Transplantation proceedings最新文献

{"title":"Mucormycosis Infection in Lung Transplant Patients: Experience in Andalusia, Spain","authors":"Alba María Fernández González ,&nbsp;Ninoska Moreira Lorenzo ,&nbsp;Benito Cantador Huertos ,&nbsp;Manuel Causse Del Río ,&nbsp;Francisco Javier González García ,&nbsp;Antonio Álvarez Kindelan","doi":"10.1016/j.transproceed.2024.11.030","DOIUrl":"10.1016/j.transproceed.2024.11.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Mucorales infections in the airways of lung transplant (LT) patients are rare but have a rising incidence in transplanted lungs.</div></div><div><h3>Objective</h3><div>We present our experience with LT in immediate postoperative infections due to mucormycosis.</div></div><div><h3>Methods</h3><div>Review of 767 LT performed in Andalusia between 2000 and 2023 identifying Mucorales through microbiological results and histological findings.</div></div><div><h3>Results</h3><div>The incidence of Mucorales was less than 1% of all LTs performed at our institution but resulted in 100% mortality. In our series, all cases underwent LT for chronic obstructive pulmonary disease. They presented with pulmonary infection that progressed to disseminated infection. Major associated risk factors included prior corticosteroid treatment, malnutrition, solid organ transplantation, single lung transplantation, immunosuppression, and concomitant Aspergillus infection.</div></div><div><h3>Conclusions</h3><div>Mucormycosis infection in grafts after lung transplantation is a lethal complication poorly documented in the literature. Vigilance for Mucorales in these patients is crucial for early diagnosis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 70-72"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection by Trichosporon Inkin in Lung Transplant: Rare Infection, or Not So Rare?","authors":"Ignacio Fernández-Granda ,&nbsp;Rodrigo Alonso-Moralejo ,&nbsp;Carlos-Andrés Quezada-Loaiza ,&nbsp;Virginia-Luz Pérez-González ,&nbsp;Francisco López-Medrano ,&nbsp;Ana Pérez-Ayala ,&nbsp;Beatriz González-Blanco ,&nbsp;Iván Martínez-Serna ,&nbsp;Felisa Jaén-Herreros ,&nbsp;Alicia de Pablo-Gafas","doi":"10.1016/j.transproceed.2024.12.002","DOIUrl":"10.1016/j.transproceed.2024.12.002","url":null,"abstract":"<div><div>The incidence of invasive fungal infections has increased in recent years among transplant patients, with <em>Trichosporon inkin</em> being a rare but relevant etiological agent. This study examines the experience of our multidisciplinary lung transplant unit in the diagnosis and treatment of 6 cases of <em>T. inkin</em> infection in transplant patients from 2016 to 2023. The cumulative incidence was 1.25% (6/480), with 2 temporal clusters: 5 cases between 2016 and 2017, and 1 case in 2023. The patients had a mean age of 59 ± 5.5 years, and all had undergone bilateral lung transplantation. The median time from transplantation to diagnosis was 53 days. Three patients (50%) presented with local dissemination, while the other three (50%) showed hematogenous spread, resulting in a 66.6% (2/3) mortality rate in the latter group. Treatment included the use of azoles, with voriconazole administered either as monotherapy or in combination with other antifungals such as amphotericin B, fluconazole or micafungin. The overall mortality was 33.3% (2/6). These findings highlight the importance of early diagnosis of <em>T. inkin</em> infection in lung transplant patients, as hematogenous dissemination is associated with a significantly worse prognosis. Azole therapy, combined with surgical interventions for localized infections, was effective in the majority of patients. Additional preventive measures were implemented following the initial 5 cases, including environmental cultures, carrier screening, and reverse isolation protocols.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 82-85"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-HLA Antibodies and the Risk of Antibody-mediated Rejection without Donor-specific Anti-HLA Antibodies After Lung Transplantation","authors":"Alejandra Comins-Boo ,&nbsp;Víctor Manuel Mora-Fernández ,&nbsp;Paula Padrón-Aunceame ,&nbsp;María Toriello-Suárez ,&nbsp;Elena González-López ,&nbsp;Adriel Roa-Bautista ,&nbsp;Carolina Castro-Hernández ,&nbsp;David Iturbe-Fernández ,&nbsp;Manuel Cifrián José ,&nbsp;Marco López-Hoyos ,&nbsp;David San Segundo","doi":"10.1016/j.transproceed.2024.11.031","DOIUrl":"10.1016/j.transproceed.2024.11.031","url":null,"abstract":"<div><h3>Background</h3><div>Antibody-mediated rejection (ABMR) has become one of the leading causes of chronic lung graft dysfunction. However, in lung transplantation, this entity is sometimes difficult and controversial to diagnose. It is mainly caused by the appearance of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA), although there are situations with C4d deposits in biopsy in the absence of circulating DSA. The aim of this work was to study the potential role of non-HLA antibodies in the development of ABMR without DSA after lung transplantation.