Case Reports in Transplantation最新文献

{"title":"High-Intensity Transient Signals Detected in a Renal Allograft","authors":"Lea Kaadi, Christele Lahoud, Samir Hachem, Tarek Smayra, Kamal Hachem","doi":"10.1155/2023/9921063","DOIUrl":"https://doi.org/10.1155/2023/9921063","url":null,"abstract":"High-intensity transient signals (HITS) are signals recorded by the Doppler ultrasounds, reflecting either the passage of microemboli, both solid or gaseous in the vessels, or artifacts. Their identification during Duplex US highlights the need for further evaluation to rule out a potential embolic source. A 49-year-old female was referred to our hospital for renal transplantation. The Doppler ultrasound done on day 4 after the surgery revealed the presence of high-intensity transient signals (HITS) suggesting the passage of an emboli. Renal magnetic resonance angiography (MRA) confirmed the presence of peripheral parenchymal defects suggestive of a distal embolus. A better understanding and recognition of this radiological sign are essential in order to initiate appropriate patient management when needed. In this report, we review the importance of HITS and present a case in which HITS were detected in an unusual location: an allograft kidney artery.","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" 24","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135340522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Complete Regression of Colon Cancer Liver Metastases in a Lung Transplant Patient: A Case Report.","authors":"Koen Zwart,&nbsp;Dieuwertje Ruigrok,&nbsp;Magda de Graaf-Bos,&nbsp;Roel Goldschmeding,&nbsp;Miriam Koopman,&nbsp;Guus M Bol","doi":"10.1155/2023/9643370","DOIUrl":"https://doi.org/10.1155/2023/9643370","url":null,"abstract":"<p><strong>Background: </strong>Cancer has become an important cause of death in solid organ transplant patients. The cause of malignancies in patients with solid organ transplants is multifactorial, but the use of intensive immunosuppression is regarded as an important factor. We describe the spontaneous, complete regression of colon cancer liver metastases, without initiation of antitumor therapy, in a solid organ transplant patient after modulation of immunosuppressants. <i>Case Presentation.</i> A 59-year-old female was admitted with fever, general discomfort, and elevated liver enzymes. She had received a single lung transplant, five years prior, for end-stage chronic obstructive pulmonary disease. Abdominal ultrasound and a computed tomography scan showed extensive liver lesions, and liver biopsy determined that the lesions were liver metastases originating from a colonic adenocarcinoma. Histopathologic analysis revealed that the primary tumor and liver metastases were mismatch repair-deficient (BRAF^V600E mutant and MLH1/PMS2-deficient), also known as a microsatellite instable tumor. The patient's clinical condition deteriorated rapidly, and she was discharged home with palliative care. No antitumor treatment was initiated. Additionally, there was a short period without any immunosuppressants. Unexpectedly, her clinical condition improved, and complete regression of liver metastases was observed on imaging two months later. Unfortunately, the patient developed rejection of her lung transplant and succumbed to pulmonary disease six months following her cancer diagnosis. The autopsy confirmed the primary colon tumor location and complete regression of >40 liver metastases.</p><p><strong>Conclusions: </strong>Disinhibition and reset of the host immune response could have led to immune destruction of the liver metastases of this patient's immunogenic dMMR colon carcinoma. This case underscores the huge impact that temporary relief from immunosuppressive therapy could have on tumor homeostasis. Balanced management of care for organ transplant recipients with malignancies requires a multidisciplinary approach involving medical oncologists and transplant physicians to reach the best quality of care in these complex cases.