Posttransplant infectious complications: a prospective study on 142 kidney allograft recipients

We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality. A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients' status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed. Infections occurred in 77 patients [54%]. The lower urinary [42%] and respiratory [6.3%] tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 [24%] and cytomegalovirus in 25 patients [18%]. Wound infection occurred in 7 patients [5%]. The mortality rate was 7.7% and infection-related death was seen in 5 patients [3.5%] who developed sepsis. Graft loss was seen in 16 patients [11%], of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare [0.7% and 2.8%, respectively]. This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection

Preoperative corporal biopsy as a predictor of postoperative results in venoocclusive erectile dysfunction

Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction [ED] and whether preoperative corporeal biopsy can help predict postoperative results. Thirty-six patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction [IIEF] scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months postoperatively, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. The mean age of the patients with ED was 32.1 +/- 8.6 years. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity, however, decreased from 11.0 cm/s to 5.1 cm/s [P=.023]. Only 2 patients had satisfactory penile rigidity after venous ligation. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had normal histologies, and 2 had a slight decrease of smooth muscle cell mass. Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy

Microchimerism and renal transplantation: doubt still persists

Background: The Presence of donor leukocytes in recipients of organ allograft has been shown even several years after transplantation. However, it remains unclear whether this donor cell microchimerism plays an effective role in allograft acceptance or is simply a consequence of immunosuppressive conditions in recipients

Objective: To study microchimerism in a group of kidney transplant recipients

Methods: In this study, the Peripheral Blood Microchimerism [PBM] after renal transplantation was retrospectively evaluated in 32 male-to-female recipients of living [unrelated] and cadaveric donor renal transplants. Using a Nested Polymerase Chain Reaction [Nested-PCR] amplification specific for SRY region of the Y chromosome, microchimerism was detected with a sensitivity of 1:1000000. Recipients were classified and compared according to the presence of PBM, acute and chronic rejection episodes, type of allotransplant, recipient and donor age at transplantation, previous male labor or blood transfusion, allograft function [serum creatinine level], and body mass index

Results: Among 32 recipients, 7 [21.9] were positive for PBM in multiple testing at different post-transplantation times. All microchimeric recipients had received kidney from living-unrelated donors. No significant difference was observed with regard to other parameters mentioned above. In addition, acute rejection rate in the microchimeric group was 3 [42%] versus 4 [16%] in the nonmicrochimeric recipients [not significant]

Conclssion: Our results demonstrate better establishment of microchimerism after living donor kidney transplantation. However, concerning the true effect of microchimerism after renal transplantation doubt still persists; and it seems that microchimerism alone has no major protective role in renal allograft survival