</div></div><div><h3>Methods</h3><div>A case-control study was designed with a cohort of lung transplant recipients at our institution. Twenty-seven patients with ABMR and without anti-HLA antibodies were identified after lung transplantation, and a control group of 21 transplant recipients was selected with the same post-transplant follow-up without evidence of rejection. Non-HLA antibodies were studied pretransplant using Luminex (ThermoFisher, One Lambda).</div></div><div><h3>Results</h3><div>The median of the pretransplant non-HLA–positive antibodies in the group with ABMR without DSA is significantly higher than in the control group: 2 (interquartile range, 0–16) vs 0 (interquartile range, 0–1; <em>P</em> &lt; .01). Patients with &gt;1.5 pretransplant non-HLA antibodies were more likely to develop ABMR without DSA (sensitivity, 80.95%; specificity, 55.55%; area under the curve, 71.3%).</div></div><div><h3>Conclusion</h3><div>The increase of non-HLA antibodies before lung transplantation has recently been shown to increase the risk of chronic lung allograft dysfunction. These results confirm that patients with a higher number of non-HLA antibodies could be at risk of developing ABMR without DSA. These results point out the possible usefulness of pre-lung transplant non-HLA antibodies to identify patients with end-stage lung disease at risk of developing ABMR without DSA.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 73-76"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Portable Ultrasound for the Diagnosis of Hepatic Steatosis and Degree of Agreement With Macroscopic and Microscopic Findings of the Hepatic Graft Accepted for Transplantation","authors":"Camino Rodríguez-Villar,&nbsp;Andrea Tomás Pulgarín,&nbsp;Rebeca Roque Ardá,&nbsp;David Paredes-Zapata,&nbsp;Carolina Sanchez Marcos,&nbsp;Sabina Herrera Fernández,&nbsp;Ángel Ruíz Arranz","doi":"10.1016/j.transproceed.2024.11.025","DOIUrl":"10.1016/j.transproceed.2024.11.025","url":null,"abstract":"<div><h3>Background</h3><div>The viability of the liver pre-transplant depends on the type of donor, age, medical history, circumstances of death, result of analytics, and complementary exploration of the abdominal cavity. Abdominal ultrasound is the initial option for the assessment of previously unknown liver disease, such as the qualitative determination of hepatic steatosis. The presence of hepatic steatosis is considered a risk factor for graft failure after liver transplantation, therefore, at the time of clinical assessment of the donor or its presence in the macroscopic assessment in the operating room can be cause for rejection of the organ by the transplant teams. The objective is the usefulness of ultrasound for the diagnosis of hepatic steatosis and degree of agreement with macroscopic and microscopic findings of the hepatic graft accepted for transplantation.</div></div><div><h3>Methods</h3><div>We analyzed the results of ultrasound in the population of donors accepted for assessment of the hepatic graft for transplantation and the correlation with the macroscopic finding determined by surgery in the operating room and with the microscopic finding determined by histology in the transplanted grafts. The determinations made describe the demographic variables of the different types of donors, probability of presenting hepatic steatosis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the use of ultrasound and degree of agreement with macroscopic and microscopic findings.</div></div><div><h3>Results</h3><div>Of the grafts evaluated, hepatic steatosis was described by ultrasound in 48 of 299 cases (16.05%) and by macroscopic aspect in 79 of 299 cases (26.4%). Coinciding in 29 of 79 (36.70%) of the cases (kappa = 0.328, <em>P</em> = .000). The 63.21% (189/299) of the livers evaluated were valid for transplantation. Of the valid grafts, 9.6% presented steatosis by ultrasound, 8.4% by macroscopy, and 21.4% by histology. An ultrasound that reports hepatic steatosis implies an increase of 1.87 of log-odds that the donor presents macroscopic steatosis (95% confidence interval [CI] = 3.34–12.65, <em>P =</em> .000) according to the binary logistic regression model. The sensitivity of ultrasound for hepatic steatosis based on microscopy was 29%, specificity 91%, PPV 66%, and NPV 68%.