Case Reports in Transplantation最新文献

{"title":"Xanthogranulomatous Pyelonephritis in a Transplant Kidney Leading to Severe Allograft Dysfunction.","authors":"Usman Baig, Ahmad Mirza, Payaswini Vasanth, Laura Mulloy, Shameem Beigh, Imran Gani","doi":"10.1155/crit/6605652","DOIUrl":"https://doi.org/10.1155/crit/6605652","url":null,"abstract":"<p><p>Xanthogranulomatous pyelonephritis (XPN) is a rare and unusual form of pyelonephritis that infrequently occurs in renal allografts. Clinical presentation ranges from asymptomatic to fever, pyuria, and graft dysfunction. We present a case of a young African American male who presented with a marked elevation in serum creatinine from a baseline of 1.8-1.9 to 9.86 mg/dL. Transplant kidney biopsy was consistent with the diagnosis of XPN, showing xanthoma cells, which are pathognomonic for this condition. Following antibiotic treatment, allograft function improved and return to dialysis was averted. Clinicians should consider XPN in transplant patients with deteriorating allograft function, as its presentation can mimic more common conditions. Graft salvage with appropriate antimicrobial therapy should be attempted before considering nephrectomy which risks reinitiation of dialysis.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2025 ","pages":"6605652"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Living Kidney Donor Transplantation: A Case Report.","authors":"Meredith Wells, Keith Melancon, Robert Young, Adam Greenwood, Joseph Manley, Pablo Serrano Rodriguez","doi":"10.1155/crit/2822007","DOIUrl":"10.1155/crit/2822007","url":null,"abstract":"<p><p>This case report describes the successful kidney donation of a 68-year-old female to a 56-year-old female recipient with end-stage renal disease (ESRD). The donor in this case presented with an extensive abdominal surgical history, which had resulted in an incidental injury to the right ureter and a subsequent nephrostomy tube placement. After establishing the low likelihood of reconstruction of the damaged ureter, she then initiated kidney donor evaluation after electing to undergo a nephrectomy. This case report highlights the meticulous evaluation and preparation of the donor under particular circumstances, the surgical techniques employed, and the positive outcomes for both the donor and the recipient.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2025 ","pages":"2822007"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11858834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Transplantation in Patients With Urinary Diversion-Bypassing the Conduit: A Case Report.","authors":"Matthew D Wainstein, Obi Ekwenna","doi":"10.1155/crit/6764308","DOIUrl":"10.1155/crit/6764308","url":null,"abstract":"<p><p>Kidney transplantation in patients with supravesical urinary diversions is a relatively rare procedure. The typical approach for establishing urinary drainage in these patients is through an ureteroileal anastomosis. However, a tension-free ureteroileal anastomosis can be difficult to achieve based on variations in the anatomy of the donor ureter or recipient conduit. An alternative technique can be to create an anastomosis between the donor and recipient ureter, although reports of this technique in the last 20 years have been sparse. Here, we present two cases of patients with prior ileal conduits who underwent successful renal transplantation with uretero-uretero anastomoses.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2025 ","pages":"6764308"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Allograft Torsion After Simultaneous Pancreas Kidney Transplantation: Case Report and Review of Literature.","authors":"Ayato Obana, Miho Akabane, Matthew Hamilton, Kejal Shah, Rithin Sai Punjala, Ashley Limkemann, Austin Schenk, Navdeep Singh, Amer Rajab, Ginny Bumgardner, Kenneth Washburn, Musab Alebrahim","doi":"10.1155/crit/2902758","DOIUrl":"10.1155/crit/2902758","url":null,"abstract":"<p><p>Kidney allograft torsion (KAT) is a rare but critical complication of kidney transplantation that can lead to graft loss due to acute ischemia. This report presents a case of KAT resulting in graft loss 9 months following intraperitoneal simultaneous pancreas and kidney (SPK) transplant and reviews previous reports to identify potential high-risk features. A 38-year-old female with end-stage renal disease secondary to Type 1 diabetes mellitus underwent an intraperitoneal enteric drained SPK transplant. Nine months post-transplantation, she presented with nausea, vomiting, severe abdominal pain, decreased urine output, and diarrhea. An ultrasound showed moderate hydronephrosis and no blood flow to the renal hilum. Exploratory laparotomy revealed a necrotic renal allograft twisted 360° counterclockwise on its vascular pedicles. Despite detorsion, the graft showed no signs of viability, necessitating transplant nephrectomy. This case highlights the rarity and severity of KAT, particularly in intraperitoneal kidney transplants. The patient's low body mass index (BMI) (23.4 kg/m²), female sex (wider pelvis), and minimal intra-abdominal adhesions may have contributed to increased graft mobility, predisposing to KAT. Other potential risk factors include elongated vascular pedicle and immunosuppression-related reduced adhesion formation. The nonspecific presentation of KAT emphasizes the need for high clinical suspicion and prompt ultrasonographic evaluation in cases of graft abnormalities. This report underscores the importance of considering patient- and graft-specific factors in assessing KAT risk and the critical nature of early detection and intervention to prevent graft loss.