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2023 ","pages":"9643370"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10582577","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":"Inescapable Fibrosis: The Development of Desquamative Interstitial Pneumonia Post-Lung Transplantation Performed for a Patient with Idiopathic Pulmonary Fibrosis.","authors":"Paul Lilburn,&nbsp;Divya Pillutla,&nbsp;Vanathi Sivasubramaniam,&nbsp;Marshall Plit","doi":"10.1155/2023/1737309","DOIUrl":"https://doi.org/10.1155/2023/1737309","url":null,"abstract":"<p><p>Interstitial lung disease is characterised by a combination of cellular proliferation, inflammation of the interstitium and fibrosis within the alveolar wall. A 58-year-old man was referred for lung transplantation after developing worsening dyspnoea and progressive hypoxaemic respiratory failure from idiopathic pulmonary fibrosis. Three years later, he developed desquamative interstitial pneumonia in his transplanted lungs, and despite augmentation of immune suppression, he had a progressive decline in his lung function and exercise capacity. Interestingly, in our case, the histopathology obtained post transplant strongly goes against the recurrence of usual interstitial pneumonia/idiopathic pulmonary fibrosis; rather, two separate interstitial disease processes have been identified.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2023 ","pages":"1737309"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10115523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9444392","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 Successful Living Donor Liver Transplantation Using Hepatic Iron Deposition Graft Suspected by Magnetic Resonance Imaging.","authors":"Nobuhiko Kurata,&nbsp;Masato Shizuku,&nbsp;Kanta Jobara,&nbsp;Yoji Ishizu,&nbsp;Masatoshi Ishigami,&nbsp;Yasuhiro Ogura","doi":"10.1155/2023/9075184","DOIUrl":"https://doi.org/10.1155/2023/9075184","url":null,"abstract":"<p><p>Recently, magnetic resonance imaging (MRI) has been developed as a widely available and noninvasive method for detecting and evaluating hepatic iron overload. This case report presents a successful living donor liver transplantation (LDLT) in which the donor was suspected to have hepatic iron deposition by MRI evaluation. A preoperative donor liver biopsy and genetic examination were performed to exclude hereditary hemochromatosis and other chronic liver diseases. A liver biopsy showed an almost normal liver specimen with a slight deposition of iron in 2-3% of hepatocytes, and a genetic examination of hereditary hemochromatosis revealed no typical mutations in HFE, TFR2, HJV, HAMP, or SLC40A1. Despite the traumatic hemothorax complication caused by the liver biopsy, the liver transplant eligibility was confirmed. Two months after the hemothorax complication, an LDLT donor operation was performed. The donor was discharged from the hospital on postoperative day (POD) #17 with favorable liver function. The recipient's posttransplant clinical course was generally favorable except for acute cellular rejection and biliary complications, and the recipient was discharged from the hospital on POD #87 with excellent graft function. A one-year follow-up liver biopsy of the recipient demonstrated almost normal liver with iron deposition in less than 1% of the hepatocytes, and no iron deposition was identified in the liver graft by MRI examination. Liver biopsy and genetic examination are effective methods to evaluate the eligibility of liver transplant donors with suspected hepatic iron deposition. The living donor with slight hepatic iron deposition, if hereditary hemochromatosis was ruled out, can donate partial liver safely.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2023 ","pages":"9075184"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192742","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":"Long-Term Suitability of Left Gastric Artery Inflow for Arterial Perfusion of Living Donor Right Lobe Grafts.","authors":"Judyta A Lipinska,&nbsp;Johnny Wang,&nbsp;Joseph N Carey,&nbsp;Aaron A Ahearn,&nbsp;Yuri S Genyk","doi":"10.1155/2022/9421648","DOIUrl":"10.1155/2022/9421648","url":null,"abstract":"<p><p>Poorer than expected, living donor liver transplant outcomes are observed after recipient graft artery thrombosis. At grafting, the risk for later thrombosis is high if a dissected hepatic artery is used for standard reconstruction. Surgeon diagnosis of dissection requires nonstandard management with alternative technique in addition to microvascular expertise. Intimal flap repair with standard reconstruction is contingent on basis of a redo anastomosis. It is a suboptimal choice for living donor transplantation. Achieving goal graft arterial perfusion at first revascularization is crucial for superior outcomes. Managing dissection at grafting with nonstandard left gastric artery reconstruction is unreported. Our experience is limited, but this is our preferred alternative technique to standard hepatic artery reconstruction complicated by dissection. Here, we describe our two-case experience with left gastric arterialized grafts for management of dissection. Our living donor graft recipients with alternatively arterialized grafts are now 6- and 2-years posttransplant.