Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation.

INTRODUCTION: Bacteriuria (symptomatic and asymptomatic) is the most common infectious complication after kidney transplantation. This study aimed to determine its prevalence among kidney transplant recipients hospitalized after transplantation, respective risk factors, and frequency of isolates and antibacterial susceptibility. METHODS: Retrospectively, we divided hospitalized patients into 3 groups. Groups 1 and 2 included 78 and 152 recipients with and without bacteriuria, respectively, and the potential risk factors were compared. Cefixime was prescribed as early postsurgical prophylaxis. Group 3 patients were 116 randomly selected nontransplantation patients with urinary tract infection. Frequency of uropathogens and their antibiotic susceptibility were compared in groups 1 and 3. RESULTS: In total, 103 bacteriuria episodes were detected in 15.2% of the patients. The frequency of risk factors in groups 1 and 2 was similar. Escherichia coli was the most common isolate in groups 1 (40.8%) and 3 (68.1%; P = .03). Streptococcus faecalis was the most common gram-positive isolate in groups 1 (17.5%) and 3 (6.9%; P = .03). Sensitivity rates in group 1 were 9% to trimethoprim-sulfamethoxazole, 20% to ciprofloxacin, and 38.4% to gentamicin, which was not significantly different from group 3. However, the sensitivity rates of gram-negative isolates to ceftriaxone were 9.5% and 28.4% (P = .004) in groups 1 and 3, respectively, and to cefixime 4.5% and 22% (P = .01). DISCUSSION: High antibacterial resistance of uropathogens isolated from kidney transplantation and nontransplantation patients is alarming. The higher resistance to third-generation cephalosporins in transplant recipients may be due to antibiotic selection pressure secondary to postsurgical prophylaxis with cefixime.

En-bloc Transplantation: an Eligible Technique for Unilateral Dual Kidney Transplantation.

BACKGROUND: Kidney transplantation is the best available treatment for patients with end-stage renal disease. OBJECTIVE: To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). METHODS: From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. RESULTS: Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. CONCLUSION: Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.

Graft survival rate of renal transplantation: a single center experience, (1999-2009).

BACKGROUND: Renal transplantation is the best option for treatment of the end-stage renal diseases and has more advantages than dialysis. The objective of this study is to determine the ten-year graft survival rate of renal transplantation and its associated factors in patients who have been transplanted from March 1999 to March 2009 in Nemazee Hospital Transplantation Center. METHODS: This is a historical cohort study of 1356 renal transplantation carried out during 1999 to 2009. Kaplan-Meier method was used to determine the survival rate, log rank test to compare survival curves, and Cox regression model to determine hazard ratios and for modeling of variables affecting survival. RESULTS: The 1, 3, 5, 7 and 10 years graft survival rates were 96.6, 93.7, 88.9, 87.1 and 85.5 percent, respectively.Cox regression model revealed that the donor source and creatinine level at discharge were effective factors in graft survival rate in renal transplantation. CONCLUSION: Our study showed that 10 year graft survival rate for renal transplantation in Nemazee Hospital Transplantation Center was 85.5% and graft survival rate was significantly related to recipients and donor's age,donor source and creatinine level at discharge. Our experience in renal transplantation survival rate indicates asuccess rate comparable to those noted in other reports.

Endogenous Aspergillus endophthalmitis occurring after liver transplantation: a case report.

Endogenous Aspergillus endophthalmitis (AE) is a rare complication of invasive aspergillosis in transplant patients. In this report, we have described a patient who underwent liver transplantation because of drug-induced cholestatic cirrhosis and developed AE at 2 weeks after the surgery. The patient was a 22-year-old man who received a right liver lobe from his father. The operation was uneventful but the patient developed signs and symptoms of small-for-size syndrome after the second day of surgery. The patient received intense immunosuppression with methylprednisolone for 3 days, tacrolimus and mycophenolate mofetil from the first day after the operation, with ceftriaxone and metronidazole as prophylactic antibiotics. Because of signs of respiratory distress with pneumonia, vancomycin and amphotericin B were added empirically to his regimen. Polymerase chain reaction for aspergillus DNA in the blood was positive. The patient received one course of methylprednisolone pulse therapy for signs of acute rejection at day 10, and tacrolimus was changed to sirolimus because of a rising serum creatinine and convulsions. After 2 weeks, the patient's symptoms improved and liver function tests were normal, but the complained of sudden intense pain in the left eye with unilateral blurred vision, redness, and other signs of endophthalmitis upon examination by an ophthalmologists. After 24 hours, visual acuity decreased to light perception. AE was confirmed by microscopy and culture of the vitreous fluid and retinal biopsy. Despite changing amphotericin to intravitreal injection of voriconazole followed by intravenous voriconazole and transient resolution of the symptoms, no improvement was seen in visual acuity. Pain and signs of inflammation in the eye recurred after 2 weeks. At last the patient underwent enucleation for resistant infection and fear of involvement of the other eye by aspergillosis or sympathetic ophthalmia.

