Common viral infections in kidney transplant recipients

Infectious complications have been considered as a major cause of morbidity and mortality after kidney transplantation, especially in the Asian population. Therefore, prevention, early detection, and prompt treatment of such infections are crucial in kidney transplant recipients. Among all infectious complications, viruses are considered to be the most common agents because of their abundance, infectivity, and latency ability. Herpes simplex virus, varicella zoster virus, Epstein–Barr virus, cytomegalovirus, hepatitis B virus, BK polyomavirus, and adenovirus are well-known etiologic agents of viral infections in kidney transplant patients worldwide because of their wide range of distribution. As DNA viruses, they are able to reactivate after affected patients receive immunosuppressive agents. These DNA viruses can cause systemic diseases or allograft dysfunction, especially in the first six months after transplantation. Pretransplant evaluation and immunization as well as appropriate prophylaxis and preemptive approaches after transplant have been established in the guidelines and are used effectively to reduce the incidence of these viral infections. This review will describe the etiology, diagnosis, prevention, and treatment of viral infections that commonly affect kidney transplant recipients.

Twin pregnancy after renal transplant: the first case report in Thailand

Background: With more advanced technology, the renal transplant women have more chance to get pregnant, even multiple gestations. Obstetricians need the knowledge to provide the better care for these patients.Objective: Report the natural course of disease and the intervention for renal transplant woman with twin pregnancy.                                     Patient and methods: A 20-year-old primigravida who underwent living-related renal transplantation eight months before pregnancy with monochrorionic diamniotic twins was treated throughout her pregnancy.Results: At 30 weeks of gestation, the patient was admitted due to rising of creatinine level, high blood pressure, and proteinuria. After conservative treatment for 12 days, the pregnancy was terminated by cesarean section with tubal resection. Both alive twins weighed 1385 g and 1525 g. Allograft kidney biopsy was undertaken, and histologic examination showed acute rejection. The renal function gradually improved after one month of antirejection therapy.Conclusion: The complications of pregnancy and poor perinatal outcomes are higher in renal transplant recipients. A multidisciplinary team is required for the management of these patients.Keywords: Acute graft rejection, renal transplantation, twin pregnancy

Living-donor kidney transplantation across ABO barriers: the first case in Thailand

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.

Successful treatment of polyomavirus infection in kidney allograft recipients: case reports and literature review

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.