RESUMEN
BACKGROUND: Tuberculosis (TB) is a common infection in chronic kidney disease. The prolonged therapy of TB can delay kidney transplantation in patients on antitubercular therapy (ATT). METHODS: This was a retrospective single-center study to analyze the safety of kidney transplantation and its outcomes in patients undergoing transplantation while on the continuation phase of ATT. RESULTS: Between 2013 and 2022, 30 patients underwent kidney transplantation while on ATT. Median age was 38 years and 70% were males. Majority of the patients (86.7%) had extrapulmonary tuberculosis, most common site of involvement being tubercular lymphadenitis. 14/30 patients had microbiological/histopathological diagnosis of TB and the rest were diagnosed by ancillary tests. Patients were treated with 4 drug ATT (isoniazid, rifampicin, pyrazinamide, ethambutol) before transplantation for aminimum of 2 months. Post-transplantation fluoroquinolone-based non-rifamycin ATT was used (median duration 11 months). All patients completed therapy. At 2 years, there was 100% patient survival and 96.7% graft survival. Median eGFR at 6, 12, and 24 months post-transplantation was 71.9, 64.7, and 67 mL/min/1.73m2, respectively. The percentage of patients suffering a biopsy proven acute rejection at 6, 12, and 24 months was 3.3%, 6.7%, and 6.7%. CONCLUSION: Kidney transplantation can be done in patients with TB who have a satisfactory response to the intensive phase of the ATT. The decision for transplantation while on the continuation phase of ATT should be individualized. In our experience, there is excellent patient and graft survival in these patients with a low risk of failure of ATT or relapse of TB.
Asunto(s)
Antituberculosos , Rechazo de Injerto , Trasplante de Riñón , Tuberculosis , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Antituberculosos/uso terapéutico , Persona de Mediana Edad , Tuberculosis/tratamiento farmacológico , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Resultado del Tratamiento , Pirazinamida/uso terapéutico , Etambutol/uso terapéutico , Adulto Joven , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/complicaciones , Rifampin/uso terapéuticoRESUMEN
In the original publication of the article, while submitting the case report.
RESUMEN
Post transplant lymphoproliferative disorder (PTLD) is a rare complication after kidney transplantation. Graft dysfunction is often encountered during the course of the treatment of PTLD, at times leading to need for retransplantation. We describe here the case of a young boy who underwent retransplantation after treatment of early Epstein Barr virus (EBV) related post transplant lymphoproliferative disorder. Our case highlights the various factors needing deliberation before retransplantation including time from remission of PTLD, EBV serostatus and choice of induction and maintenance immunosuppression agents.
Asunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Trasplante de Riñón/efectos adversos , Trastornos Linfoproliferativos/etiología , Disfunción Primaria del Injerto/etiología , Retratamiento/métodos , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Niño , Quimioterapia Combinada , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Virus de Epstein-Barr/virología , Herpesvirus Humano 4/inmunología , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/virología , Masculino , Complicaciones Posoperatorias , Inducción de Remisión , Resultado del Tratamiento , Valaciclovir/administración & dosificación , Valaciclovir/uso terapéuticoRESUMEN
The effect of bariatric surgery on renal functions of patients with chronic kidney disease (CKD) is not well characterized. This prospective study included 13 adult patients having chronic kidney disease who underwent bariatric surgery. The primary objective was to examine the change in glomerular filtration rate (GFR) at 6 months post-bariatric surgery. Median GFR (measured by creatinine clearance) did not change significantly (55 ml/min vs 59 ml/min, p = 0.345) although there was a significant decrease in the protein excretion rate (1700 mg/day vs 900 mg/day, p = 0.001) at 6 months. An improvement in the KDIGO CKD risk category was seen in 30.7% patients. In CKD patients undergoing bariatric surgery, renal function improves over the first 6 months with a decrease in proteinuria and a stable GFR.