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2025 ","pages":"2902758"},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11769581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Solid Organ Transplant and Transfusion-Associated Graft-Versus-Host Disease in a Lung Transplant Recipient: An Uncertain Culprit With Lethal Complications.","authors":"Devika Sindu, Brian J Franz, Ian Scott, Hashem Ayyad, Kristina Gaines, Kendra McAnally, Sofya Tokman","doi":"10.1155/crit/3034200","DOIUrl":"10.1155/crit/3034200","url":null,"abstract":"<p><p>Although graft-versus-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation, it is rare after solid organ transplantation (SOT) or blood transfusion. We present a rare case of SOT-derived and/or transfusion-associated graft-versus-host disease (TA-GVHD) in a 66-year-old man with interstitial lung disease who underwent bilateral lung transplantation (LT) from a 12-year-old female donor and required three units of packed red blood cells intraoperatively. He presented with signs and symptoms consistent with GVHD, and a bone marrow biopsy revealed an XX karyotype. He died 3 months after bilateral LT, and postmortem chimerism testing using next-generation sequencing identified three sources of DNA within his bone marrow, including the recipient, the lung donor, and a third donor, thereby suggesting the presence of solid organ transplant graft-versus-host disease (SOT-GVHD), TA-GVHD, or a combination of both.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"3034200"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De Novo Kaposi Sarcoma in an HIV-Negative Liver Transplant Recipient With Ulcerative Colitis and Primary Sclerosing Cholangitis.","authors":"Pavithra Ramakrishnan, Khalid Amin, Wolfgang Gaertner, Elizabeth S Aby","doi":"10.1155/crit/4699128","DOIUrl":"https://doi.org/10.1155/crit/4699128","url":null,"abstract":"<p><p>De novo or viral reactivation cancers are a major cause of morbidity and mortality in the solid organ transplant (SOT) population. Primary sclerosing cholangitis (PSC) is an aggressive disease which can lead to cholestatic liver damage and cirrhosis. PSC often cooccurs with inflammatory bowel disease (IBD). Here, we describe the case of a 28-year-old male with PSC along with poorly controlled IBD who underwent a liver transplant and developed colonic Kaposi sarcoma (KS). Our case highlights the importance of adequate pretransplant screening for endemic viruses, high clinical suspicion for KS in the setting of difficult-to-control colitis, and early multidisciplinary involvement.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"4699128"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor-Derived Disseminated Toxoplasmosis in a Liver Transplant Recipient With Documented Sulfa Allergy.","authors":"Zoe Raglow, Emily Herriman, Gabriel Abrams, Marc Najjar, Christopher J Sonnenday, Kevin S Gregg","doi":"10.1155/2024/8839805","DOIUrl":"https://doi.org/10.1155/2024/8839805","url":null,"abstract":"<p><p>Transplant recipients who are seronegative for <i>Toxoplasma</i> and receive an organ from a seropositive donor are at high risk for donor-derived toxoplasmosis in the absence of prophylaxis. While the risk in cardiac transplant recipients is well known, this infection is often underrecognized in noncardiac transplant recipients. Toxoplasmosis in transplant patients is associated with high mortality, and diagnosis is challenging as the presentation is nonspecific. Recommendations for prophylaxis in cardiac transplant recipients are well-defined, but the optimal prophylactic strategy in noncardiac transplant recipients, especially those with sulfa allergies, is unknown. We report a case of donor-derived disseminated toxoplasmosis in a liver transplant recipient who did not receive prophylaxis due to documented sulfa allergy. The patient subsequently underwent a challenge with trimethoprim/sulfamethoxazole and was successfully treated with this therapy. This case underscores the variable clinical presentation of donor-derived toxoplasmosis as well as the critical importance of accurate allergy evaluation pretransplant.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"8839805"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of <i>Cladophialophora bantiana</i> Intracranial Infection: Highlighting the Utility of Next-Generation Sequencing in Diagnosis.","authors":"Melissa Whitman, Nicole Vissichelli","doi":"10.1155/2024/8892177","DOIUrl":"10.1155/2024/8892177","url":null,"abstract":"<p><p><i>Cladophialophora bantiana</i> is a dematiaceous fungi and the most common cause of cerebral phaeohyphomycosis. Here, we report a rare case of cerebral ventriculitis with development of a cerebral abscess due to <i>C. bantiana</i> diagnosed by cell-free DNA next-generation sequencing. Noninvasive diagnostics led to earlier disease identification and initiation of antifungal therapy, which has the potential to reduce mortality in this highly fatal disease.