High proportion of CD95(+) and CD38(+) in cultured CD8(+) T cells predicts acute rejection and infection, respectively, in kidney recipients.

The aim of this study was to find noninvasive T-cell markers able to predict rejection or infection risk after kidney transplantation. We prospectively examined T-lymphocyte subsets after cell culture stimulation (according to CD38, CD69, CD95, CD40L, and CD25 expression) in 79 first graft recipients from four centers, before and after transplantation. Patients were followed up for one year. Patients who rejected within month-1 (n=10) showed high pre-transplantation and week-1 post-transplantation percentages of CD95(+), in CD4(+) and CD8(+) T-cells (P<0.001 for all comparisons). These biomarkers conferred independent risk for early rejection (HR:5.05, P=0.061 and HR:75.31, P=0.004; respectively). The cut-off values were able to accurately discriminate between rejectors and non-rejectors and Kaplan-Meier curves showed significantly different free-of-rejection time rates (P<0.005). Patients who rejected after the month-1 (n=4) had a higher percentage of post-transplantation CD69(+) in CD8(+) T-cells than non-rejectors (P=0.002). Finally, patients with infection (n=41) previously showed higher percentage of CD38(+) in CD8(+) T-cells at all post-transplantation times evaluated, being this increase more marked in viral infections. A cut-off of 59% CD38(+) in CD8(+) T-cells at week-1, week-2 and month-2 reached 100% sensitivity for the detection of subsequent viral infections. In conclusion, predictive biomarkers of rejection and infection risk after transplantation were detected that could be useful for the personalized care of kidney recipients.

[Dissecting aneurysm of the renal artery in patient with transplantation. Report of a case. Review of the literature]. / Aneurisma disecante de la arteria renal en paciente trasplantado. Presentación de un caso. Revisión de la literatura.

OBJECTIVES: Aneurysmatic processes of the renal artery after transplant are rare entities, generally secondary to technical defects or infectious pictures. Among other presentations, dissecting aneurysm are exceptional, having a particularly difficult diagnosis due to the lack of specific clinical data which could differentiate them from other processes such as graft rejection or acute tubular necrosis, as well as the absence of characteristic representative images. METHODS: We report one case of dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS: We analyze the presentation form, diagnostic procedures, pathologic studies, and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal artery is a rare entity of difficult diagnosis due to the poorness of presenting symptoms and the difficulty of finding it in routine tests, being necessary to think of it and to perform angiography as the only diagnostic test. Treatment is carried out by hilar reconstruction or transplant nephrectomy when the former is not possible.

Aneurisma disecante de la arteria renal en paciente trasplantado. Presentación de un caso. Revisión de la literatura / Dissecting aneurism of the renal artery in a transplant patient. Report of one case and bibliographic review

OBJETIVOS: Los procesos aneurismáticos de la arteria renal en el trasplante, son entidades poco frecuentes, secundarias generalmente a defectos técnicos o cuadros infecciosos. Entre las formas de presentación, el aneurisma disecante es excepcional, teniendo la particularidad de su difícil diagnóstico, por la falta de datos clínicos específicos que lo diferencien con otros procesos tales como el Rechazo del Injerto o la Necrosis Tubular Aguda, así como por la ausencia de imágenes representativas del mismo. MÉTODOS: Presentamos el caso de un aneurisma disecante en el curso evolutivo de un trasplante renal que motivó la pérdida del injerto. RESULTADOS: Se analiza la forma de presentación, el proceder diagnóstico, el estudio anatomopatológico, el diagnóstico diferencial y las posibilidades terapéuticas del mismo. CONCLUSIONES: El aneurisma disecante de la arteria renal es una entidad rara de difícil diagnóstico por la pobreza de síntomas que presenta y la dificultad de encontrarlo en las exploraciones de rutina, debiendo pensar en él, para la realización de angiografías como único método diagnóstico. El tratamiento, bien reconstrucción del hilio, bien trasplantectomía, en casos en los que nos sea posible el anterior (AU)

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