Prevalence of Human Herpesvirus-8 and BK Polyoma Virus Infections in End-stage Renal Disease and the Influence of Renal Transplantation.

Viral infections lead to significant morbidity and mortality in kidney transplant recipients. We evaluated 49 kidney transplant recipients for human herpesvirus 8 (HHV-8) and BK polyomavirus infections in conjunction with data obtained from 43 donors. The seroprevalence of HHV-8 was 6.9% in donors and 12.2% in recipients. HHV-8 DNA was detected below the limit of quantification (<5000 copies/mL) in a recipient with HHV-8 seropositivity at the pretransplant period and was undetectable at month 3 after transplantation. Transient viruria with BK polyomavirus was recorded in 10.2% of recipients without viremia. Multiple factors contribute to viral reactivation, particularly immunosuppressive treatment. Reduction in maintenance immunosuppression seems beneficial in terms of viral reactivation. At our center, routine use of valganciclovir for antiviral prophylaxis may be effective for the prevention of HHV-8 reactivation.

Evaluation of TH17 and TH1 Immune Response Profile in Patients After Renal Transplant.

BACKGROUND: Renal transplantation (RT) is the best treatment option for patients with end-stage renal disease (ESRD) because it improves both quality of life and survival. However, allograft rejection remains the most important barrier to successful transplantation. Underlying immunologic mechanisms should be understood to develop appropriate treatment strategies. METHODS: In this prospective study, we followed renal transplant recipients for 6 months. The study population comprised 50 recipients of renal transplants, and these were divided into 2 groups: 44 patients with stable graft function (SGF) and 6 patients with rejection (RX). Peripheral blood samples were drawn from patients on the pre-RT day, at post-RT day 7, month 1, and month 6, and on the day of rejection for analysis of the percentages of cytokines interleukin (IL) 17 and interferon (IFN) γ with the use of flow cytometry and enzyme-linked immunosorbent assay. RESULTS: The percentages of intracellular IFN-γ were not significant in the group with RX compared with SGF. Levels of intracellular IL-17 obtained at the 6th month after RT were significantly higher in the RX group than in the SGF group. Plasma levels of pre-RT IL-17 were also higher in the RX group; therefore, it may be a predictive biomarker of acute rejection of renal transplants. CONCLUSIONS: The present study provides information about pre-RT and post-RT cytokine profiles of Turkish patients with ESRD. We consider cytokine analysis to be a valuable biomarker panel in the prevention of rejection and in assisting with new treatment strategies for patients undergoing renal transplant.

Eculizumab for Treatment of Refractory Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience.

Antibody-mediated rejection (AMR) is responsible for up to 20%-30% of acute rejection episodes after kidney transplantation. In several cases, conventional therapies including plasmapheresis, intravenous immunoglobulin, and anti-CD20 therapy can resolve AMR successfully. But in some cases the load of immunoglobulins that can activate complement cascade may submerge the routine desensitization therapy and result in the formation of membrane attack complexes. Eculizumab, a monoclonal antibody against C5, was reported to be an option in cases with severe AMR that are resistant to conventional therapy. Here, we present 8 cases that were resistant to conventional therapy and in which eculizumab was given as a salvage treatment. Given the bad prognosis for renal transplants displaying acute injury progressing rapidly to cortical necrosis on the biopsy, the prompt use of eculizumab could have the advantage of immediate effects by stopping cellular injury. This can provide a therapeutic window to allow conventional treatment modalities to be effective and prevent early graft loss.

Computed tomography features of small bowel obstruction due to mesodiverticular band.

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include hemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report a case of small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum. The important aspect of our case is clear demonstration of the mesodiverticular band adjacent to the Meckel's diverticulum on pre-operative computed tomography (CT).

What has changed in pediatric kidney transplantation in Turkey? Experience of an evolving center.

