BK virus-associated nephropathy in two pediatric kidney recipients.

Posttransplant renal dysfunction episodes can result from a variety of causes, including polyomavirus (BK virus)-associated nephropathy (PVAN). It is a well-recognized entity with a high incidence of graft failure. The delicate balance of viral infection and immune regulation in the transplant population would allow development of successful long-term strategies. In this presentation, we have described two PVAN cases of our institution and reviewed the literature.

Successful solid organ transplantation from septicemic cadaveric donors: case report.

Systemic donor infections especially with gram-negative organisms are regarded as an absolute contraindication to cadaveric organ donation for transplantation. This is largely due to fear of transmitting the pathogenic organisms to the immunosuppressed recipient. However, due to the current shortage of organs available for transplantation, clinicians are faced with the option to use organs from infected donors. Between 1996 to January 2006, we collected 44 solid organs. Two out of nine donors had microorganisms from blood cultured. Case 1 was of 23-year old woman whose cause of brain death was intracerebral bleeding due to a traffic accident. The donor had stayed 9 days in the intensive care unit prior to brain death. Two kidneys, two livers (split), and or heart were used. Klebsiella was the organism on blood culture. Case 2 was of 35-year-old man; cause of brain death was cerebral hematoma due to traffic accident. The donor had stayed 6 days prior to brain death onset. The liver and two kidneys were used. Acinetobacter baumannii was yielded upon blood culture. All donors were treated with appropriate antibiotics for at least 48 hours prior to organ procurement with consequent negative blood cultures, while the recipients received the same culture-specific antibiotics for 10 days following transplantation. One donor (case 1) heart and both donor corneas were not used due to infection. All patients are alive with excellent graft function at a median of 90 days following transplantation. In conclusion, our results suggested that bacteremic donors with severe sepsis under proper treatment can be considered for transplantation.

How often do we face side effects of sirolimus in pediatric renal transplantation?

We analyzed 25 pediatric renal transplantation patients on sirolimus (SRL) therapy to assess changes in serum creatinine, glomerular filtration rate, electrolytes, triglycerides, cholesterol, and side effects. Mean time to initiate SRL therapy was 3.2 years. The serum creatinine levels of patients on SRL treatment at 1, 6, 12, and 24 months were 1.67 ± 1.15 mg/dL, 1.18 ± 0.52 mg/dL, 1.24 ± 0.32 mg/dL, 1.15 ± 0.31 mg/dL, and 1.17 ± 0.12 mg/dL, respectively. We observed proteinuria in 3, hyperlipidemia in 5, and anemia in 2 patients, but none had the treatment discontinued. We diagnosed interstitial pneumonia in (n = 1), nasal acneiform lesions (n = 1), and lower extremity edema (n = 1). Hypokalemia developed in 1 subject with high blood SRL levels. In the follow-up period there was no case of acute rejection episode during SRL therapy.

Outcome of the using older donors for kidney transplantation;Gazi University, Ankara experience.

The extreme organ shortage in Turkey has led to expansion of living and diseased donors. We retrospectively analyzed patient data to determine the outcomes of elderly donors. Among 210 donors, 28 (13.3%) were atleast ≥55 years old. In this group, 17 were from living and 11 from diseased donors. Mean cold ischemia time was 68 ± 21 minutes. The immunosuppressive protocol consisted of induction therapy (simulect 20 mg on days 0 and 4) and immunosuppression with calcineurin inhibitors, mycophenolic acid, and steroids. Nine patients (32.6%) with delayed graft function (DGF) required transient hemodialysis. None of the recipients or their grafts were lost due to surgical complications. We noted 5 acute rejection episodes which were all reversed by pulse steroids. Mean creatinine levels at 1, 3, and 5 years were 1.7, 2.1 and 2.3 mg/dL respectively. Patient and graft survivals at 1, 3, and 5 years were 100%, 96%, and 92% and 100%, 92%, and 92%, respectively. Although 3.6% of recipients displayed DGF, it did not affect graft outcomes. In conclusion, kidney transplantation from older donors should be considered to be an option for kidney transplantation.