Oral candidiasis in immunosuppressed children and young adults after liver or kidney transplantation.

PURPOSE: Candidiasis is an infectious complication in organ transplant recipients resulting from the patients' immunodeficiency and virulence of fungi pathogens. The purpose of this study was to evaluate the frequency of Candida spp. and identify their presence in the oral lesions of graft recipients. METHODS: This study included 185 patients, 1.5 to 25.2 years of age (mean = 13.1 +/- 4.2 years) who were receiving combined immunosuppression treatment after kidney or liver transplantation and 70 control subjects. Evaluation included clinical oral examination, mycology, and statistical analysis. RESULTS: Candida spp. colonies were found in the oral mucosa of 63 (34%) graft recipients and in 19 (27%) control subjects. Candida albicans was the most prevalent species. This study showed that, regardless of the type of the organ transplant and immunosuppression, frequent, regular oral follow-up and mycologic tests are recommended. Diagnosing increased density of Candida spp. colonies in the oral cavity will help initiate early antifungal treatment. CONCLUSIONS: Candida spp. prevalence in the oral cavity in transplant recipients was higher than in immunocompetent control subjects. Kidney or liver transplantation predisposes one to the development of an increased density of Candida spp. colonies.

Local presence of cytomegalovirus and Candida species vs oral lesions in liver and kidney transplant recipients.

BACKGROUND: Anti-CMV prophylaxis is currently a routine management in patients after organ transplantation. One of the clinical symptoms of CMV infection may be lesions in the oral cavity.The aim of this study was to determine the relationship between CMV infection, occurrence of Candida species and presence of oral mucosal ulceration in transplant recipients. MATERIAL/METHODS: Twenty fi ve patients after kidney or liver transplantation (mean age 13 years +/-4 years), receiving immunosuppression (tacrolimus, cyclosporine or sirolimus), who presented minor and major recurrent aphtous stomatitis (RAS), atypical ulcerations or focal necrosis in the oral cavity were enrolled into the study. Mean duration of post-transplant follow-up was 4 years and 3 months (+/-3 years and 5 months). Clinical dental examination (Pl I, GI), mycological tests and blood tests for CMV infection (specific IgM antibodies and/or pp65 antygenemia) were performed in all patients. Eighteen specimens of oral mucosa were evaluated for CMV presence in situ. RESULTS: CMV infection was confirmed in 13 patients with oral mucosal ulceration (46.43%); which were accompanied by gingivitis (average GI=1.34); in two cases Candida albicans was identified. DNA of HCMV was found in-situ in 5.5% of all biopsies, and in 9% of biopsies of patients with clinical CMV infection; changes did not show the presence of Candida spp. CONCLUSIONS: There is a significant correlation between CMV infection and oral lesions; in some cases, CMV may be a direct cause.

Longitudinal study of renal function in pediatric liver transplant recipients.

OBJECTIVES: Study was performed to evaluate prospectively long-term renal function in pediatric liver transplant recipients. METHODS: In 50 children aged 1-18 years, renal function tests (sCr, GFR, ERPF, Cr clearance, renal Doppler ultrasound, ABPM) have been performed before and several times during 36 months follow-up after liver transplantation. RESULTS: Signifficant reduction of renal filtration function was found in studied children (increase of sCr, decrease of GFR, ERPF, Cr clearance) within 12 months after transplantation, which did not progress further in most children after this time. None of patients progressed to stage 4 or 5 renal failure according to CKD. Schwartz formula was not found reliable in assessing renal function in children after liver transplantation. There was no difference in renal function according to cyclosporine or tacrolimus treatment, however arterial hypertension was more common in cyclosporine treated group. CONCLUSIONS: Although renal damage may be a problem for an individual chuild after liver transplantation, majority of children have stable renal function 36 months after Tx. DTPA GFR should be performed yearly in all children until adulthood not to overlook progression of renal injury.

[Clinical aspects of plasmapheresis therapy in children: single center experience]. / Kliniczne aspekty leczenia dzieci plazmafereza--doswiadczenie jednego osrodka.

Data concerning 576 plasmapheresis sessions (indications, anticoagulation applied, supplement type and acute complications) in children (mean body weight = 35 kg +/- 15; min 5 kg, max 75 kg) performed between 1990 and 2001 were analysed. INDICATIONS: Glomerulonephritis (GN)--185 (32%) (including recurrence after kidney transplantation--108, rapidly progressive GN--63, other GN--14), other immunological diseases--110 (19%) (systemic lupus erythematosus, Wegener's granulomatosis, myasthenia, Guillain-Barré syndrome, other), haemolytic-uraemic syndrome--104 (18%) (after kidney transplantation--50, atypical--54), Amanita poisoning 100 (17%), acute hepatic encephalopathy--41 (7%) (after liver transplantation--9), poisoning with drugs bound by plasma albumin--22 (4%) and complications in kidney graft recipients--14 (2%) (acute vascular rejection, parathormone toxicity). ANTICOAGULATION: Until the end of 1999--unfractionated heparin (in divided doses every 30 min--100 IU/kg/session on the average), from 2000 on--single dose of Fraxiparine (mean 70 IU anty-Xa/kg/session). SUPPLEMENT: Until 1995--Ringer solution + fresh frozen plasma, from 1996 on--Ringer solution + fresh frozen plasma or 4% albumin solution diluted in 5% dextrose (depending on indications, contraindications and fibrinogen concentration). COMPLICATIONS: Deaths in the course of plasmapheresis--0, others (rash, abdominal pain, headache, nausea and vomiting, blepharoedema, drop of arterial pressure, pruritus)--19 (3%), necessity of session termination because of patient condition (dyspnoea, urticaria, hypotension)--3 (0.5%) and technical problems--23 (4.5%) (filter damage--8, filter clotting--5, haemolysis--3, machine malfunction--5, problems with vascular access--2).