Successful Pregnancy Outcome in a Recipient With Simultaneous Kidney and Pancreas Transplant Who Underwent Posttransplant Metabolic Surgery.

Although chronic kidney disease decreases fertility, kidney transplantation provides restoration of fertility in women, enabling them to get pregnant. Data available from registries have shown that pregnancy is feasible in solid-organ transplant recipients without significant impact on long-term graft function. Despite these reassuring data, some studies have reported that one-third of female transplant recipients are still actively being counseled against pregnancy. Here, we present a patient who received a simultaneous deceased-donor kidney and pancreas transplant and who had a favorably evolved pregnancy. The 36-yearold kidney-pancreas transplant recipient conceived 5 months after her marriage. The patient was closely followed during pregnancy by a multidisciplinary team that included a nephrologist, gynecologist, and endocrinologist. Renal function and blood glucose levels remained within normal limits. She delivered her baby normally at 31 weeks of pregnancy (1.3-kg male baby). Currently, both mother and baby are doing well. Pregnancy in combined kidney and pancreas transplant recipients with stable graft functions is feasible but remains risky. Proper planning, modification of immunosuppressive drugs, and close monitoring are the keys to optimized maternal, fetal, and graft outcomes.

Early Versus Late Acute Antibody-Mediated Rejection Among Renal Transplant Recipients in Terms of Response to Rituximab Therapy: A Single Center Experience.

OBJECTIVES: There are no comparable trials concerning the use of rituximab among renal transplant recipients with acute antibody-mediated rejection. Here, we compared early and late acute antibody-mediated rejection in renal transplant recipients in terms of response to rituximab therapy. MATERIALS AND METHODS: Of 1230 kidney transplants performed at Hamed Al-Essa Organ Transplant Center (Kuwait) over the past 10 years, 103 recipients developed acute antibody-mediated rejections and were subcategorized into 4 groups according to the onset of rejection and rituximab treatment. All patients received the standard treatment for acute antibody-mediated rejection according to our protocol (plasma exchange and intravenous immunoglobulin). We added rituximab to the treatment regimen in 2 groups of patients: 27 patients with early rejection (group 1) and 38 patients with late rejection (group 2). Groups 3 and 4 represented nonrituximab groups, with 20 patients with early (group 3) and 18 patients with late rejection (group 4). We compared the 4 groups regarding graft and patient outcomes. RESULTS: All patients were comparable regarding patient age, sex, pretransplant type of dialysis, viral profile, type of induction, donor criteria, and pretransplant comorbidities. We observed that delayed and slow graft function were significantly higher in groups 1 and 3 (P = .016); however, we found no significant differences in the 4 groups regarding new-onset diabetes after transplant, BK viral infection, and malignancy. Graft outcomes were significantly better in groups 1 and 2 than in groups 3 and 4 (P = .028). However, patient outcomes were comparable in the 4 groups (P > .05). CONCLUSIONS: Early acute antibody-mediated rejection in renal transplant recipients had significantly better outcomes when rituximab was added to the standard treatment regimen.

Bariatric Surgery in Renal Transplant Patients.

OBJECTIVES: The idea of transplanting organs is not new, nor is the disease of obesity. Obese transplant recipients have greater risk of early death than their cohorts, which is not due to increased rejection but due to obesity-related complications, including arterial hypertension, diabetes, and delayed graft function. Here, our aim was to evaluate the effects of bariatric surgery versus lifestyle changes on outcomes of moderate to severely obese renal transplant recipients. MATERIALS AND METHODS: Twenty-two morbidly obese patients with stable graft function who underwent bariatric surgery were compared with 44 obese patients on lifestyle management (control group). Both groups were evaluated regarding graft and patient outcomes. RESULTS: The studied groups were comparable demographically. In the bariatric study group versus control group, we observed that the mean body mass index was 38.49 ± 9.1 versus 44.24 ± 6 (P = .024) at transplant and 34.34 ± 7.6 versus 44.38 ± 6.7 (P = .002) at 6 months of bariatric surgery. Both groups received a more potent induction immunosuppression, but this was significantly higher in the obese nonbariatric control group (P < .05). There were more patients with slow and delayed graft functions in the same nonbariatric group. The 2 groups were comparable regarding new-onset diabetes after transplant, total patients with diabetes, and graft outcomes (P > .05). CONCLUSIONS: Bariatric surgeries are feasible, safe pro cedures for selected obese renal transplant recipients.

