ABSTRACT
Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.
ABSTRACT
Background: Vanadate (V) inhibits while potassium (K) depletion stimulates collecting tubule H, K-ATPase activity. In the presence of V, K depletion could not restore the decreased H,K-ATPase activity. The effects of V and K depletion on renal H,K-ATPase protein expression might explain such observation.Objective: To examine the effects of V and K depletion on renal H,K-ATPase protein expression. Methods: Rats treated with normal saline solution (NSS) or V (5 mg/kg body weight) received either normal potassium (NK) or low potassium (LK) diet for 10 days. Protein expressions of renal H,K-ATPase \α₁ and \α₂ isoforms were determined by immunohistochemistry.Results: Both NK and LK animals treated with V had significantly increased vanadium levels in serum, urine, and renal tissues. LK diet caused hypokalemia. Animals treated with LK and V showed progressive hypokalemia. LK stimulated renal H,K-ATPase \α₁ protein expression in both cortex and medulla but enhanced H,K-ATPase \α₂ protein expression only in the cortex. Vanadate did not affect H,K-ATPase \α₁ protein expression in both NK and LK groups. Vanadate unaltered H,K-ATPase \α₂ protein expression in NK animals but could attenuate the increased expression in LK group.Conclusion: The magnitude of direct inhibitory effect of V on renal H,K-ATPase activity with small suppressive effect on protein expression is greater than the stimulatory effect of K depletion on H,K-ATPase activity and protein expression.
ABSTRACT
Background: Polyomavirus nephropathy, also termed BK virus nephropathy, is an infectious complication after kidney transplantation, causing allograft failure. The state of immunosuppression of the patient is the principal risk for the infection. Most cases of BK virus nephropathy were associated with the use of potent immunosuppressive regimens like tacrolimus and mycophenolate mofetil. To the best of our knowledge, no patient with BK virus nephropathy has been reported in Southeast Asia.Objective: We report two cases of BK virus nephropathy in patients who received the immunosuppressive regimen of sirolimus with cyclosporine. We also review the literature regarding the pathogenesis, clinical manifestations, and treatment strategies.