Kidney transplantation from a SARS-CoV-2-positive donor for the recipients with immunity after COVID-19.

The coronavirus (COVID-19) pandemic is evolving very quickly and has affected healthcare systems worldwide. Many uncertainties remain about transplantation from a SARS-CoV-2-positive donor as only a few cases have been reported. Here, we present the successful transplantation of 2 kidneys from a 52-year-old male donor with active (2 weeks of COVID-19-like symptoms and positive nasopharyngeal swab SARS-CoV-2 polymerase chain reaction on the day of organ recovery) SARS-CoV-2 disease. The immediate postoperative course of both recipients was uneventful. This case emphasizes that patients with SARS-CoV-2 may be safe organ donors.

Complement inhibitor eculizumab in thrombotic microangiopathy: Single-center case series.

Our case series showed that eculizumab is efficacious and safe in treating thrombotic microangiopathy, as well as it has positive effects on quality of life. Further extensive studies are required to develop unified treatment guidelines.

[Cytomegalovirus infection in kidney transplant recipients in Santariskes Clinics of Vilnius University Hospital]. / Ligoniu, kuriems persodintas inkstas, citomegalovirusines infekcijos analize Vilniaus universiteto ligonines Santariskiu klinikose.

Between January 2000 and December 2006, 318 kidney transplants were performed in our unit. Cytomegalovirus infection in transplanted patients causes both direct and indirect effects on other organ systems, including acute allograft rejection and decreased graft and patient survival. The aim of our study was to evaluate the incidence of cytomegalovirus infection after kidney transplantation, the treatment strategies, and the impact of cytomegalovirus infection on allograft function and survival. Those patients who at least once were treated for cytomegalovirus infection were assigned to the study group (n=102). The control group included the remaining patients (n=216) in whom kidney transplantation was performed between January 2000 and December 2006. The mean age of the recipients in both groups was 39.8+/-12.8 years (range 15-60) and 38.5+/-12.6 years (range 7-66), respectively; retransplantations and acute allograft rejections were more common in the group treated for cytomegalovirus infection: 13 (12.7%) vs. 18 (8.3%) and 55 (53.9%) vs. 103 (47.2%), respectively. Between January 2000 and December 2006, the total number of cytomegalovirus infection episodes was 167. The greatest number of cytomegalovirus infection episodes occurred during the first 1-3 months after transplantation and accounted for 27.5%; during 3-6 months, 17.4%; during 6-12 months, 18.6%. Serum creatinine levels were higher in our study group. Cytomegalovirus infection manifested as pneumonitis in 26.5% and as gastrointestinal tract disorders in 9.8% of cases; 3.9% of patients were treated for encephalitis. Patients in the study group reported more frequently other infections: bacterial infections, 66 (64.7%) vs. 116 (53.7%); virus infections, 2 (2%) vs. 3 (1.4%); and mixed bacterial-virus infections, 8 (7.8%) vs. 4 (1.9%). The number of patients who did not experience any infection was higher in control group: 26 (25.5%) vs. 93 (43.1%). Death from cytomegalovirus infection occurred in 15 (14.7%) of the 102 patients in the study group.

[The first experience with sirolimus (Rapamune) after kidney transplantation in Lithuania]. / Pirmoji sirolimo (Rapamune) vartojimo po inkstu persodinimo patirtis Lietuvoje.

Sirolimus is a new immunosuppressive agent. This study aimed to evaluate the efficiency of sirolimus in patients after renal transplantation and to compare graft function, the frequency of rejection episodes and complications with patients under cyclosporin A treatment. From May 2002 to January 2005 26 renal transplant patients were treated with sirolimus. 13 patients (group A) were treated with sirolimus before renal transplantation and 13 patients (group B) were converted to sirolimus in late period after transplantation because of chronic cyclosporin A nephrotoxicity, chronic graft nephropathy and due to intolerance of cyclosporin A (mean time after transplantation: 18 months). Sirolimus was started as a loading dose 5-6 mg per day and reduced to 2-3 mg per day. Mean sirolimus blood concentration was 8.19+/-6.7 ng/ml. Results were compared according to age, gender, the number of HLA matches, plasma renin activity levels, etc., with 52 patients (control (C) group) under cyclosporin A, mycophenolate mofetil and steroids treatment. During 3 months, the acute rejections were in 30.8% of patients (4/13) and 65.4% of patients (17/26) for group A and group B, respectively (chi2=6.568, p<0.05). Renal function at 12 months: mean serum creatinine was 165.5+/-29 micromol/l vs. 214.2+/-67.9 micromol/l, urea 9.6+/-2.6 mmol/l vs. 13.9+/-9.3 mmol/l. There were no differences in platelet counts between groups, but serum cholesterol value was higher in the patients of group A (8.11+/-0.9 mmol/l vs. 6.54+/-1.4 mmol/l), blood pressure (140+/-13/87+/-14 mmHg vs. 150+/-15/85+/-12 mmHg). Patients were treated for different infections, cytomegalovirus infection and sepsis (28.6% (6/21) vs. 45.2% (19/52) for group A and group B, respectively). Our results have shown that sirolimus in combination with mycophenolate mofetil and steroids is an effective alternative to continuous therapy without cyclosporine.

[Delayed graft function and its impact on the antigraft response after cadaver kidney transplantation]. / Uminis persodinto inksto nepakankamumas ir jo rysys su imuniniu atsaku i transplantata

The purpose of this study was to evaluate the incidence of delayed graft function and its impact on the antigraft response after cadaver kidney transplantation. The analysis is based on 183 consecutive cadaver kidney transplantations performed in Vilnius University Hospital Santariskiu klinikos from January 2000 to December 2004. Delayed graft function occurred in 21.3% (39/183) of kidney transplantations. The frequency and severity of acute rejection episodes in recipients during first three months after transplantation and graft survival rate at one and two years were evaluated. Group 1 consisted of 39 patients with delayed graft function and group 2 (control group) of 144 patients with graft function immediately after transplantation. The maintenance immunosuppressive therapy consisted of cyclosporine, mycophenolate mofetil/azathioprine and prednisolone. The proportion of patients treated with monoclonal antibodies was similar in both groups (35.9% vs. 33.3%). Actuarial graft survival was estimated by the modified Kaplan-Meier method, graft loss was censored for death of recipient with functioning transplant and other causes of loss not related to rejection. There were no significant differences in the age of recipients (42.3+/-11.3 vs. 39.4+/-14.1), as well as in HLA matching (2.2/6 M vs. 2.2/6 M), in the number retransplanted patients (10.3% vs. 10.4%) and in highly sensitized patients (plasma renin activity >50.0%) (5.1% vs. 4.8%) between those groups. Significant differences were observed in donors over 50 year (33.3% vs. 18.7%; p<0.05), in cold ischemic time over 20 h (53.8 vs. 32.6%, respectively). The occurrence of acute rejection episodes was higher in group 1 than in group 2 (69.2% (27/39) vs. 34.7% (50/144); chi2=14.9945, p<0.05). Graft survival was 88.5%, 84.3% at one year and two years in group 1 and 94.7%, 93.8% at one year and two years in group 2 (ns). Donor age >50, cerebral vascular disease as cause of donor death, and cold ischemic time >20 h are the main risk factors for delayed graft function. Delayed graft function is a risk factor for acute rejection episodes, but it has no impact on graft loss due to immunological reason at one and two years. These data may serve for tailoring immunosuppressive protocols.