Are large nonfunctional kidneys risk factors for posttransplantation urinary tract infection in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease?

OBJECTIVES: The objective of this study was to evaluate the effect of bilateral nephrectomy on posttransplantation urinary tract infection (UTI) among patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD). METHODS: In a retrospective case-control design, 62 patients with ESRD with ADPKD were divided into 2 groups: (A) 24 patients who underwent bilateral nephrectomies, and (B) 38 patients in whom bilateral nephrectomies had not been done. Pretransplantation and posttransplantation urine cultures were evaluated for UTI. RESULTS: Sixty-two patients with ESRD with ADPKD were enrolled in this study. The average age was 42 years (range, 6-60 years). Forty patients (64.5%) were male and 22 (35.5%) were female. The mean duration of hemodialysis was 24 months (range, 2-120 months), which was the same for both groups. Bilateral nephrectomies were done for 24 participants (38.7%). There were 38 patients (61.3%) in group B who did not have the operation. UTI occurred in 23 patients (37.1%): 6 patients (25%) in group A and 17 patients (44.7%) in group B. The incidence of UTI was not statistically different between the 2 groups (P>.05). Furthermore, no relationship was found between age, gender, blood group, and UTI in patients with ADPKD (P>.05). CONCLUSION: According to our study, the presence of large nonfunctional kidneys is not a risk factor for posttransplantation UTI in patients with ADPKD and ESRD.

Outcome of hepatitis B and C virus infection on graft function after renal transplantation.

INTRODUCTION: Chronic liver disease resulting from hepatitis B virus (HBV) and hepatitis C virus (HCV) infections is still a major concern in kidney recipients. It is unclear whether HCV antibody status and markers of HBV infection are associated with renal dysfunction. Thus, we designed a study to investigate the incidence of HBV and HCV infection after renal transplantation and whether these infections alter graft function. METHODS: Fifty-eight patients who underwent renal transplantation participated in the study. Serum creatinine and aminotransferase levels were measured with standard automated analyzers. Anti-HCV antibodies were detected with an enzyme immunoassay, and a reverse transcriptase-polymerase chain reaction (RT-PCR) technique was used to test for HCV-RNA. Serological markers for HBV (HBsAg and anti-HBc antibody) were detected by enzyme immunoassay. All samples from patients who were seropositive for HBsAg or anti-HBc antibody were PCR-tested for HBV-DNA. A serum sample collected from living donors was tested for anti-HCV antibodies and serological markers for HBV. Serum creatinine and aminotransferase levels were also measured in living donors. RESULTS: Anti-HCV was not detected in serum samples of any cases before transplantation. However, 10 (17.2%) tested positive after transplantation. HCV-RNA was detected in 2 of the 10 patients (3.4% of all patients). None of the pretransplantation serum samples tested positive for HBsAg. However, anti-HBc antibody was identified in 8 (13.8%) of the 58 patients.. No HBV DNA was detected in serum samples of the patients with anti-HBc or HBsAg-positive. HBsAg was only detected in 1 (1.7%) recipient after transplantation. None of the 58 patients showed clinical signs or symptoms of renal dysfunction during the study period. CONCLUSION: Our data suggest that, neither HBV nor HCV infection appears to cause or contribute to renal dysfunction in the early period (1 year) after renal transplantation. Nevertheless, a long-term consequence of chronic HBV or HCV liver disease or graft loss is not impossible in renal transplant recipients.

Neurological complications of first 100 orthotopic liver transplantation patients in southern Iran.

Neurological complications which are responsible for significant mortality and morbidity after orthotopic liver transplantation have been reported in 8.3% to 47% of cases in various series. This prospective study was performed to investigate the prevalence and characteristics of neurological complications in the first 100 patients who have undergone orthotopic liver transplantation from 1993 to 2004. Neurological symptoms and signs as well as routine laboratory tests, including complete blood cell counts, electrolyte levels, drug levels, microbiologic and serological studies, brain computed tomography scans, magnetic resonance imaging, and electrodiagnostic studies were reviewed in all patients. Follow-up periods were from 2 months to 10 years. Nineteen patients of mean age of 34.9 years developed neurological complications after orthotopic liver transplantation. The most common neurological symptoms and signs were confusion (42.1% of cases with neurological complications), convulsions (36.8%), and hallucinations (31.6%). Hepatic encephalopathy (31.6%) and drug toxicity (26.2%) were the most common neurological syndromes. The mortality rate was significantly higher among patients with neurological complications. Compared to other centers, neurological complications were less common in our center.