Kidney Transplant Loss Due to May-Thurner Syndrome: Case Report and Review of the Literature.

BACKGROUND: May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. METHODS: We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. RESULT: After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. CONCLUSION: Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.

Desensitization of Highly Immunized Kidney Transplant Recipients Awaiting Transplantation-Polish Single-Center Experience.

INTRODUCTION: The increasing number of highly immunized patients waiting for kidney transplantation is a significant problem in Europe as the proportion of such patients has doubled in the last decade. Transplantation in this group is enabled by desensitization methods, i.e., intravenous pharmacotherapy with human immunoglobulin (IVIG), anti-CD20 monoclonal antibody (rituximab), and plasma exchange. The objective was to evaluate the efficacy and safety of this protocol. MATERIAL AND METHODS: The inclusion criteria: presence of established anti-HLA antibodies with complement-binding capacity, i.e., anti-HLAC1q+ (>MFI 15,000 for the most common antigens), no renal transplantation within 1 year after activation on the waiting list. Thirteen patients were selected for the procedure. IVIG was administered twice (2 g/kg-maximum 140 g/dose). Between IVIG doses, patients received rituximab (375 mg/m2). Anti-HLA was tested after 1 and 2 months after completion of the procedure. RESULTS: All patients have completed the protocol. No significant changes after desensitization in the amount/profile of alloantibodies were observed. However, with negative vCM for HLA-A/B/DR (no DSA against the reported donor) and negative CM-CDC, according to the allocation system, patients were given priority on the recipient list. Seven out of 13 patients received a transplant within 12 months after treatment (mean 11.5 weeks). Renal graft function was good (mean creatinine level after 1 month: 1.5 mg/dL). No incidents of acute rejection were reported. The most common complications were infections (especially pneumonia). CONCLUSION: The desensitization protocol (IVIG + rituximab) allows highly immunized patients to undergo organ transplantation. In short-term analysis, no acute rejection was observed, graft function was satisfactory. Desensitization was associated with an increased risk of infection.

[The nephrological knowledge of patricipants of World Kidney Day 2012 in Gdansk center]. / Znajomosc zagadnien nefrologicznych u uczestników Swiatowego Dnia Nerek 2012--doswiadczenia osrodka gdanskiego.

INTRODUCTION: In many countries on different continents, at least 10-12% of people are suffering from chronic kidney disease (CKD). These data indicate that CKD is a big problem, much more than previously expected. Therefore, programs should be promoted for early detection of kidney diseases and carry out public education and also the medical community. MATERIAL AND METHODS: The aim of this article was the assessment of the nephrology knowledge of participants of the World Kidney Day in Gdansk in 2012. Analysis of the survey conducted for the entire cohort and the separate subgroups of people who were more than 60 years old and less than 60. RESULTS: Among the total sample and in the subgroups, complications of hypertension knowledge was declared by more than 75% of the participants, diabetes more than 70%. However the symptoms of CKD have been known only for about 60%, the concept of creatinine 40%, while the concept of dialysis/transplant for about 80% of respondents. The main source of medical information were non-medical journals for more than 50% of study participants. However the doctor as a source of medical knowledge, identified 47% of respondents. CONCLUSIONS: Participants of questionnaires have showed in described analysis mediocre acquaintance of signs of kidney disease, the notion of creatinine in comparison for acquaintance of complication of hypertension and diabetes. However, for all participants of research and for older subgroup, main source of medical knowledge was a physician and unmedical magazines. But internet or television was the main source of knowledge for younger subgroup.