Derivation and external validation of the SIMPLICITY score as a simple immune-based risk score to predict infection in kidney transplant recipients.

Existing approaches for infection risk stratification in kidney transplant recipients are suboptimal. Here, we aimed to develop and validate a weighted score integrating non-pathogen-specific immune parameters and clinical variables to predict the occurrence of post-transplant infectious complications. To this end, we retrospectively analyzed a single-center derivation cohort of 410 patients undergoing kidney transplantation in 2008-2013 in Madrid. Peripheral blood lymphocyte subpopulations, serum immunoglobulin and complement levels were measured at one-month post-transplant. The primary and secondary outcomes were overall and bacterial infection through month six. A point score was derived from a logistic regression model and prospectively applied on a validation cohort of 522 patients undergoing kidney transplantation at 16 centers throughout Spain in 2014-2015. The SIMPLICITY score consisted of the following variables measured at month one after transplantation: C3 level, CD4+ T-cell count, CD8+ T-cell count, IgG level, glomerular filtration rate, recipient age, and infection within the first month. The discrimination capacity in the derivation and validation cohorts was good for overall (areas under the receiver operating curve of 0.774 and 0.730) and bacterial infection (0.767 and 0.734, respectively). The cumulative incidence of overall infection significantly increased across risk categories in the derivation (low-risk 13.7%; intermediate-risk, 35.9%; high-risk 77.6%) and validation datasets (10.2%, 28.9% and 50.4%, respectively). Thus, the SIMPLICITY score, based on easily available immune parameters, allows for stratification of kidney transplant recipients at month one according to their expected risk of subsequent infection.

Gemcitabine-induced hemolytic-uremic syndrome treated with eculizumab or plasmapheresis: two case reports
.

BACKGROUND: Drug-induced hemolytic-uremic syndrome (HUS) has shown good response to eculizumab (ECU). We present 2 cases of patients with gemcitabine-induced HUS (GEM-HUS), one of whom was treated with ECU and the other with conventional treatment. Patient 1: A 74-year-old male with resected adenocarcinoma of the pancreas started adjuvant treatment with GEM, but after 5 months GEM was discontinued due to acute kidney injury and severe hypertension. Laboratory analyses identified microangiopathic hemolytic anemia (MHA) and thrombocytopenia. Plasmapheresis (Pph) was initiated but was stopped due to a severe adverse reaction. Treatment with ECU was initiated at the time of clinical progression requiring hemodialysis. After 7 doses of ECU, hemolysis and kidney function improved and the patient was able to stop hemodialysis. 1 month after the last dose of ECU serum creatinine (sCr) was 1.8 mg/dL. Patient 2: A 68-year-old male with resected urothelial carcinoma stopped GEM after 2 months due to hematologic toxicity. 1 month later the patient visited the emergency room due to minimal effort dyspnea, hypertension, and peripheral edema. Laboratory analyses showed decreased kidney function, MHA, and thrombocytopenia. Symptomatic treatment was started. After an initial recovery, kidney dysfunction, hemolysis, and thrombocytopenia progressed. Corticoid boluses were ineffective and hemodialysis was initiated. Eleven Pph treatments were necessary to recover hematologic data. The patient remained on hemodialysis for 2 months and evolved to stage IV chronic kidney disease. 8 months after hospital release, sCr was 3.5 mg/dL. CONCLUSION: ECU successfully improved kidney function in a patient with GEM-HUS, while conventional treatment did not.
.

[Dissecting aneurysm of the renal artery in patient with transplantation. Report of a case. Review of the literature]. / Aneurisma disecante de la arteria renal en paciente trasplantado. Presentación de un caso. Revisión de la literatura.

OBJECTIVES: Aneurysmatic processes of the renal artery after transplant are rare entities, generally secondary to technical defects or infectious pictures. Among other presentations, dissecting aneurysm are exceptional, having a particularly difficult diagnosis due to the lack of specific clinical data which could differentiate them from other processes such as graft rejection or acute tubular necrosis, as well as the absence of characteristic representative images. METHODS: We report one case of dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS: We analyze the presentation form, diagnostic procedures, pathologic studies, and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal artery is a rare entity of difficult diagnosis due to the poorness of presenting symptoms and the difficulty of finding it in routine tests, being necessary to think of it and to perform angiography as the only diagnostic test. Treatment is carried out by hilar reconstruction or transplant nephrectomy when the former is not possible.

Aneurisma disecante de la arteria renal en paciente trasplantado. Presentación de un caso. Revisión de la literatura / Dissecting aneurism of the renal artery in a transplant patient. Report of one case and bibliographic review

OBJETIVOS: Los procesos aneurismáticos de la arteria renal en el trasplante, son entidades poco frecuentes, secundarias generalmente a defectos técnicos o cuadros infecciosos. Entre las formas de presentación, el aneurisma disecante es excepcional, teniendo la particularidad de su difícil diagnóstico, por la falta de datos clínicos específicos que lo diferencien con otros procesos tales como el Rechazo del Injerto o la Necrosis Tubular Aguda, así como por la ausencia de imágenes representativas del mismo. MÉTODOS: Presentamos el caso de un aneurisma disecante en el curso evolutivo de un trasplante renal que motivó la pérdida del injerto. RESULTADOS: Se analiza la forma de presentación, el proceder diagnóstico, el estudio anatomopatológico, el diagnóstico diferencial y las posibilidades terapéuticas del mismo. CONCLUSIONES: El aneurisma disecante de la arteria renal es una entidad rara de difícil diagnóstico por la pobreza de síntomas que presenta y la dificultad de encontrarlo en las exploraciones de rutina, debiendo pensar en él, para la realización de angiografías como único método diagnóstico. El tratamiento, bien reconstrucción del hilio, bien trasplantectomía, en casos en los que nos sea posible el anterior (AU)

No disponible