INTRODUCTION: Reluctance to perform kidney transplantations on children is an ongoing problem in Turkey. Moreover, urological pathologies still constitute the largest portion of the underlying etiologies in chronic renal failure patients. Herein, we retrospective analyzed the data acquired from our pediatric renal transplantation patients and reviewed the registry of dialysis and transplantation data prepared by the Turkish Society of Nephrology. MATERIAL AND METHODS: Forty-six living donor kidney transplantations were performed in children between 2008 and 2012. Seventeen of 46 (37%) transplantations were preemptive. The mean age at operation time was 10.8 ± 5 years. The mean patient weight was 31.3 ± 15.8 kg (range, 9.4 to 66.4 kg). A detailed urologic evaluation was performed for every child with an underlying lower urinary tract disease. One enterocystoplasty and 2 ureterocystoplasties were performed for augmentation of the bladder, simultaneously. RESULTS: One-year death-censored graft survival and patient survival rates were 100% and 97.8%, respectively. The mean serum creatinine level was 0.86 ± 0.32 mg/dL (range, 0.3 to 1.8 mg/dL). None of the patients had vascular complications or acute tubular necrosis. One patient suffered graft-versus-host disease during the second month after renal transplantation and died with a functioning graft. In one patient with massive proteinuria detected after transplantation, recurrence of primary disease (focal segmental glomerulosclerosis) was considered and the patient was treated successfully with plasmapheresis. One child had an acute cellular rejection and was administered pulse steroid treatment. CONCLUSION: Although challenging, all patients in all pediatric age groups can successfully be operated and managed. With careful surgical technique, close postoperative follow-up, and efforts by the experienced and respectful surgical teams in this country, we could change the negative trends toward perform kidney transplantation in the Turkish pediatric population.

Eculizumab for salvage treatment of refractory antibody-mediated rejection in kidney transplant patients: case reports.

Antibody-mediated rejection (AMR) in a group of preoperatively desensitized patients may follow a dreadful course and result in loss of the transplanted kidney. In several cases, conventional therapies including plasmapheresis, intravenous immunoglobulin, and anti-CD 20 therapy can resolve AMR successfully. But in some cases the load of immunoglobulins that can activate complement cascade may submerge the routine desensitization therapy and result in the formation of membrane attack complexes. Eculizumab, monoclonal antibody against C5, was reported to be an option in cases with severe AMR that are resistant to conventional therapy. Here, we present two cases of acute-onset AMR in preoperatively desensitized patients. Eculizumab was used as a salvage agent in addition to conventional therapy. Given the bad prognosis for renal transplants displaying acute injury progressing rapidly to cortical necrosis on the biopsy, the prompt use of eculizumab could have the advantage of immediate effects by stopping cellular injury. This can provide a therapeutic window to allow conventional treatment modalities to be effective and prevent early graft loss.

Is localized prostate cancer an obstacle for an immediate consideration for renal transplantation? A case report.

Currently, renal failure patients with a history of prostate cancer are recommended to have a 2 to 5-year disease-free interval prior to being allowed to receive a kidney transplant. This disease is now amenable to curative therapy if diagnosed at an early stage when the tumor is organ-confined. We report a patient undergoing immediate renal transplantation following a laparoscopic radical prostatectomy for the treatment of prostate cancer. Candidates for renal transplantation who are diagnosed with early stage, organ-confined prostate cancer may be immediately considered for transplantation following radical prostatectomy in view of the high likelihood of cure of their prostate cancer.

Cadaveric liver transplantation in biliary atresia splenic malformation syndrome with the absence of retrohepatic inferior vena cava, preduodenal portal vein, and intestinal malrotation: a case report.

A 9-month-old female infant with biliary atresia underwent cadaveric liver transplantation due to progressive cholestatic hepatitis following a Kasai operation. She had biliary atresia splenic malformation syndrome (BASM) composed of an absent retrohepatic inferior vena cava with an azygous connection, preduodenal portal vein, polysplenia, and intestinal malrotation. A portal vein thrombosis developed on the 4th postoperative day requiring immediate treatment by thrombectomy. The patient is well with normal liver function at 3 months follow-up. Although BASM may render the transplantation more difficult, the presence of BASM is no longer a contraindication to liver transplantation.

