Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study.

BACKGROUND: Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life-threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine. METHODS: A questionnaire was sent to all associated doctors to the Brazilian Organ Transplantation Association through its website, calling for reports of organ transplanted patients who have been vaccinated against YF. RESULTS: Twelve doctors reported 19 cases. None had important side effects. Only one had slight reaction at the site of YFV injection. Eleven patients were male. Organs received were 14 kidneys, 3 hearts, and 2 livers. Twelve patients received organs from deceased donors. Mean age at YFV was 45.6 ± 13.6 years old (range 11-69); creatinine: 1.46 ± 0.62 mg/dL (range 0.8-3.4); post-transplant time: 65 ± 83.9 months (range 3-340); and time from YFV at the time of survey: 45 ± 51 months (range 3-241). Immunosuppression varied widely with different drug combinations: azathioprine (7 patients), cyclosporine (8), deflazacort (1), mycophenolate (10), prednisone (11), sirolimus (3), and tacrolimus (4). CONCLUSIONS: YFV showed no important side effects in this cohort of solid organ transplanted patients. However, owing to the small number of studied patients, it is not possible to extend these findings to the rest of the transplanted population, assuring safety. Therefore, these data are not strong enough to safely recommend YFV in organ transplanted recipients, as severe, even life-threatening side effects may occur.

Mucosa-associated lymphoid tissue gastric lymphoma regression in a renal transplant patient after conversion of the immunosuppression to sirolimus: a case report.

The treatment of B-cell non-Hodgkin lymphoma, the most common posttransplant lymphoproliferative disorder, is not well defined. Herein we have reported a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma with rapid, persistent, and complete remission after conversion of the immunosuppression from cyclosporine (CsA) to sirolimus (SRL). A 42-year-old woman underwent renal transplantation in 1992 with no major abnormalities until 2006 when a gastroscopy performed to investigate dyspeptic symptoms showed a mixed MALT gastric lymphoma (with low- and high-grade components) associated with the presence of Helicobacter pylori infection. Two therapeutic interventions in a 1-week interval were performed: treatment of the H. pylori infection (omeprazole, amoxicillin, and clarithromycin for 14 days) and modification of the immunosuppression by substitution of CsA and azathioprine (AZA) with SRL. Control endoscopy performed 1 month later showed persistence of H. pylori infection and absence of the gastric tumor. New endoscopies performed at 2 and 7 months after therapy confirmed the absence of neoplasia and H. pylori eradication. Currently, the patient has no complaints, displaying a creatinine value of 1.8 mg/dL and a hemoglobin of 9.4 mg/dL using SRL and ibersatan. SRL has been studied extensively as an anticancer drug, acting as a mammalian target for rapamycin (mTOR) inhibitor. Accumulating data support the role of mTOR in lymphomagenesis. In conclusion, our case of gastric MALT lymphoma in a renal transplant patient displayed a complete remission after alteration of the immunosuppressive scheme with the introduction of SRL.

Progression of the renal graft: treatment of acute rejection based on a biopsy against a presumptive diagnosis.

The aim of this study was to compare the progression of renal grafts following treatment of an acute rejection event based on the histological diagnosis of a graft biopsy compared to a presumptive (clinical and laboratory) diagnosis. A historical cohort was used to study 44 patients undergoing a living haploidentical related donor renal transplant, using a similar immunosuppressive treatment: cyclosporine, azathioprine, and prednisone. Acute rejection events were treated with methylprednisolone (250 mg for 3 to 5 days) based on a histological diagnosis (biopsy group = 14) or on a clinical and laboratory diagnosis (presumptive group = 30), which consisted of an elevation over 20% in plasma creatinine in 24 hours and renal ultrasound or scintigraphy findings. The study demonstrated no significant difference in renal function (plasma creatinine) and other outcomes 2 years following transplantation in both groups. The results show that treatment of acute rejection based on a presumptive diagnosis is not a risk factor for unfavorable outcomes following 2 years of renal transplantation monitoring.

Hepatopatia em receptores de transplante renal. / Hepatopathy in renal transplantation recipients

Treze dentre 55 pacientes em hemodialise (23,6%) foram submetidos a biopsia hepaticas antes e apos transplante renal e acompanhados, em media, por 18,3 meses, por serem HBaAg positivo (12 pacientes, 21,8%) e/ou terem disfuncao hepatica. A simples persistencia do HBsAg no soro se acompanhava, com frequencia, de biopsias normais ou com alteracoes inespecificas. Entretanto, quatro pacientes HBsAg positivos apresentaram hepatopatia fatal algum tempo apos o transplante: dois com cirrose comprovada, um com necrose submacica e outro, que se tornara etilista inveterado, com provavel cirrose. Um quinto paciente HBaAg positivo evoluiu para hepatite cronica ativa apos rejeicao do transplante. Embora a persistencia do HBsAg no soro indique sempre mau prognostico apos o transplante, parece ser a principal causa de hepatopatia em nosso grupo de renais cronicos e associa-se, por vezes, a disfuncao hepatica intensa e ate fatal

Tuberculose pos-transplante renal. / Tuberculosis post-renal transplantation

Em 166 pacientes transplantados de rim, 4 casos de tuberculose foram constatados, uma incidencia de 2,4% bem superior a da populacao geral brasileira de 0,3%. Tres casos foram da forma extrapulmonar, surgida entre o 2o.e 4o.anos apos transplante, e um caso de forma pulmonar, surgida um mes apos cirurgia.O quadro observado consistiu de febre, tosse, anorexia, perda de peso hepatosplenomegalia, ascite e pericardite. Todos os pacientes apresentaram PPD nao reator, leucopenia e alteracoes das provas de funcao hepatica.O diagnostico foi feito atraves de biopsia hepatica em um caso e com tratamento de prova nos tres restantes. Um paciente faleceu em decorrencia a doenca