Safe Use of Infected Donor Organs in Kidney Transplantation.

INTRODUCTION: Organ availability is limited in the face of the growing number of candidates. Using organs from individuals with an infection at the time of transplantation emerged as a possible but controversial solution. MATERIALS AND METHODS: Retrospective analysis of patients submitted to kidney transplantation in Hospital Garcia de Orta (Almada, Portugal) from January 2008 to March 2019, comparing outcomes between recipients of organs from donors with an active infection and noninfected donors in the referred interval. RESULTS: An active infection in the donor was identified in 55 cases (28.4%) from a total of 194 transplants. The most frequent site of infection was the lung (n = 30), followed by the urinary tract (n = 13); 9 donors (16.4%) had documented bacteremia. None of the identified microorganisms were multidrug-resistant. All recipients from an infected donor received adequate antibiotic prophylaxis (mean duration of 11.1 ± 3.0 days). No significant differences between groups were found regarding patients' demographics, cold ischemia time, duration of hospital stay, delayed graft function, rejection episodes, noninfectious complications, or patient and graft survival. Basiliximab was the preferred induction agent in both groups but was used in a larger proportion of recipients in the infected donor group (87.0% vs 60.6%; P = .001). The rate of infectious complications was significantly lower in the infected donor group (14.5% vs 42.4%; P = .001), and none of the previously isolated agents in the donor was found in the recipient. CONCLUSION: Kidney transplant using infected donors can be performed safely, without worse organ-specific or recipient outcomes, if certain conditions are considered.

Use of acetazolamide in lithium-induced nephrogenic diabetes insipidus: a case report.

Lithium-induced nephrogenic diabetes insipidus (Li-NDI) is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series). We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients. LEARNING POINTS: Treatment of lithium-induced nephrogenic diabetes insipidus might be challenging.Vasopressin, amiloride and thiazide diuretics have been used in lithium-induced nephrogenic diabetes insipidus treatment.Acetazolamide might be an option to treat lithium-induced nephrogenic diabetes insipidus patients who fail to respond to standard treatment.The use of acetazolamide in lithium-induced nephrogenic diabetes insipidus must be monitored, including its effects on glomerular filtration rate.