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":"2022 ","pages":"9421648"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10393402","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":"Use of Cidofovir for Safe Transplantation in a Toddler with Acute Liver Failure and Adenovirus Viremia.","authors":"Vikram J Christian,&nbsp;Raiya Sarwar,&nbsp;Joseph C Resch,&nbsp;Sarah Lim,&nbsp;Arif Somani,&nbsp;Catherine Larson-Nath,&nbsp;Shane McAllister,&nbsp;Beth K Thielen,&nbsp;Oyedele Adeyi,&nbsp;Srinath Chinnakotla,&nbsp;Heli Bhatt","doi":"10.1155/2022/9426175","DOIUrl":"https://doi.org/10.1155/2022/9426175","url":null,"abstract":"<p><strong>Background: </strong>Since October 2021, there have been more than 500 cases of severe hepatitis of unknown origin in children reported worldwide, including 180 cases in the U.S. The most frequently detected potential pathogen to date has been adenovirus, typically serotype 41. Adenovirus is known to cause a self-limited infection in the immunocompetent host. However, in immunosuppressed individuals, severe or disseminated infections may occur.</p><p><strong>Method: </strong>We present the case of a two-year-old female who presented with cholestatic hepatitis and acute liver failure (ALF). Work up for etiologies of ALF was significant for adenovirus viremia, but liver biopsy was consistently negative for the virus. The risk for severe adenoviral infection in the setting of anticipated immunosuppression prompted us to initiate cidofovir to decrease viral load prior to undergoing liver transplantation.</p><p><strong>Result: </strong>Our patient received a successful liver transplant, cleared the viremia after 5 doses of cidofovir, and continues to maintain allograft function without signs of infection at the time of this report, 5 months posttransplant.</p><p><strong>Conclusion: </strong>Recent reports of pediatric hepatitis cases may be associated with adenoviral infection although the exact relationship is unclear. There is the possibility of the ongoing SARS-CoV-2 environment, or other immunologic modifying factors. All patients presenting with hepatitis or acute liver failure should be screened for adenovirus and reported to state health departments. Cidofovir may be used to decrease viral load prior to liver transplantation, to decrease risk of severe adenoviral infection.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" ","pages":"9426175"},"PeriodicalIF":0.0,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40475865","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":"Disseminated Histoplasmosis, Pulmonary Tuberculosis, and Cytomegalovirus Disease in a Renal Transplant Recipient after Infection with SARS-CoV-2.","authors":"Carvallo-Venegas Mauricio,&nbsp;Fuentes-López Elsa Angélica,&nbsp;Andrade-Ortega Antonio de Jesús,&nbsp;Torres-Baranda José Rodrigo,&nbsp;Carrasco-Carrizosa Aldo,&nbsp;Cerrillos-Gutierrez José Ignacio,&nbsp;Andrade-Sierra Jorge","doi":"10.1155/2022/8042168","DOIUrl":"https://doi.org/10.1155/2022/8042168","url":null,"abstract":"<p><strong>Introduction: </strong>Infection with SARS-CoV-2 increases the risk of acute graft dysfunction (AGD) in renal transplant recipients (RTR), and the risk of concurrently presenting with opportunistic infections is also increased. There is no current consensus on the management of immunosuppression during SARS-CoV-2 infection in RTR. <i>Case Presentation</i>. A 35-year-old male RTR from a living related donor presented with SARS-CoV-2 infection (January 2021). Two months later, despite alterations to his immunosuppression regimen (tacrolimus (TAC) was reduced by 50%, and the mycophenolic acid (MMF) was suspended with the remission of symptoms), the patient presented with pulmonary tuberculosis, pneumonia due to respiratory syncytial virus (RSV), cytomegalovirus (CMV) pneumonitis, and histoplasmosis (HP). Management was initiated with antituberculosis medications, ganciclovir, antibiotics, and liposomal amphotericin B, and the immunosuppressants were suspended, yet the patient's evolution was catastrophic and the outcome fatal.</p><p><strong>Conclusion: </strong>We recommend that in RTR post-COVID-19, the immunosuppression regimen should be gradually reinstated along with strict vigilance in observing for highly prevalent coinfections (TB, HP, and CMV).