Chronic antibody-mediated rejection: review of literature.

Chronic antibody-mediated rejection among kidney transplant recipients is a major unresolved problem which is covered in this review article which included different lines of its management.

Effect of chronic hepatitis C virus infection on bone mineral density in pediatric renal transplant recipients.

Previous studies have suggested that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis C virus (HCV) infection. Furthermore, to the best of our knowledge, such an effect has never been studied in pediatric renal transplant recipients. The aim of this study was to assess the impact of HCV infection on BMD in pediatric renal transplant patients. We performed a cross-sectional study to assess BMD and HCV in 83 patients who received living renal allotransplants in the Mansoura Urology and Nephrology Center between 1983 and 2005. The mean age of the study patients at transplantation was 13.4 ± 2.9 years; there were 53 males (63.9%) and 30 females (36.1%). BMD was studied using dual energy X-ray absorptiometry at various time intervals up to 16 years after transplantation (mean duration after transplantation was 48 ± 34 months, range 12- 192 months). Thirty-three patients tested positive for HCV-RNA (positive group) and 50 patients were negative (negative group), and we compared the BMD between the two groups. Before transplantation, 58 patients (69.9%) were on maintenance hemodialysis, four (4.8%) were on peritoneal dialysis and 21 (25.3%) were pre-emptive. Among the HCV-positive group, six patients (18.2%) had osteoporosis, 17 (51.5%) had osteopenia and ten (30.3%) had normal BMD. In the HCV-negative group, ten patients (20.0%) had osteoporosis, 24 (48.0%) had osteopenia and 16 (32.0%) had normal BMD. The difference was not significant between the two groups (P = 0.9). Also, there was no significant difference in the serum creatinine, calcium, phosphorus and parathormone levels between the two groups. Our results suggest that chronic HCV infection does not pose a risk for low BMD in pediatric renal transplant recipients.

Focal segmental glomerulosclerosis and kidney transplantation.

The recurrence rate of focal segmental glomerulosclerosis after kidney transplantation is ranging between 20% and 40%. Focal segmental glomerulosclerosis is associated with poor graft survival. In this review, the etiology, pathogenesis, clinicopathological features, risk factors of recurrence, and updated lines of management are discussed.

The effects of gender on health-related quality of life in pediatric live-donor kidney transplantation: a single-center experience in a developing country.

To evaluate the effects of gender on HRQOL and overall health status in our pediatric kidney transplants. We performed a cross-sectional study in 77 children who received living renal allo-transplants in our center between 1981 and 2003. The patients were given a questionnaire at a post-transplant visit. After completing, the patients returned it in a closed envelope. The questionnaire included demographic questions plus 57 multiple-choice questions designed to analyze various aspects of post-transplant life. Overall, the patients show satisfactory HRQOL. Most of the patients lived with their parents (79.2%). The current health status did not cause difficulties at work in 70.1% and did not interfere with the social life in 62.3% of patients. Physical and sexual growth was delayed in 48% and 85.7% of patients, respectively. A total of 67.5% of patients had normal health life or minor symptoms with normal activity. There was no significant effect of gender on HRQOL except for onset of puberty, sexual function, practicing sports, and obesity. Overall, the patients show satisfactory HRQOL. There was mild significant effect of gender on HRQOL. These findings may help health care professionals to develop gender-specific interventions to optimize HRQOL of kidney transplants.

Proteinuria after kidney transplantation: its relation to hepatitis C virus and graft outcome.

