Surgical complications and technical failure of simultaneous pancreas-kidney transplantation: A 22-year experience from a single center.

Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end-stage renal disease. Despite advances in surgical techniques, donor and recipient selection, and immunosuppressive therapies, SPKT remains a complex procedure with associated surgical complications and adverse consequences. We conducted a retrospective study that included 263 SPKT procedures performed between May 2000, and December 2022. A total of 65 patients (25%) required at least one relaparotomy, resulting in an all-cause relaparotomy rate of 2.04 events per 100 in-hospital days. Lower donor body mass index was identified as an independent factor associated with reoperation (OR .815; 95% CI:  .725-.917, p = .001). Technical failure (TF) occurred in 9.9% of cases, primarily attributed to pancreas graft thrombosis, intra-abdominal infections, bleeding, and anastomotic leaks. Independent predictors of TF at 90 days included donor age above 36 years (HR 2.513; 95% CI 1.162-5.434), previous peritoneal dialysis (HR 2.503; 95% CI 1.149-5.451), and specific pancreas graft reinterventions. The findings highlight the importance of carefully considering donor and recipient factors in SPKT. The incidence of TF in our study population aligns with the recent series. Continuous efforts should focus on identifying and mitigating potential risk factors to enhance SPKT outcomes, thereby reducing post-transplant complications.

Renal Artery Stenosis in Living Donor Kidney Transplantation: A Rare Cause of "Flash Edema".

Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplantation, with an incidence ranging from 1% to 23%. TRAS often presents with clinical features such as refractory hypertension, de novo hypertension, allograft dysfunction, and the presence of a bruit over the graft. A rare manifestation of TRAS is flash pulmonary edema. Here, we present a case of a 37-year-old male who received a living donor kidney. Four years after the transplant, he presented with acute kidney injury, hypertensive crisis, and flash pulmonary edema. Initially, methylprednisolone pulses were administered due to suspicion of acute rejection, which was later ruled out after a kidney graft biopsy. Computed tomography angiography showed findings suggesting stenosis or thrombus in the renal artery. The patient developed sudden acute pulmonary edema, requiring hemodialysis, with notable clinical improvement. Subsequently, stent placement was performed without complications, resulting in the complete recovery of renal function and effective blood pressure control. The incidence of renal artery stenosis is higher in living donor kidney transplantation, mainly due to technical complexities during surgery. Acute presentations, such as flash edema, are exceptionally rare but can occur years after transplantation. Prompt intervention can lead to favorable outcomes.

Catastrophic Antiphospholipid Syndrome and Renal Failure: An Unexpected Recovery After Three Years on Dialysis.

Catastrophic antiphospholipid syndrome (CAPS) is a rare and life-threatening disorder characterised by arterial or venous thrombotic events, involving three or more organs in a short period of time, in the presence of persistent antiphospholipid antibodies. Long-term anticoagulation with warfarin is the standard of care to prevent recurrent vascular events. Besides supportive care, optimal management of CAPS is unclear and consensus among experts is lacking. We describe a patient with primary antiphospholipid syndrome who experienced probable CAPS after receiving rivaroxaban, resulting in extensive cutaneous ulceration, acute coronary syndrome and dialysis-dependent renal failure. Anticoagulation, glucocorticoids and plasmapheresis were started. In the haemodialysis period, he maintained treatment with long-term vitamin K antagonist. The international normalized ratio target was optimized to 3.5-4. This strategy was associated with the healing of skin lesions, regression of cardiac lesions and recovery of renal function after three years on dialysis.

Septic Shock Due to Capnocytophaga canimorsus Infection in a Splenectomized Patient.

Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal flora of dogs' mouths. Among splenectomized patients who maintain close contact with dogs, the bacteria can lead to infection and fulminant sepsis even without evidence of a skin breach. In this report, we describe the case of a 71-year-old woman who had undergone splenectomy 35 years ago. She came to our emergency department complaining of back pain, myalgia, asthenia, and a fever of 40.2ºC. No other symptoms were noted upon her admission. Blood workup revealed hyperlacticaemia, increased C-reactive protein, and lymphopenia. A urinalysis and chest radiography were ordered, with no abnormal findings, and the SARS-CoV-2 test was negative. The patient developed persistent hypotension and drowsiness that did not improve with intravenous fluids. Therefore, she was started on a norepinephrine infusion. Cultures were collected, and intravenous antibiotic therapy was started with amoxicillin/clavulanic acid 2.2 mg and azithromycin 500 mg. Besides all the diagnostic tests, no infectious cause was found. On the second day of hospitalization, she started to deteriorate, and antibiotic therapy was escalated to piperacillin/tazobactam 4.5 g, resulting in a good clinical response. On the third day after admission, thanks to a group discussion, we were able to identify C. canimorsus in the patient's blood cultures. A review of history revealed that the patient was in close contact with her pet dog. This case highlights the importance of a multidisciplinary discussion, including the microbiology team, in order to reach an uncommon diagnosis. When dealing with splenectomized individuals presenting with the septic shock of unclear origin, a history of close contact with dogs must lead clinicians to consider C. canimorsus as a causative agent.

