ABSTRACT
Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.
ABSTRACT
Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.
ABSTRACT
Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.
ABSTRACT
Objective:Objective To explore the clinical values of next-generation sequencing (NGS) in bacterial 16S rRNA region and fungal ITS region for diagnosing and treating urinary tract infection (UTI) in renal transplant recipients.Methods:A total of 90 mid-stream clean-catch urine samples were collected from renal transplant recipients who were diagnosed with UTI at Hospital from January 2017 to December 2019. Each sample was equally divided and tested via NGS method and traditional urine culture separately. The results of pathogen test and detection rate were analyzed and compared.Results:And 21/90 sample were considered to be contaminated due to the identification of three or more kinds of microorganisms by culture. And among the remaining 69 samples, 36 (52.17%) cases tested positive by 16S rRNA sequencing, 25 (36.23%) positive by urine bacterial culture; meanwhile, 34(49.28%) tested positive by ITS sequencing and 4(5.80%) positive by urine fungal culture.Conclusions:The detection rate of both bacteria and fungi in NGS microorganism testing is higher than that in traditional urine culture ( P< 0.05). For renal transplant recipients with UTI, NGS microorganism testing is an effective supplement for traditional urine culture. Improving the detection rate and accuracy of etiology may enable an optimization of individualized treatment.
ABSTRACT
OBJECTIVE@#To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation.@*METHODS@#A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation.@*RESULTS@#The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1-, 5-, and 10- year patient survival rates (96.6% 96.0%, 94.1% 93.9%, and 90.6% 93.9%, respectively; > 0.05), 1-, 5-, and 10-year graft survival rates (95.2% 96.0%, 90.8% 87.2%, and 79.0% 82.3%, respectively; > 0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms ( > 0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation ( < 0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group ( < 0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration ( < 0.05).@*CONCLUSIONS@#In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.
Subject(s)
Humans , Graft Survival , Immunosuppressive Agents , Kidney Transplantation , Polycystic Kidney, Autosomal Dominant , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the changes in sexual function in premenopausal women after renal transplantation.</p><p><b>METHODS</b>Forty-two married premenopausal women receiving dialysis therapy for at least 6 months with normal renal function for 6 months after renal transplantation were examined for hormonal profiles and menstrual cycles. The sexual functions of the patients were evaluated using Female Sexual Function Index (FSFI) before and 6 months after the transplantation.</p><p><b>RESULTS</b>Before renal transplantation, amenorrhea, oligomenorrhea, polymenorrhea, and eumenorrhea were found in 18 cases (42.9%), 10 cases (23.8%), 5 cases (11.9%) and 9 cases (21.4%), as compared to 7 cases (16.7%), 5 cases (11.9%), 6 cases (14.3%) and 24 cases (57.1%) after the transplantation, respectively. Prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels significantly decreased and estradiol (E2) and progesterone (P) significantly increased after renal transplantation (P<0.001). Nineteen patients (45.2%) before and 36 patients (85.7%) after the surgery reported to have an active sexual life (P<0.001). The total incidences of female sexual dysfunction before and after kidney transplantation were 90.5% and 40.5% (P<0.001), respectively. The scores for sexual desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly increased after kidney transplantation (P<0.001).</p><p><b>CONCLUSIONS</b>A successful renal transplantation can significantly improve sexual functions in premenopausal women.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Estradiol , Blood , Follicle Stimulating Hormone , Blood , Kidney Transplantation , Menstrual Cycle , Premenopause , Progesterone , Blood , Prolactin , Blood , Sexual Behavior , Sexual Dysfunction, Physiological , EpidemiologyABSTRACT
Objective To investigate sexual function in male kidney transplant recipients and their offsprings health condition.Methods We studied 60 male kidney transplant recipients who had a normal sex life before kidney failure and had good renal graft function after transplant.The questionnaire was used to investigate the time of first spermatorrhea,viability of sex activities,frequency and sexual intercourse satisfaction of sex activities,procreation status,growth and intelligence status of the offspring.Semen routine tests before and after the transplantation were done.Results Hyposexuality or declined sexual function was found in all over 60 cases of recipients.And after surgery,sexual function of the recipients was improved obviously following the graft function gradually regained.Fifty-four patients had spermatorrhea in the first 1-3 months post-transplantation,and rest 6 cases had no spermatorrhea because of sexual life.After operation 56 male patients began to have sex life in 2-4 months with satisfaction rate of 86.7％ (52/60),except the other 4 cases who refused sex life due to worrying about graft damage by sex life.Sixty-eight children were born by 56 recipients after operation,and the growth and intelligence status had no significant difference from the children of the same age.No transplant graft failure or rejection was found after the recipients had children.Conclusion After kidney transplantation,the sexual function of male recipients could return to the normal status and the growth and intelligence status of the offspring is normal.