</div></div><div><h3>Conclusions</h3><div>Given the moderate or low agreement among ultrasound, macroscopy, and histology, the bedside portable ultrasound for the diagnosis of hepatic steatosis seems to be a method that undervalues the presence of hepatic steatosis in potential donors accepted for liver transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 43-47"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living Donor Liver Transplantation Using Right Posterior Section Graft in a Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patient With Hemophilia: A Case Report","authors":"Takanobu Hara ,&nbsp;Ayaka Sato ,&nbsp;Akihiko Soyama ,&nbsp;Hajime Matsushima ,&nbsp;Takashi Hamada ,&nbsp;Hajime Imamura ,&nbsp;Ayaka Kinoshita ,&nbsp;Kazushige Migita ,&nbsp;Yuta Kawaguchi ,&nbsp;Tomohiko Adachi ,&nbsp;Tetsuya Hara ,&nbsp;Tomoyuki Endo ,&nbsp;Susumu Eguchi","doi":"10.1016/j.transproceed.2024.12.033","DOIUrl":"10.1016/j.transproceed.2024.12.033","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation is an important treatment option for liver cirrhosis in patients with HIV/HCV coinfection. In Japan, the limited number of deceased donors may force the selection of living donor liver transplantation. Appropriate graft selection is the key to success.</div></div><div><h3>Case presentation</h3><div>The patient, a 66-year-old male with hemophilia A, acquired HIV and HCV through blood transfusions. He had a multidrug-resistant HIV strain, requiring frequent changes in antiretroviral therapy. Although his HCV cleared spontaneously, liver fibrosis progressed. With a Child-Pugh score of 9 and a MELD score of 13, liver transplantation was considered. His child became the living donor. A factor VIII concentrate test was performed preoperatively, and his HIV treatment was adjusted to avoid drug interactions. The chosen graft was a posterior segment (graft-to-recipient weight ratio of 0.8), and surgery lasted 787 min with a blood loss of 7046 g. Factor VIII concentrate was stopped on the second postoperative day as activity increased. The patient was discharged on postoperative day 47.</div></div><div><h3>Conclusion</h3><div>This is the first reported living donor liver transplantation using a posterior segment graft in a hemophilia patient coinfected with HIV and HCV. Liver transplantation can be safely performed by formulating a preoperative coagulation factor supplementation protocol.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 122-125"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Vascular Graft Reconstruction of Short Renal Artery Using Polytetrafluoroethylene (PTFE) in Living Donor Kidney Transplantation—A Case Report and Review of Literature","authors":"Hany M. El Hennawy ,&nbsp;Eisa Al Atta ,&nbsp;Amal Awadh ,&nbsp;Omar Safar ,&nbsp;Shaher Al Kawasmeh ,&nbsp;Yasser S. Mansour ,&nbsp;Mohammad F. Zaitoun ,&nbsp;Abdullah S. Al Faifi","doi":"10.1016/j.transproceed.2024.11.013","DOIUrl":"10.1016/j.transproceed.2024.11.013","url":null,"abstract":"<div><div>Short donor renal artery during nephrectomy poses a technical challenge. We present a main renal artery (RA) reconstruction case in Living-donor kidney transplantation (LDKT) using an extension polytetrafluoroethylene vascular graft(PTFE). A 57-year-old man received LDKT from his son. Postlaparoscopic donor nephrectomy, a PTFE graft was used to reconstruct the short RA. Excellent reperfusion, good renal turgor, and immediate urine production were noted. Serial Doppler assessments on postoperative days 1, 3, and 7 and 180 confirmed good blood flow. The PTFE graft did not cause any additional morbidity or complications related to kidney transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 100-104"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of a Desensitization Treatment With Rituximab and Immunoglobulin in Hyperimmunized Patients Awaiting a Cadaveric Kidney Transplantation","authors":"Elena González García ,&nbsp;María López Oliva ,&nbsp;Esther Mancebo ,&nbsp;María José Santana ,&nbsp;Lina María León Machado ,&nbsp;Cristina Fuentes Fernández ,&nbsp;Carlos Jiménez","doi":"10.1016/j.transproceed.2024.12.001","DOIUrl":"10.1016/j.transproceed.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Patients on a kidney transplant waiting list with antibodies against more than 80% of a panel reactive antibody (PRA) are difficult to transplant, even with national or regional programs. Desensitization treatment with high-dose intravenous immunoglobulin and rituximab could be offered to patients with a long waiting time for a cadaveric donor to improve their odds of finding a kidney.