Efficacy of mTOR Inhibitors and Intravenous Immunoglobulin for Treatment of Polyoma BK Nephropathy in Kidney Transplant Recipients: A Biopsy-Proven Study.

OBJECTIVES: We investigated the efficacy of a predetermined protocol that consisted of immunosuppressive drug reduction/withdrawal and intravenous immunoglobulin administration for the treatment of polyoma BK virus nephropathy. MATERIALS AND METHODS: Patients with biopsy-proven polyoma BK virus nephropathy received a treatment regimen based on discontinuation of both calcineurin inhibitors and antiproliferative agents and switching to mTOR inhibitors accompanied by intravenous immunoglobulin administration. RESULTS: Our study included 508 patients, with polyoma BK viremia detected in 80 patients. The mean age was 45.3 ± 9.5 years (range, 18-71 y), 64% were male, and mean follow-up was 37 ± 21 months (6-94 mo). All 16 patients who developed polyoma BK virus nephropathy and 9 patients who had highgrade polyoma BK viremia without nephropathy received intravenous immunoglobulin treatment. Compared with patients with viremia, patients with polyoma BK virus nephropathy had significantly higher rates of graft loss due to rejection (18.8% vs 1.6%; P = .024) and all-cause graft loss (31.2% vs 6.3%; P = .014). Histopathologically, viral inclusion bodies disappeared and SV40 became negative after treatment in all 13 patients who underwent protocol biopsies. Unfortunately, histopathologically complete recovery without chronic tubular and interstitial tissue damage was achieved in only 4 patients after treatment. In addition, 3 patients lost their grafts due to acute antibody-mediated or mixed-type rejection (18.8%). CONCLUSIONS: In patients with polyoma BK virus nephropathy, clearance of viremia and SV40 should not be the sole outcomes to obtain. Aggressive reductions in maintenance immunosuppression and switching to double-drug therapy combined with high-dose intravenous immunoglobulin leads to high rates of graft loss/rejection and sequalae of chronic histological changes.

Kidney Transplantation From Infected Donors With Particular Emphasis on Multidrug-Resistant Organisms: A Single-Center Cohort Study.

OBJECTIVES: Prevention of sepsis-related organ dysfunction in septic donors is crucial. In this study, septic donors were followed-up based on donor Sequential Organ Failure Assessment criteria. MATERIALS AND METHODS: Between January 2014 and 2020 at our center, 29 primary kidney transplant recipients received organs from 20 septic donors. All donors received either pathogen-specific or broad-spectrum antibiotics at least 48 hours before procurement, and all recipients received similar treatment posttransplant for an average of 7 to 14 days. Donor eligibility was determined according to the sum of donor-Sequential Organ Failure Assessment scores obtained from 6 parameters: Pao2/Fio2 ratio; platelet count; serum bilirubin, creatinine, and lactate levels; and presence of hypotension. The cut-off value for bacteremic donor acceptance was below 12 points. RESULTS: Fever (≥38 °C) persisted in 5 donors in the last 24 hours before organ removal. However, in these 5 donors, the mean donor-Sequential Organ Failure Assessment score was 6.5 ± 1.1, mean arterial pressure was >70 mm Hg, and serum lactate levels were <2 mmol/L. Fifteen donors had systemic inflammatory response syndrome scores of ≤2 with corresponding donor-Sequential Organ Failure Assessment scores of 7.9 ± 1.2; none had systemic inflammatory response syndrome scores >3, which would have indicated severe organ failure. In 28 recipients (97%), no donor-related infections were observed in the perioperative first month and afterwards. CONCLUSIONS: Treatment of donors and recipients with a common protocol greatly reduced the risk of donor-induced infection transmission. In addition, we found the donor-Sequential Organ Failure Assessment criteria to be a helpful tool in predicting organ failure in infected donors.

Acute lower gastrointestinal bleeding due to low-grade mucinous neoplasm of appendix.

INTRODUCTION: Lower gastrointestinal tract (GIT) bleeding originating from the appendix is rare and may be difficult to diagnose. PATIENTS AND METHODS: In this case report, we present an 88-year-old male patient who was admitted with hematochezia due to appendiceal bleeding. A colonoscopy revealed bleeding in the appendix orifice so an appendectomy was performed, and bleeding did not recur in the postoperative period. RESULTS: The results of the microscopic examination showed low-grade mucinous neoplasm (LGMN) of the appendix. CONCLUSION: It should be kept in mind that bleeding may originate from the appendix in patients presenting with GIT bleeding. Our patient is the first to present with an acute lower GIT bleed who was diagnosed as having LGMN in the appendectomy specimen.

COVID-19 pneumonia in kidney transplant recipients: A promising treatment algorithm in the absence of a disease-specific drug.

