ABSTRACT
BACKGROUND: Orthotopic liver transplantation (OLT) is a potential curative treatment in patients with hepatocellular carcinoma (HCC); however, treatment options for recurrent HCC after OLT are limited. Immune checkpoint inhibitors, such as nivolumab, an inhibitor of programmed cell death protein 1, have been successfully used for metastatic HCC but data on safety of nivolumab following solid organ transplantation are limited. METHODS: We report a 53-year-old woman with HCC who was treated with OLT. After 2 years, HCC recurred. Initial treatment with sorafenib was discontinued due to side effects and disease progression. Progressive HCC in the lung and lymph nodes was subsequently treated with nivolumab. One week after the first nivolumab dose, rapid progressive liver dysfunction was noted. Liver biopsy revealed severe cellular graft rejection prompting treatment with intravenous steroids and tacrolimus. Liver function continued to decline, leading to severe coagulopathy. The patient succumbed to intracranial hemorrhage. RESULTS: A systematic PubMed search revealed 29 cases treated with a checkpoint inhibitor following solid organ transplantation. Loss of graft was described in 4 (36%) of 11 cases with OLT and in 7 (54%) of 13 cases after kidney transplantation. However, cases with favorable outcome were also described. Eighteen cases with adverse events were identified upon searching the World Health Organization database VigiBase, including 2 cases with fatal outcome in liver transplant recipients due to graft loss. CONCLUSION: Experience with checkpoint inhibitors in solid organ transplant recipients is limited. Published cases so far suggest severe risks for graft loss as high as 36% to 54%.
Subject(s)
Schistosomiasis mansoni/diagnosis , Schistosomiasis mansoni/drug therapy , Animals , Biomphalaria/parasitology , Cross-Sectional Studies , Diagnosis, Differential , Emigrants and Immigrants , Female , Guinea/ethnology , Host-Parasite Interactions/physiology , Humans , Praziquantel/therapeutic use , Rats , Schistosoma mansoni , Schistosomiasis mansoni/epidemiology , Schistosomiasis mansoni/parasitology , Switzerland , TravelABSTRACT
We report on a 35-year-old man who presented to the emergency department with acute abdominal pain, postural hypotension, and tachycardia after having been diagnosed with Epstein-Barr virus infection 1 week before. Abdominal ultrasound and computed tomography revealed splenic rupture, and the patient underwent successful proximal angiographic embolization of the splenic artery. The course was complicated by painful splenic necrosis and respiratory insufficiency due to bilateral pleural effusions. Six weeks later, he additionally developed severe sepsis with Propionibacterium granulosum due to an intrasplenic infected hematoma, which required drainage. All complications were treated without surgical splenectomy, and the patient finally made a full recovery.
Subject(s)
Drainage , Embolization, Therapeutic , Infectious Mononucleosis/complications , Sepsis/therapy , Splenic Rupture/therapy , Actinomycetales Infections/diagnosis , Actinomycetales Infections/etiology , Actinomycetales Infections/therapy , Adult , Humans , Male , Propionibacterium/isolation & purification , Sepsis/diagnosis , Sepsis/etiology , Splenic Rupture/complications , Splenic Rupture/diagnosisABSTRACT
BACKGROUND: Validity, reliability and clinical value of classical urinary parameters for transplant monitoring are controversial. Urinary parameters were analyzed regarding cost-effectiveness, frequency of urinary tract infection and prediction of renal graft function and rejection. METHODS: Urinary parameters of the first two postoperative weeks of 120 renal transplant patients were retrospectively correlated with the postoperative course. RESULTS: Creatinine levels were significantly different on each postoperative day between the groups with and without rejection. Osmolaluria, diuresis and serum creatinine are equivalent in predicting graft rejection. Osmolaluria is not suitable as a distinguishing criterion between graft rejection and other complications. Measurement of glucosuria has no diagnostic value. Proteinuria has no prognostic relevance regarding rejection, although proteinuria >0.5g/l occurred more often in patients with rejection. Despite antibiotic prophylaxis with co-trimoxazole, 41 of 120 patients (34%) suffered from urinary tract infection (UTI; mostly E. coli) within the first 14 days after transplantation. CONCLUSIONS: The measurement of some classical urinary parameters delivers no diagnostic gain. UTIs are frequent despite antibiotic prophylaxis, but the use of urine cultures makes sense only if a (cheaper) semiquantitative test is positive.