</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" ","pages":"8042168"},"PeriodicalIF":0.0,"publicationDate":"2022-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449699","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 Orthostasis, Dizziness, and Non-O1, Non-O139 <i>Vibrio cholerae</i> Infection in a Lung Transplant Recipient.","authors":"Michael T Olson,&nbsp;Tejus Walia,&nbsp;Satish Chandrashekaran,&nbsp;Sreeja Biswas Roy,&nbsp;Ashwini Arjuna","doi":"10.1155/2022/9008372","DOIUrl":"https://doi.org/10.1155/2022/9008372","url":null,"abstract":"<p><p>Non-O1, non-O139 <i>Vibrio cholerae</i> are rare strains that are generally nonpathogenic in immunocompetent hosts. However, this pathogen has been shown to cause gastroenteritis, wound infections, or bacteremia in immunocompromised patients and is associated with significant mortality in these hosts. Herein, we describe a case of hemorrhagic enterocolitis in a lung transplant recipient with an atypical presentation of non-O1, non-O139 <i>V. cholerae</i> and ongoing orthostasis. The patient reported recent seafood consumption and was managed appropriately with antibiotic therapy before necessitating esophagogastroduodenoscopy (EGD) for further objective testing.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" ","pages":"9008372"},"PeriodicalIF":0.0,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40352275","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":"Postoperative and Recurrent Hematuria after Pretransplant Core Needle Biopsy in Living Donor Kidney Transplant.","authors":"Yazan Al-Adwan,&nbsp;Navdeep Singh,&nbsp;Pranit N Chotai,&nbsp;Farjad Siddiqui,&nbsp;Ashley Limkemann,&nbsp;Austin Schenk,&nbsp;Jayanthan Subramanian,&nbsp;W Kenneth Washburn,&nbsp;Musab Alebrahim,&nbsp;Amer Rajab","doi":"10.1155/2022/5274521","DOIUrl":"https://doi.org/10.1155/2022/5274521","url":null,"abstract":"<p><strong>Background: </strong>Core needle and wedge biopsies are the two main pathologic ways to determine the suitability of a kidney allograft and to have a baseline allograft biopsy in case of future rejection. <i>Case Presentation</i>. A 57-year-old patient developed a renal arteriovenous fistula causing postoperative and recurrent hematuria after allograft pretransplant renal core needle biopsy and treated with selective Interventional radiology coil embolization.</p><p><strong>Conclusion: </strong>Delayed profound hematuria can be seen after pretransplant core needle renal biopsies and can recur again even after complete resolution, due to arteriovenous fistula formation in the renal calyceal system.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" ","pages":"5274521"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9352472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40677692","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":"Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants.","authors":"Yazan Al-Adwan,&nbsp;Navdeep Singh,&nbsp;Amer Rajab,&nbsp;Musab Alebrahim,&nbsp;Jayanthan Subramanian,&nbsp;W Kenneth Washburn,&nbsp;Farjad Siddiqui,&nbsp;Ashley Limkenmann,&nbsp;Pranit N Chotai,&nbsp;Austin Schenk","doi":"10.1155/2022/3823066","DOIUrl":"https://doi.org/10.1155/2022/3823066","url":null,"abstract":"<p><strong>Background: </strong>Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is sometimes necessary to use the aorta and vena cava for implantation. Gaining safe exposure in these cases can be complicated by history of prior laparotomy, adhesive disease, and other surgical histories. <i>Case Presentation</i>. A 58-year-old female with type 1 diabetes and end-stage renal disease presented for surgical evaluation for kidney transplant. Surgical history was notable for prior simultaneous kidney-pancreas transplant followed by both a living donor kidney transplant and a pancreas after kidney transplant. She had undergone both an allograft nephrectomy and an allograft pancreatectomy and currently had a nonfunctioning kidney in the left retroperitoneal position and a nonfunctioning pancreatic allograft on the right common iliac artery. The entire distal aortoiliac system was surgically inaccessible. She was listed for transplantation, and a cadaveric graft was allocated. Intraoperatively, severe lower abdominal and pelvic adhesions prevented any use of the iliac system. A left native nephrectomy was performed, and the allograft was implanted in the left orthotopic position. The native left renal vein was used for outflow, the donor renal artery was joined end-to-side to the infrarenal aorta, and a uretero-ureterostomy was created. The operation was uneventful. The allograft functioned without delay, and almost one year later, the GFR is approximately 50 mg/dL.</p><p><strong>Conclusion: </strong>The left orthotopic position can be a good choice for kidney transplant candidates with histories of prior complex lower abdominal surgery.</p>","PeriodicalId":30327,"journal":{"name":"Case Reports in Transplantation","volume":" ","pages":"3823066"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40604802","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}