Efficacy of conversion to sirolimus in posttransplantation Kaposi's sarcoma.

UNLABELLED: The increased incidence of Kaposi's sarcoma (KS) in organ transplantation has been related to the KS herpes virus and the permissive effect of immunosuppressive therapy. We postulated that conversion to SRL in renal recipients with KS favored regression of KS lesions without increasing the risk of graft rejection. METHODS: In this study we performed a retrospective chart review of 7 caucasian renal transplant recipients affected by KS to determine demographic data, etiology of ESRD, immunologic risk factors, immunosuppressive treatment, KS disease follow-up, and renal function before and after SRL conversion. RESULTS: All seven patients were under calcineurin inhibitor treatment at the onset of KS which was limited to the skin, without regression despite attempts to minimize immunosuppression. After conversion to SRL, six patients showed progressive regression of KS lesions, with only hyperpigmented atrophic cutaneous lesions remaining after a mean time of 8.1 months (2-18 months). The seventh patient has completed 9 months follow-up with a near complete regression of KS lesions. One patient returned to hemodialysis after 13 months following irreversible acute renal failure not directly related to SRL conversion; in the other six, renal function was stable. The mean serum creatinine was 1.87 +/- 0.64 versus 1.74 +/- 0.68 mg/dL, pre-conversion versus the end of follow up, respectively. Mean SRL blood level was 9.2 +/- 2.0 ng/mL. CONCLUSION: After SRL conversion, patients with KS showed progressive regression without an increased risk of acute rejection. SRL offers a promising approach to the management of posttransplantation KS and probably other malignancies in organ transplant recipients.

Immunoprophylaxis with Simulect (basiliximab) in kidney transplantation: results from routine clinical practice at 18 kidney transplant units.

OBJECTIVE: The objective of this study is to assess a Simulect (basiliximab) regimen in routine clinical practice in the Spanish kidney transplantation units to evaluate efficacy and safety. METHODS: In this prospective, observational study, data on demographics, parameters of efficacy, and safety in patients who under with kidney transplantation treated with Simulect (basiliximab) were collected through an on-line collection system. RESULTS: One hundred sixty three patients at 18 kidney transplant units included 12 months follow-up. The patient mean age was 52 years (DS 13,67) including 96 (58.90%) men and 67 (41.10%) women. Cold ischemia time was 19 hours (DS 6,79). Only 2 patients presented with PRA >50%. For prophylactic immunosuppression, 67.13% of patients received triple therapy with CNI (cyclosporine 49.65% or tacrolimus 17.48%), MMF (66.43%) or AZA (10.49%), and steroids. Incidence of acute rejection (AR) at 12 months was 12.27% (1.84% steroid-resistant). In subgroup analysis, AR was 13.5% in nondiabetics and 4.5% in diabetics, including 3 steroid-resistant episodes (1.84%) in nondiabetics and none in diabetics. In relation to donor age, AR was incidence 10.3% in patients with kidneys from donors aged 50 years or younger and 10.6% when donors were older than 50 years, including 1 (1.73%) and 2 (1.93%) steroid-resistant episodes, respectively. The graft and patient survival rates at 12 months were 90% and 98%, respectively. CONCLUSIONS: Simulect (basiliximab) used in routine clinical practice provided good prophylaxis against acute rejection in several kidney transplant patient populations, similar to that observed in randomized clinical studies with excellent tolerability and safety.

[Acute renal failure caused by cholesterol embolism in kidney transplantation from cadaver donor. Is the prognosis more favorable than in native kidneys?]. / Fracaso renal agudo por embolismo de colesterol (EC) en injerto renal de donante cadáver. Pronóstico más favorable que en riñones nativos?

We present the case of a 47 years old women with a third cadaveric kidney transplant. After surgery, she had effective diuresis reaching a serum creatinine of 2.2 mgs% at 19 postoperative day. In the nest few days, the patient was oliguric with worsening of renal function. The ultrasound examination excluded urinary obstruction. With the suspicion of acute rejection, a renal biopsy was performed. The histopathological record disclosed cholesterol emboli with a widespread multifocal ischemic infarct and eosinophilic tubulointerstitial nephritis. The renal function deteriorated in the seven next days and peritoneal dialysis was carmedow. She then recovered diuresis with improvement of renal function, reaching at discharge a serum creatinine of 1.8 mgs%. The renal function remains stable after 3 years. We analysed the etiopathogenic factors of this disease and the possible beneficial effects of immunosuppresive drugs in better prognosis compared with the same entity in native kidneys.

Fracaso renal agudo por embolismo de colesterol (EC) en injerto renal de donante cadáver. ¿Pronóstico más favorable que en riñones nativos? / Acute renal failure from cholesterol emboli (CE) in renal allograft of cadaveric donor, may have better outcome than native kidneys?

Presentamos el caso de una mujer de 47 años de edad, receptora de un tercer trasplante renal de donante cadáver. Tras la cirugía presentó diuresis eficaz, alcanzando en el 19° día post-trasplante una cifra de creatinina sérica de 2,2 mg/dL.A partir de ese día, asistimos a un empeoramiento progresivo de la función renal, oliguria y aumento de peso, descartándose ecográficamente dilatación de la vía excretora. Se sospechó rechazo agudo, por lo que se realizó biopsia del injerto y se instauró de forma empírica tratamiento de rescate con bolus de Metilprednisolona y se sustituyó la Ciclosporina (CsA) por Tacrólimus en el tratamiento inmunosupresor. El informe anatomopatológico fue tromboembolismo de colesterol (EC) con infarto isquémico multifocal extenso y nefritis túbulo-intersticial con presencia de eosinófilos. Durante los primeros siete días tras la biopsia la función renal siguió empeorando, por lo que fue necesario la realización de Diálisis Peritoneal (DP). A partir de ese momento se produce una recuperación progresiva de la diuresis y de la función renal, hasta alcanzar una creatinina sérica de 1,8 mg/dL, que se mantiene estable 3 años después. Se analizan los factores precipitantes y se discute el efecto etiopatogénico de la Ciclosporina en la enfermedad ateroembólica, así como la acción antiinflamatoria del tratamiento esteroideo y del resto de los inmunosupresores en el curso más favorable del EC en el trasplante renal (AU)

Leg bone pain syndrome due to cyclosporine in a renal transplant patient.

A leg bone pain syndrome of unclear etiology has been recently described in renal transplant patients receiving cyclosporine A. Herein we report a 54-year-old woman treated with cyclosporine A (CsA), corticosteroids and azathioprine who developed two months after renal transplantation severe symmetric pain with periarticular soft tissue swelling in the knees and metatarsophalangeal joints. Scintigraphy showed periarticular radionuclide activity. Clinical onset was associated with both the high dosage and with the plasma levels of CsA. Symptoms improved when the dosage of CsA was reduced and the plasma levels declined to less than 150 ng/ml.

Renal artery thrombosis occurring in an adult with the idiopathic nephrotic syndrome: results of local treatment with streptokinase.

A 55 year old male with the idiopathic nephrotic syndrome (minimal glomerular lesions by light microscopy and negative immunofluorescent stainings) presented righ renal artery thrombosis as evidenced by clinical and arteriographic findings. Local Streptokinase infusion by means of a renal artery catheter resulted in revascularization of the arterial tree, although recovery of renal function was only partial.