Outcome of ABO-incompatible kidney transplantation using a modified desensitization protocol without plasmapheresis.

OBJECTIVES: Several controversies regarding desensitization strategies for successful ABO-incompatible (ABOi) kidney transplantation still exist. This study aimed to investigate whether pretransplant anti-A/B antibody removal is mandatory in an ABOi kidney transplant recipient with low baseline isoagglutinin titers. METHODS: We adopted a modified desensitization protocol with two doses of rituximab (RTX, 100 mg/body) without pretransplant antibody removal for ABOi kidney transplant recipients with a titer of ≤1:64 (group A; n = 35) and investigated the feasibility of this protocol by comparing it with the clinical outcomes of patients undergoing standard pretransplant plasmapheresis (group B; n = 21). RESULTS: There was no significant difference in the rate of antibody-mediated rejection within the first month after transplantation between the two groups (11.4% in group A vs. 2% in group B, p = 0.6019). Moreover, no differences were observed in the short- and long-term graft outcomes between the groups. However, two major critical acute antibody-mediated events occurred in group A; one patient lost the graft due to hyperacute rejection, and the other patient developed thrombotic microangiopathy after surgery. Risk factors predicting these perioperative complications were not identified. CONCLUSIONS: We conclude that not only B-cell depletion using RTX but also pretransplant antibody removal is still recommended even for patients with low isoagglutinin titers. In addition, a new diagnostic tool is needed for accurate risk stratification.

Vesicoureteral Reflux Causes Interstitial Inflammation in Pediatric Kidney Allograft: A Clinicopathological Analysis of 1-Year Protocol Biopsies.

INTRODUCTION: At present, there is limited evidence of the histological impact of vesicoureteral reflux (VUR) on pediatric kidney allografts. In this study, we aimed to investigate the relationship between VUR diagnosed by voiding cystourethrography (VCUG) and 1-year protocol biopsy results. METHODS: One hundred thirty-eight pediatric kidney transplantations were performed in Toho University Omori Medical Center between 2009 and 2019. We included 87 pediatric transplant recipients who were evaluated for VUR by VCUG prior to or at the time of the 1-year protocol biopsy and underwent a 1-year protocol biopsy after transplantation. We evaluated the clinicopathological findings of the VUR and non-VUR groups, and histological scores were evaluated using the Banff score. Tamm-Horsfall protein (THP) within the interstitium was identified by light microscopy. RESULTS: Of the 87 transplant recipients, 18 cases (20.7%) were diagnosed with VUR by VCUG. The clinical background and findings were not significantly different between the VUR and non-VUR groups. The pathological findings revealed a significantly higher Banff total interstitial inflammation (ti) score in the VUR group than in the non-VUR group. Multivariate analysis indicated a significant relationship between the Banff ti score and THP within the interstitium, and VUR. The 3-year protocol biopsy results (n = 68) revealed a significantly higher Banff interstitial fibrosis (ci) score in the VUR group than in the non-VUR group. CONCLUSION: VUR caused interstitial fibrosis in the 1-year pediatric protocol biopsies, and interstitial inflammation at the 1-year protocol biopsy may affect interstitial fibrosis at the 3-year protocol biopsy.

[ACUTE SCROTUM IN THE PEDIATRIC EMERGENCY ROOM: A SINGLE CENTER RETROSPECTIVE STUDY].

(Objective) The objective of this study was to survey cases of acute scrotum examined at the pediatric emergency room (ER). (Subjects and methods) All patients examined for acute scrotum at the emergency outpatient unit between March 2010 and March 2014 were designated subjects of the study. Medical records were used to retrospectively investigate the final diagnoses including testicular torsion (TT), torsion of the testicular appendage, epididymitis, orchitis, incarcerated inguinal hernia, idiopathic scrotal edema, Schönlein-Henoch purpura, hydrocele, external trauma, as well as those with no confirmed diagnosis. (Results) A total of 257 patients presented with acute scrotum at the emergency outpatient unit. The patients had an average age of 6.7 years, with symptoms present on the right side in 120 cases (47%), left side in 108 cases (42%), and both sides in 29 cases (11%). Observing the frequency of each condition, TT was present in 33 cases (13%), torsion of the testicular appendage in eight cases (3%), epididymitis in 85 cases (33%), orchitis in four cases (2%), incarcerated inguinal hernia in 59 cases (23%), idiopathic scrotal edema in six cases (2%), Schönlein-Henoch purpura in nine cases (4%), hydrocele in 10 patients (4%), external trauma in 12 patients (5%), and unconfirmed diagnosis in 31 cases (12%). Average time between onset and presentation at the ER was 0.6 days for TT, with patients having previously been examined at other hospitals before coming to this institution in 12 cases (36%). Emergency urological surgery was performed in 31 cases (12%), with TT comprising 28 cases (90%), and orchiectomy performed in six cases (21%). (Conclusion) Of all patients examined for acute scrotum, epididymitis were high and TT in 13% at the pediatric ER. Average time for TT patients from symptom onset to ER presentation were longer, we must ensure that patients present at earliest possible opportunity requires educating the general population.