Prophylactic

Background: Contrasting results have emerged from limited studies investigating the role of prophylactic surgical drainage in preventing wound morbidity after liver and kidney transplantation. This retrospective study analyzes the use of surgical drain and the incidence of wound complications in combined liver and kidney transplantation. Methods: A total of 55 patients aged >18 years were divided into two groups: the drain group (D) (n= 35) and the drain-free group (DF) (n= 20). Discretion to place a drain was based exclusively on surgeon preference. The primary outcome was the development of superficial/deep wound complications during the study follow-up. Secondary outcomes included the development of delayed graft function (DGF) of the transplanted kidney, primary non function (PNF) and early allograft dysfunction (EAD) of the transplanted liver, graft failure, graft and patient survival, overall postoperative morbidity rate and length of hospital stay. Results: With a median follow-up of 14.4 months after transplant, no difference in the incidence of superficial/deep wound complications, except for hematomas, in collections size, intervention rate, PNF, EAD, graft failure and patient survival, was observed between the 2 groups. Significantly lower level of platelets, higher INR values, length of hospital stay, DGF and morbidity rates were reported postoperatively in the D group. Preoperative hypoalbuminemia and longer CIT were included in the propensity score for receiving a drain and were associated with a significantly higher rate of developing a hematoma post-transplant. Conclusions: Absence of the surgical drain did not appear to adversely affect wound morbidity compared to the prophylactic use of drains in renal transplant patients during CLKTx.


Background:
In Japan, where very few deceased donor kidney transplants are performed, approximately 30% of living donor kidney transplants are ABOincompatible.In these patients, pre-transplant antibody removal by apheresis is generally performed in addition to immunosuppressive therapy.Clinical problems include side effects such as allergic reactions, which are known to frequently occur in conventional plasma exchange (PEx) using fresh frozen plasma (FFP).In this study, we performed PEx using 5% albumin as the replacement fluid in the first half of the procedure followed by FFP.
Methods: PEx starting with albumin replacement fluid was performed in ABOincompatible kidney transplant recipients (5 patients; 22 sessions).Of the total replacement volume (1.5 plasma volume), 5% albumin was used in the first half, and FFP in the latter half.The incidence of side effects was compared with that of recipients who underwent conventional PEx using FFP (18 patients; 39 sessions).We also studied the changes in coagulation factors before and after PEx using albumin.
Results: The incidence of side effects was significantly higher in recipients who underwent PEx using only FFP (29/39 sessions; 74.4%) compared to that of recipients who underwent PEx using albumin (6/22 sessions; 27.3%) (p<0.001).Among recipients who underwent PEx using albumin, there were only two sessions in which the patient had side effects including skin rash, redness, and itching, which were frequently observed in recipients who underwent PEx using FFP.The median [IQR] of fibrinogen and factor XIII removal rate was 31.6 [27.5, 42.5] and 31.0 [18.0, 44.4] %.
Conclusions: Recently, it has been reported that type AB soluble ABO substances (SAS) neutralizes ABO antibodies.In conventional PEx using FFP, antigen-antibody reaction of SAS and ABO antibodies is thought to induce allergic reactions.Our results suggested that there were fewer allergic reactions in recipients who underwent PEx starting with albumin replacement fluid, because ABO antibodies were removed by albumin first, making it difficult for SAS contained in FFP to react with ABO antibodies.In addition, because there was a slight decrease in the amount of coagulation factors using this method, studies should be made to determine the optimal ratio of albumin to use as the replacement fluid.Methods: We searched all adult kidney transplant biopsy reports between January 2010 and May 2021.We excluded biopsies performed on a non-functioning transplant kidney and with a concurrent acute rejection or glomerulonephritis diagnosis.We identified 13 patients with nephrocalcinosis as a principle histological diagnosis.
Results: Patient characteristics and laboratory findings are shown in Table 1.Mean age was 49±13 years, 69.2% were male and 53.8% Caucasian.Time from transplant to biopsy was 15±18 months.Post-transplant nadir creatinine was 1.25±0.55mg/dL.Creatinine at the time of biopsy was 1.9±0.72 mg/dL.Creatinine measured at mean of 28 months post-biopsy was 1.89±0.61mg/dL.Pre-and post-transplant parathyroid hormone levels were 1516±1192 and 264±190 pg/mL respectively.4 patients underwent posttransplant parathyroidectomy for a parathyroid adenoma in all cases.7 and 9 patients were prescribed cinacalcet pre-and post-transplant respectively.Hypocitraturia was found in all 5 patients with available urine studies.
Conclusions: Long dialysis vintage, markedly elevated pre-transplant parathyroid hormone level, and cinacalcet use were common in patients with post-transplant nephrocalcinosis.Further study is required to identify risk factors and treatments for posttransplant nephrocalcinosis.
Funding: Other NIH Support -National Institute of Allergy and Infectious Diseases, Grant/Award Number 1R25Al147369-01  Introduction: Adenovirus infection is associated with AKI (hemorrhagic cystitis, tubulointerstitial nephritis, or obstructive uropathy), fevers, and non-glomerular hematuria.Severe adenovirus infections are rare in solid organ transplants, manifesting within the first year of transplant.In this case, we report fever, AKI, and hematuria one year post kidney transplant due to co-infection of Clostridium difficile and adenovirus.
Case Description: 65 yo male status post deceased donor kidney transplant one year prior presented with five days of diarrhea and fever.Blood work revealed an acute kidney injury (AKI) from a baseline serum creatinine of 1.5 mg/dL to 2.3 mg/dL.He was found to be Clostridium dificile toxin positive and started on PO vancomycin and IV fluid.On hospital day 4, he began having high grade fevers to 40C, worsening creatinine to 5.9 mg/dL, and gross hematuria despite resolution of diarrhea.Urine microscopy revealed non dysmorphic red blood cells.Adenovirus blood and urine PCR returned positive >1 million copies/mL.Remainder of workup was negative.Biopsy was unable to be performed due to persistent bowel overlying the kidney.Tacrolimus was reduced to target a range of 4-7 ng/mL, mycophenolate was discontinued, prednisone was increased to 20 mg.
Nephrocalcinosis: A Single-Center Case Series Aileen Wang, Vivek Charu, Colin R. Lenihan.Stanford University School of Medicine, Stanford, CA.Background: Nephrocalcinosis is characterized by multifocal renal tubular and interstitial calcifications.Few studies describe the correlates and outcomes of posttransplant nephrocalcinosis.The goal of this study was to describe the characteristics of patients with nephrocalcinosis diagnosed on kidney transplant biopsy at our center.
difficile Coinfection in a Kidney Transplant Recipient Katherine Rizzolo, Scott Davis.University of Colorado, Denver, CO.