First A2-to-O renal transplantation in the 21st Century: a step in the transplantation history of Turkey.

Renal transplantation is the best treatment modality for patients with end-stage renal disease. Turkey is a country with limited cadaveric donor organ programs. Herein we have reported the first A2-to-O living donor kidney transplantation in Turkey. A 20-year-old female patient was admitted for a living related renal transplantation from her only potential donor her mother. She was blood group O and her mother was blood group A2. Three plasmapheresis sessions followed by intravenous immunoglobulin (IVIG) were performed every other day in the week prior to transplantation. Daclizumab was administered at the time of transplantation with an additional four doses every 2 weeks after the procedure. The immunsuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. Eight plasmapheresis sessions followed by IVIG were performed in the first 2 weeks posttransplant. Six months after transplantation, the serum creatinine was 1 mg/dL. Our experience showed that A2-to-O renal transplantation can be safely performed and may expand the pool of living kidney donors in Turkey.

An unusual presentation of sirolimus associated cough in a renal transplant recipient.

Sirolimus-associated pulmonary problems are rare but life threatening. Pulmonary problems due to sirolimus treatment are interstitial pneumonitis, bronchiolitis obliterans organizing pneumonia (BOOP), and alveolar hemorrhage. We present a case of sirolimus-related cough in the absence of any pulmonary radiological findings. A 55-year-old man with a history of 4 years of hemodialysis therapy because of end-stage renal disease of unknown etiology underwent cadaveric renal transplantation in June 2006. Three days following the initiation of sirolimus therapy he complained of dry cough and fever. There were no clinical or laboratory findings compatible with specific pulmonary disease. After switching sirolimus to tacrolimus, the cough improved within 1-2 days and resolved in 5 days. Sirolimus should be considered in the differential diagnosis of pulmonary problems in the early posttransplantation period even in the absence of radiological findings.

Patient and graft survival implications of simultaneous pancreas kidney transplantation from old donors.

We investigated graft and patient survival implications of simultaneous pancreas kidney (SPK) transplant from old donors. Data describing patients with type 1 diabetes mellitus listed for an SPK transplant from 1994 to 2005 were drawn from Organ Procurement and Transplant Network registries. Allograft survival, patient survival and long-term survival expectations among SPK recipients from young (age <45 years) and old (age >/=45 years) donors were modeled by multivariate regression. We also examined predictors of reduced early access to young donor transplants. Of 16 496 eligible SPK candidates, 8850 patients (53.6%) received an SPK transplant and 776 (8.8%) of these transplants were from old donors. Reasonable 5-year, death-censored kidney (77.8 %) and pancreas (71.3%) survivals were achieved with old donors. SPK transplantation from both young and old donors predicted lower mortality compared to continued waiting. An additional expected wait of 1.5 years for a young donor equalized long-term survival expectations to that achieved with use of old donors. Early allocation of young donor transplants declined in the more recent era and varied by region, candidate age, blood type and sensitization. We conclude that old SPK donors should be considered for patients with decreased access to young donor transplants. Prospective evaluation of this practice is needed.

A case with severe rhabdomyolysis and renal failure associated with cerivastatin-gemfibrozil combination therapy--a case report.

Gemfibrozil-statin combination therapy is a well-known risk factor for myopathy and rhabdomyolysis. Cerivastatin is a currently available statin with dual elimination; it is therefore expected to cause less drug-drug interaction. This case is the second reported case with severe rhabdomyolysis caused by cerivastatin-gemfibrozil combination. Moreover, in this case, the rhabdomyolysis was more severe and caused severe renal failure and death. The authors discuss how these drugs cause rhabdomyolysis and how rhabdomyolysis can cause renal failure.