INTRODUCTION: Chronic Hepatitis C Virus (HCV) infection has been associated with glomerular disease in native and transplanted kidneys. We evaluated the presence of HCV infection at the time of transplantation and occurrence of proteinuria in Egyptian kidney transplant patients and their link with graft survival. MATERIALS AND METHODS: This retrospective study was done on 273 patients with end-stage renal disease transplanted in Mansoura Urology and Nephrology Center Between 1993 and 1996. Their sera were routinely assayed for anti-HCV antibodies at the time of transplantation. The relationship between the HCV and the development of posttransplantation proteinuria was evaluated, along with the possible effects of proteinuria on long-term graft survival. RESULTS: A total of 169 kidney recipients (61.9%) were positive for anti-HCV antibodies. The mean durations of post-transplant follow-ups were 87.73 +/- 26.79 months (range, 19 to 123 months) and 84.29 +/- 28.55 months (range, 11 to 123 months) for the patients with and without anti-HCV antibodies, respectively. The patients in these groups were comparable regarding the incidence of proteinuria (33% and 32%, respectively) and its quantity (median, 0.6 g/d and 0.4 g/d, respectively). Irrespective of the HCV infection, patients with nephrotic-range proteinuria showed a worse graft survival (P < .001) and a higher frequency of chronic allograft nephropathy (P = .03) compared with nonproteinuric patients. CONCLUSIONS: There is a high prevalence of HCV infection in our patients with end-stage renal disease awaiting kidney transplantation. The incidence and quantity of proteinuria do not increase by HCV infection, and nephrotic-range proteinuria is independently associated with chronic allograft nephropathy and a poorer graft outcome.

Long-term effects of cyclosporine in children with idiopathic nephrotic syndrome: a single-centre experience.

BACKGROUND: Because of its potential nephrotoxicity, the long-term use of cyclosporine (CsA) as treatment for nephrotic syndrome (NS) is controversial. The clinical outcome of the patients with NS treated with CsA is unclear. METHODS: This study reports the results of long-term CsA treatment in 117 children with idiopathic NS, who received CsA therapy for more than 2 years (median, 34 months). The mean age of children at initiation of CsA therapy was 11+/-4 years. The starting dose of CsA was 5 mg/kg/day, adjusted to maintain a trough level of 100-150 ng/ml in the first 2 months, 50-100 ng/ml thereafter. Later, a level as low as 30 ng/ml was accepted so long as it maintained remission. All patients received CsA between 1993 and 2003. Indications for treatment included steroid-dependent nephrotic syndrome (SDNS) in 74 patients and steroid-resistant nephrotic syndrome (SRNS) in 43 patients. Initial renal histology showed minimal change disease (MCD) in 38 patients and focal segmental glomerulosclerosis (FSGS) in 79 patients. Most patients were receiving moderate doses of prednisone. Sixty patients received cyclophosphamide prior to CsA. The observation periods were 5.8+/-3 years and 6.1+/-1.9 years before and after CsA treatment, respectively. RESULTS: Complete remission [proteinuria <4 mg/h/m2/body surface area (BSA)], partial remission (proteinuria between 4.1 and 40 mg/h/m2/BSA) and resistance to CsA (proteinuria > or = 45 mg/h/m2/BSA) were observed in 82.1, 5.1 and 12.8%, respectively. Hypertension, renal impairment (>30% rise of serum creatinine), gingival hyperplasia and hypertrichosis occurred in 10.3, 6.0, 32.5 and 70.1%, respectively. Steroids were stopped in 102 patients, of which 31 relapsed. Out of 29 patients for whom CsA was intentionally discontinued while in remission, 22 relapsed. Of these, six patients were resistant to a second course of CsA. Post-therapy biopsies, performed in 45 patients (33 with SDNS and 12 with SRNS), showed mild stripped interstitial fibrosis and tubular atrophy in two SDNS patients (4.4%). At the last follow-up, one child had developed end-stage renal failure and two had chronic renal insufficiency. CONCLUSIONS: Long-term CsA therapy in low doses is effective in the treatment of children with idiopathic NS, but the rate of relapse is high after drug withdrawal. Hypertension developed in 10% of patients and renal insufficiency in 6% (most patients with FSGS).