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"8892177"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11455592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report.","authors":"Sara Hashemi, Reut Hod-Dvorai, Rebecca Tong, Liye Suo","doi":"10.1155/2024/9226321","DOIUrl":"https://doi.org/10.1155/2024/9226321","url":null,"abstract":"<p><p>Plasma cell-rich acute rejection (PCAR), a relatively rare subtype of acute allograft rejection, is usually associated with a significantly lower treatment response rate and a higher graft failure rate. PCAR is characterized by the presence of more than 10% of plasma cells out of all graft infiltrating cells, with approximately 40%-60% of PCAR resulting in graft failure within a year. Currently, there is no gold standard for the effective treatment of PCAR. This case report demonstrates the potential treatment effect of bortezomib in PCAR. A 37-year-old woman with reflux nephropathy received a kidney transplant from a brain-dead kidney donor. The patient presented with an acute kidney injury with a serum creatinine level over 4 mg/dL 4 months after the surgery. The allograft biopsy showed acute T cell-mediated rejection (TCMR), Grade IIA, plasma cell-rich variant. There were diffuse polyclonal plasma cells infiltrating the renal parenchyma with marked tubulitis and focal endarteritis. She received a methylprednisolone pulse of 500 mg daily x3, followed by thymoglobulin (rATG) at 4.2 mg/kg. However, a repeated biopsy after 2 months showed persistent plasma cells infiltrate with increased interstitial fibrosis with tubular atrophy. Then, the patient was given one cycle of bortezomib with a total of four subcutaneous injections and continued immunosuppressants of tacrolimus, mycophenolate mofetil, and prednisone. Following the treatment, the patient's serum creatinine level trended down to 2 mg/dL, and a second repeat biopsy after 4 months showed a significant treatment effect with complete resolution of interstitial inflammation and decreased chronicity. Bortezomib is a proteasome inhibitor that prevents cell proliferation by inducing apoptosis in plasma cells and has shown great promise as a therapeutic agent for multiple myeloma. Our case suggests that bortezomib can also be used as a potential therapeutic intervention for patients with PCAR.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"9226321"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De Novo Onset of Myasthenia Gravis after Kidney Transplantation.","authors":"Aaron de Souza, Rajesh Raj","doi":"10.1155/2024/5473862","DOIUrl":"10.1155/2024/5473862","url":null,"abstract":"<p><p>Myasthenia gravis occurring de novo after kidney transplantation is a rare course of severe muscle weakness. A 57-year-old female on treatment with peritoneal dialysis following polycystic kidney disease received a renal transplant with standard basiliximab induction. She had no preceding history of neuromuscular problems. Three months after transplant she presented with progressive weakness and fatigability, finally needing a wheelchair to mobilise. Graft function was stable. Examination revealed patchy limb weakness, worsening on repeated exercise. There were no abnormalities in cranial nerves, reflexes, or sensation. Electromyography was normal, but repetitive nerve stimulation studies showed a postsynaptic neuromuscular transmission defect suggestive of myasthenia gravis. Serological testing revealed no putative antibodies. Initial treatment with pyridostigmine was not tolerated. Following an episode of hospitalisation with severe limb weakness, she received intravenous immunoglobulin and showed dramatic improvement, which persisted over the next few weeks. Approximately 6 months later, she had a relapse of her symptoms, which once again responded to intravenous immunoglobulin therapy. De novo myasthenia gravis after transplantation is a rare entity, infrequently reported in the literature. This illness is surprising since immunosuppression after transplant is usually sufficient to prevent immune-mediated disease. This patient had no history of similar illnesses. Delayed physical recovery after major surgery such as renal transplantation is often attributed to other causes such as deconditioning, and patients are often prescribed physiotherapy as a response. In this patient, the profound unexplained weakness that persisted for several weeks after transplant prompted referral to the neurologist, which enabled this rare diagnosis to be made. This story highlights the need to monitor unexpected symptoms closely and to consider a wide differential diagnosis when improvement after transplant is not along usual expected lines. Finally, this case also illustrates the benefits of multidisciplinary involvement in the care of these complex patients.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2024 ","pages":"5473862"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}