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center study including all hyperimmunized patients on the waiting list for a cadaveric kidney donor who received a desensitization treatment between 2010 and 2020. Eight patients (50% male patients, mean age = 41.5±16.4 years) were desensitized with intravenous immunoglobulin and rituximab. Seventy-five percent of the patients had received a previous transplant. The median PRA calculated was 98%. The mean follow-up time after transplantation was 67 months.</div></div><div><h3>Results</h3><div>No patient presented significant side effects to desensitization treatment. Seven of the 8 patients (87.5%) received a transplant from a cadaveric donor, in a median 8 months after desensitization. In the immediate post-transplant period, there were two graft losses (28.6%) due to non-immunological causes (1 venous thrombosis in a patient with a coagulation disorder and 1 primary graft failure). Creatinine levels at 1 and 5 years were 1.4 ± 0.2 mg/dL and 1.7 ± 0.6 mg/dL, respectively. There were no episodes of acute rejection. No patient developed cancer during the follow-up.</div></div><div><h3>Conclusions</h3><div>Desensitization treatment with immunoglobulin and rituximab on hyperimmunized patients on the cadaveric transplant waiting list is a safe and effective treatment that increases the chances of achieving a kidney transplant in highly sensitized patients.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 3-6"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitization on Hemodialysis After Renal Graft Failure: HLA Incompatibility Still Matters","authors":"Mar Huelva-López,&nbsp;Marta Ciudad-Montejo,&nbsp;Carlos Fernando Novillo-Sarmiento,&nbsp;Cayetana Moyano-Peregrín,&nbsp;Victoria Eugenia García-Montemayor,&nbsp;Raquel Ojeda-López,&nbsp;María Luisa Agüera-Morales,&nbsp;Alberto Rodríguez-Benot","doi":"10.1016/j.transproceed.2024.11.032","DOIUrl":"10.1016/j.transproceed.2024.11.032","url":null,"abstract":"<div><div>Patients with renal graft failure can develop human leukocyte antigen (HLA) sensitization when returning to dialysis. There is no consensus on which factors could be associated with an increased risk of this kind of sensitization after graft loss. To try to identify some of these factors, a retrospective observational study was performed in our center. Demographic and transplant-related data were collected: HLA mismatches, changes in calculated panel reactive antibody percentage over time, the immunosuppression withdrawal schedule during the first year on hemodialysis (HD), among others. Patients who developed anti-HLA antibodies after 1 year on HD had a greater number of total HLA mismatches (4.15 ± 1.3 vs 3.3 ± 1.1; <em>P</em> = .001), HLA-DR (1.35 ± 0.7 vs 0.7 ± 0.6; <em>P</em> = .001) and HLA-A mismatches (1.70 ± 0.5 vs 1.27 ± 0.7; <em>P</em> = .004) than patients who never developed anti-HLA antibodies. When we only analyzed patients who develop ≥98% calculated panel reactive antibody versus those who persist without anti-HLA antibodies, these differences were more evident (5.2 ± 1.1 MM vs 3.3 ± 1.1 MM; <em>P</em> &lt; .001). The timing of discontinuation of immunosuppression did not influence sensitization. Thus, we have observed that HLA mismatches influence HLA sensitization after graft failure at least during the first year on HD. This study supports the importance of prioritizing HLA matching in patients who may require &gt;1 graft over the years and being aware of the potential importance of HLA mismatches on sensitization on HD.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 27-29"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extension of the Right Renal Vein in Deceased Donor Kidney Transplantation: A Literature Review and Analysis at Our Center","authors":"Sergio Martín Prieto Millán,&nbsp;Oskar Jon Estradé Suárez,&nbsp;Ana Isabel Llorente García,&nbsp;Joel Sanz Casero,&nbsp;Andrea Carlevaris Fernández,&nbsp;Iván Olano Grasa,&nbsp;Jorge García- Olavarri Rodríguez,&nbsp;Beatriz Martínez González,&nbsp;Jesús Padilla Nieva,&nbsp;David Lecumberri Castaños","doi":"10.1016/j.transproceed.2024.11.033","DOIUrl":"10.1016/j.transproceed.2024.11.033","url":null,"abstract":"<div><h3>Introduction</h3><div>The length of the right renal vein is a crucial vascular factor in kidney transplantation. Its shorter length compared to the left renal vein complicates venous anastomosis. The aim of this article is to review the literature on this topic and provide data from our experience.