-CMV test could be predictor of the duration of treatment. METHODS: We studied 75 renal transplant recipients who had IGRA testing just before transplantation. The donor and recipient variables were reported from the clinical history. The variables related to transplantation were collected from transplantation process data and included CMV infection or disease, CMV treatment, and immunosuppressive treatment. Laboratory variables were C3-C4 complement fractions and DNA quantification of CMV. RESULTS: Fifty percent of patients had CMV infection, and 35.9% had CMV disease. The time of negativization of CMV DNA was 56.61 ± 23.5 days. Univariate analysis related to CMV infection only showed a statistically significant relation with thymoglobulin treatment (P = .001). Statistically significant variables in relation with CMV infection incidence were donor serology (P = .044) and thymoglobulin treatment (P = .004). The probability of CMV infection was lower with positive IGRA assay (P = .025). CONCLUSION: We found that IFN-γ response measured by QF-MV is a protective factor against CMV infection in post-transplantation kidney recipients.

Severe Scedosporium apiospermum Infection in a Recent Renal Transplant Recipient: Case Report.

Infections in transplanted patients are still an important cause of morbidity and mortality. Among them, fungal infections with pathogens have become increasingly more prevalent in the last decade. We report the clinical course and management of disseminated Scedosporium apiospermum infection in a kidney transplant recipient, with microbiological isolation of the fungus in cerebrospinal fluid culture. S apiospermum is a fungus that is distributed worldwide and can be grown from soil samples or stagnant water. Disseminated infection is the most frequent form of infection, with cerebral involvement in most cases, which leads to a very high mortality (around 75%). Post-transplant renal infections require a thorough evaluation. Specifically, a high suspicion index is necessary, considering Scedosporium infection among the differential diagnosis of invasive fungal diseases in renal transplantation patients. It is essential to confirm the microbiological diagnosis for an adequate diagnosis and treatment.

Predictive factors of infection in the first year after kidney transplantation.

BACKGROUND: Infectious disease, a complication favored by immunosuppression, is the main cause of 1st-year mortality in solid organ transplantation. In renal transplant recipients (RTRs), urinary tract infection (UTI) is the most common, and the microorganisms that are isolated depend on chronology. METHODS: We present an observational study comprising 129 RTRs from January 2010 to December 2011 who were followed during the 1st year after transplantation. We analyzed occurrence of infections, predisposing factors, timing, severity, site of infection, and microorganisms. RESULTS: The patients had a total of 424 infectious episodes during the 1st year (3.29 episodes/patient/year). The predominant focus was the urinary tract, with at least 1 episode in 69.8% of patients. Bacteremia was recorded in 25.6% of patients and surgical wound infection in 20.9%. Cytomegalovirus infection or disease was diagnosed in 46.5%. Severe infections occurred in 30.2%. The predominant pathogen was E. coli. There was a significant correlation between hospital stay and the number of infections (P = .000; r = 0.407) and between body mass index and hospital stay (P = .001; r = 0.282). Severe infections were more frequent in diabetics, patients with a double-J stent, and those treated with basiliximab. Patients with cytomegalovirus replication had a higher number of infections (4.1 ± 1.2 vs 2.5 ± 5; P = .000) and significantly higher annual serum creatinine (1.65 ± 5.7 vs 1.31 ± 1.3 mg/dL; P = .003). CONCLUSIONS: The prevalence of infections in the 1st year after kidney transplantation is very high, occurring mainly in the early period, in the urinary tract, and due to E. coli. Cytomegalovirus replication is associated with a higher number of infections and higher serum creatinine at 1 year. Body mass index is a predictor of early infection and of bacteremia in the post-transplantation period. Basiliximab induction and having a double-J stent were predictors of severe infections.