There is no consensus on the management of coronavirus disease 2019 (COVID-19) and modification of immunosuppressive therapy in kidney transplant recipients (KTRs). In this study, we examined the clinical outcome of our KTRs with COVID-19 disease, who were treated with a broad-spectrum anti-inflammatory protocol. This protocol is essentially composed of intravenous immunoglobulin +/- tocilizumab in KTRs with severe COVID-19 pneumonia. Among 809 KTRs, 64 patients diagnosed with COVID-19 disease between April 2020 and February 2021, were evaluated. Twenty-nine patients with pneumonia confirmed by chest computed tomography (CCT) were hospitalized. The treatment protocol included high-dose intravenous methylprednisolone, favipiravir, enoxaparin, and empirical antibiotics. Patients with pneumonic involvement of more than 25% on CCT with or without respiratory failure were given a total of 2 g/kg intravenous immunoglobulin (IVIg) therapy. Nonresponders received tocilizumab, an interleukin-6 receptor antibody. Of the 29 patients with pneumonia, 6 were treated in other hospitals. These six patients did not receive IVIg and 5 of them deceased. In our center, IVIg treatment was applied to 15 of 23 patients. Seven of them required tocilizumab. Respiratory parameters improved significantly in all but one patient after IVIg ± tocilizumab treatment. The mortality rate was 6.6% in patients who received IVIg therapy and 35.7% in those who did not (p = 0.08). The mortality rate was higher in patients who received treatment in external centers (2.2% vs. 26.3%; p = 0.0073). The treatment of KTRs with severe COVID-19 pneumonia in organ transplant centers with significant experience yields better results. The administration of broad-spectrum anti-inflammatory treatment in this patient group was safe and provided excellent outcomes.

The efficacy of interleukin-1 antagonist drugs in combination with colchicine in patients with FMF-AA with colchicine resistance after kidney transplantation: A study with histopathologic evidence.

BACKGROUND: The efficacy of anti-interleukin-1 (IL-1) drugs in kidney transplant patients with FMF-AA who developed colchicine resistance has not been clearly demonstrated. METHOD: Thirty nine kidney transplant recipients with FMF-AA were evaluated. Group 1 consisted of patients who were in remission after transplantation with colchine and Group 2 included those who developed colchicine resistance. RESULTS: The mean follow-up of the patients was 88.5 ± 61.9 months. Following the treatment with IL-1 antagonists; serum Amyloid A (SAA) averages (79.4 ± 35.3 mg/L) as well as the average number of hospitalizations per month due to FMF episodes (1.4 ± 0.5 times/month) decreased significantly (26.6 ± 25.9 mg/L and 0.1 ± 0.3 times/month) (p < .001). Rates of death with a functional graft were 30% and 0% in group 1 and 2 (p = .086). Biopsy-proven AA amyloidosis recurrence in the allograft was observed in 11 of 19 (58%) and seven of nine (78%) patients in group 1 and 2, respectively. Interestingly, glomerular amyloid deposition was not present in the vast majority of biopsies. De novo vasculer amyloid deposition was observed during treatment. CONCLUSION: IL-1 antagonist drug and colchicine combination almost completely prevented acute FMF attacks in kidney transplant patients with colchicine resistance. However, amyloid accumulation did not cease during IL-1 antagonist drug treatment.

The relationship between serum uric acid levels and development of obesity in living kidney donors after donor nephrectomy.

BACKGROUND: Hyperuricaemia plays a role in the pathogenesis of obesity and related metabolic disorders. The aim of this study to investigate the relationship between pre-donation serum uric acid (SUA) level and obesity development after nephrectomy in living kidney donors. METHODS: Living donors of kidney transplants between 1998 and 2019 were evaluated. Donors with less than 1 year of follow-up were excluded from the study. The participants were divided into two groups according to last control body mass index (BMI) (obese; ≥ 30 kg/m2 and nonobese; <30 kg/m2 ) and median baseline SUA level (<4.6 mg/dL and ≥4.6 mg/dL). RESULTS: In the included 240 donors, the mean follow-up was 50 ± 44 (12-216) months. The mean age was 47 ± 11 (19-82) years, and 46.6% of donors were male. At last control, the percentage of obese donors had increased significantly compared to pre-donation time (22.5% vs 33.8%; P < .001) and last control obese donors had both higher baseline SUA (5.1 ± 1.4 vs 4.5 ± 1.2; P < .01) and BMI (30.7 ± 2.6 vs 24.8 ± 3.0; P < .001). Cox regression analysis showed that there is an independent relationship between the baseline SUA level and development of obesity (odds ratio: 1.30 [CI; 1.12-1.50]; P < .001). In Kaplan-Meier analysis, the development of obesity was significantly higher in kidney donors with high SUA level. CONCLUSION: Living kidney donors (LKD) have a tendency to obesity after nephrectomy. Preoperative serum uric acid level gives important information in LKDs that it could foresee the development of obesity after donation.