</div></div><div><h3>Materials and Methods</h3><div>A bibliographic review was conducted in PubMed using the keywords “kidney transplant,” “deceased donor,” “right kidney,” and “renal vein extension.” Three studies evaluating the feasibility and clinical outcomes of right renal vein extension in transplants were selected and analyzed. Additionally, a retrospective analysis of kidney transplants performed at Hospital Universitario Cruces in 2023 was carried out, focusing on cases where the technique of extending with a vena cava patch was used. Parameters such as surgical time, vascular complications, graft viability, and postoperative renal function were evaluated.</div></div><div><h3>Results</h3><div>The reviewed studies indicate that the extension of the right renal vein is safe and effective, facilitating surgery and reducing warm ischemia time as well as the incidence of complications such as renal artery kinking. The analysis of transplants at our center in 2023 showed similar results, with a simplified procedure and no increase in the risk of complications.</div></div><div><h3>Conclusion</h3><div>The extension of the right renal vein with a vena cava patch is an effective technique that does not increase morbidity or compromise graft viability, improving long-term clinical outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 10-12"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Autoimmune Hemolytic Anemia Following COVID-19 Infection Accompanied by Acute Tubulointerstitial Nephritis in a Kidney Transplant Recipient","authors":"Dong Wook Kim ,&nbsp;In Hwa Jeong ,&nbsp;Young Ki Son ,&nbsp;Seo Hee Rha ,&nbsp;Young Soo Chung","doi":"10.1016/j.transproceed.2024.10.042","DOIUrl":"10.1016/j.transproceed.2024.10.042","url":null,"abstract":"<div><h3>Background</h3><div>Acute tubular injury is one of the main causes of acute tubular injury (acute kidney injury ) in patients with COVID-19 infection. Autoimmune hemolytic anemia (AIHA) is also one of the autoimmune complications of COVID-19. However, AIHA accompanied by acute tubulointerstitial nephritis (ATIN) caused by SARS-CoV-2 is rarely reported. Here, we report a kidney transplant recipient who underwent graftectomy owing to ATIN accompanied by AIHA, possibly exacerbated by COVID-19 infection.</div></div><div><h3>Case Presentation</h3><div>A 32-year-old male renal allograft recipient owing to immunoglobulin A nephropathy visited the emergency department owing to dyspnea and general weakness. Three weeks earlier, the patient had been transplanted with deceased-donor kidney with full HLA-A, -B, -DR match, and had been on tacrolimus, prednisolone, and mycophenolate since then. At the time of the visit, laboratory findings revealed hemoglobin of 2.4 g/dL, reticulocyte of 21.7%, total bilirubin of 1.9 mg/dL, direct bilirubin of 0.3 mg/dL, lactate dehydrogenase of 946 U/L, haptoglobin of &lt;10 mg/dL, and severe red cell agglutination on peripheral blood smear, which suggested AIHA. In addition, his SARS-CoV-2 real-time polymerase chain reaction test was positive. During steroid treatment for AIHA, a sudden decrease in urine volume, estimated glomerular filtration rate (from 64.9 to 35.1 mL/min/1.73 m²) and increase of creatinine (from 1.42 to 2.36 mg/dL) indicated renal function deterioration, so steroid was increased to 500 mg. On the third day of renal function deterioration, dialysis was started owing to anuria and fluid retention. On renal biopsy, C4d was absent; however, ATIN with eosinophilic infiltration was observed. On renal ultrasound examination, a severely enlarged kidney with edema was observed. At the same time, the patient had a high fever with increased C-reactive protein and procalcitonin. Graftectomy was performed to prevent secondary infection. The postgraftectomy renal biopsy showed renal parenchymal and hilar inflammatory change, endotheliitis, and lymphocytic infiltration of peripheral nerve fibers. After graftectomy, dialysis was maintained and AIHA had ameliorated.</div></div><div><h3>Conclusion</h3><div>The patient had to have his allografted kidney removed owing to ATIN possibly caused by COVID-19 infection. Acute kidney injury caused by SARS-CoV-2 can be either by direct viral infection or as consequence of immunological response. The exact immunological mechanism of AIHA secondary to COVID-19 infection remains to be elucidated.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 109-115"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}