Avaliação do risco do desenvolvimento de lesões por pressão em pacientes de uma unidade hospitalar / Assessment of the risk of pressure injury development in patients in a hospital unit / Evaluación del riesgo de desarrollo de lesiones por presión en pacientes de una unidad hospitalaria

OBJETIVO: avaliar o risco do desenvolvimento de lesões por pressão em pacientes admitidos nas unidades de internação de um hospital da Zona da Mata Mineira. METÓDO: pesquisa transversal e descritiva, com abordagem quantitativa composta por 322 pacientes. As entrevistas foram realizadas através de um roteiro semiestruturado, organizadas e analisadas através do programa Microsoft Excel 2007. Pesquisa aprovada pelo aprovada pelo Comitê de Ética e Pesquisa com seres humanos, inscrito pelo parecer n° 4.203.388. RESULTADOS: houve predomínio no sexo feminino com 173 (53,7%) pacientes. Dentre os entrevistados, 200 (62,1%) possuíam menos de 60 anos e a principal unidade de internação avaliada foi a clínica médica com 209 (64,9%) casos. Através da aplicação da escala de Braden, 222 (68,9%) apresentaram-se sem risco para o desenvolvimento de lesão por pressão e 40 (12,4%) com baixo risco. Entretanto, 23 (7,1%) dos pacientes apresentavam alto risco e 37 (11,5%) risco moderado. CONCLUSÕES: foram observadas fragilidades na avaliação do risco dos pacientes, bem como na prevenção desses agravos. Além disso, foi possível ressaltar os principais fatores contribuintes para o paciente hospitalizado desenvolver lesão por pressão. (AU)

Objective: To assess the risk of developing pressure injuries in patients admitted to inpatient units of a hospital in Zona da Mata Mineira. Methods: Cross-sectional and descriptive research, with a quantitative approach composed of 322 patients. The interviews were conducted through a semi-structured script, organized and analyzed using the Microsoft Excel 2007 program. Results: There was a predominance of females with 173 (53.7%) patients. Among the interviewees, 200 (62.1%) were less than 60 years old and the main hospitalized unit evaluated was the medical clinic with 209 (64.9%) cases. Through the application of the Braden scale, 222 (68.9%) presented no risk for the development of pressure injury and 40 (12.4%) with low risk. However, 23 (7.1%) of the patients were at high risk and 37 (11.5%) were at moderate risk. Conclusion: Weaknesses were observed in the risk assessment of patients, as well as in the prevention of these diseases. In addition, it was possible to highlight the main contributing factors for hospitalized patients to develop pressure injuries. (AU)

Objetivo: Evaluar el riesgo de desarrollar lesiones por presión en pacientes ingresados en unidades de internación de un hospital de la Zona da Mata Mineira. Métodos: Investigación transversal y descriptiva, con abordaje cuantitativo compuesta por 322 pacientes. Las entrevistas se realizaron a través de un guión semiestructurado, organizado y analizado utilizando el programa Microsoft Excel 2007. Resultados: Hubo predominio del sexo femenino con 173 (53,7%) pacientes. Entre los entrevistados, 200 (62,1%) eran menores de 60 años y la principal unidad hospitalizada evaluada fue la clínica médica con 209 (64,9%) casos. Mediante la aplicación de la escala de Braden, 222 (68,9%) no presentaron riesgo para el desarrollo de lesión por presión y 40 (12,4%) con riesgo bajo. Sin embargo, 23 (7,1%) de los pacientes tenían alto riesgo y 37 (11,5%) tenían riesgo moderado. Conclusion: Se observaron debilidades en la evaluación del riesgo de los pacientes, así como en la prevención de estas enfermedades. Además, fue posible destacar los principales factores que contribuyen a que los pacientes hospitalizados desarrollen lesiones por presión. (AU)