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Case Reports in Transplantation

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https://www.readbyqxmd.com/read/28620559/ivig-associated-aseptic-meningitis-in-a-renal-transplant-patient
#1
Tamara Wanigasekera, Rachel J Grainger, Donal J Sexton, Colm Magee
The management of antibody-mediated rejection in renal transplant recipients involves plasmapheresis with IVIG. Aseptic meningitis is a rare adverse effect of IVIG therapy and is a diagnosis of exclusion. We report a case of a renal transplant patient who developed IVIG associated aseptic meningitis in the context of management of antibody-mediated rejection, four years after transplantation.
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28480091/duodenal-graft-perforation-after-simultaneous-pancreas-kidney-transplantation
#2
Akihito Sannomiya, Ichiro Nakajima, Yuichi Ogawa, Kotaro Kai, Ichiro Koyama, Shohei Fuchinoue
A 45-year-old woman with type 1 diabetes and chronic renal failure on dialysis underwent simultaneous pancreas-kidney transplantation from a brain dead donor. On postoperative day 15, acute generalized peritonitis was diagnosed and emergency laparotomy was performed. Perforation of the donor duodenum was found, which had apparently resulted from duodenal compression by the tip of the intestinal fistula tube placed for decompression. The perforation was sutured and the intestinal fistula tube was exchanged. Following this, perforation repeatedly recurred at the same site and open repair at laparotomy was required a total of four times...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28386509/successful-treatment-of-recurrent-pulmonary-mucormycosis-in-a-renal-transplant-patient-a-case-report-and-literature-review
#3
Morgan S Martin, Alison A Smith, Monica Lobo, Anil S Paramesh
Background. We describe the unusual case of a recently transplanted cadaveric renal transplant recipient who presented with recurrent pulmonary mucormycosis. Case Report. An 18-year-old man with end stage renal disease secondary to congenital renal agenesis status after cadaveric kidney transplant 4 months before presented with acute onset of fever, hemoptysis, and back pain. The patient underwent an emergent left lower lobectomy due to the critical nature of his illness. He was also treated with amphotericin with resolution of his symptoms...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28367350/immune-reconstitution-inflammatory-syndrome-occurring-in-a-kidney-transplant-patient-with-extrapulmonary-tuberculosis
#4
Jose Iglesias, Kandria Jumil Ledesma, Paul J Couto, Jessie Liu
Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28348914/brincidofovir-use-after-foscarnet-crystal-nephropathy-in-a-kidney-transplant-recipient-with-multiresistant-cytomegalovirus-infection
#5
Romain Vial, Christine Zandotti, Sophie Alain, Alexandre Decourt, Noémie Jourde-Chiche, Raj Purgus, Charleric Bornet, Laurent Daniel, Valérie Moal, Tristan Legris
Background. Cytomegalovirus (CMV) antiviral drug resistance constitutes an increasing challenge in transplantation. Foscarnet is usually proposed when resistance for ganciclovir is suspected, but its use is limited by its nephrotoxicity. Case Presentation. We report a case of multiresistant CMV disease in a kidney transplant recipient. Foscarnet was prescribed after ganciclovir treatment failure in a patient with two mutations in the UL97 viral gene. Foscarnet induced biopsy-proven kidney crystal precipitation that resulted in severe acute transplant failure and nephrotic syndrome...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28168079/successful-treatment-of-plasma-cell-rich-acute-rejection-using-pulse-steroid-therapy-alone-a-case-report
#6
Yo Komatsuzaki, Yasuyuki Nakada, Izumi Yamamoto, Mayuko Kawabe, Takafumi Yamakawa, Ai Katsuma, Haruki Katsumata, Aki Mafune, Akimitsu Kobayashi, Yusuke Koike, Hiroki Yamada, Jun Miki, Yudo Tanno, Ichiro Ohkido, Nobuo Tsuboi, Keitaro Yokoyama, Hiroyasu Yamamoto, Takashi Yokoo
Despite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months after kidney transplantation, with a stable serum creatinine level of 1.6 mg/dL. Histological examination showed focal aggressive tubulointerstitial inflammatory cell infiltration of predominantly polyclonal mature plasma cells, leading to our diagnosis of PCAR...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28163950/tacrolimus-toxicity-due-to-biliary-obstruction-in-a-combined-kidney-and-liver-transplant-recipient
#7
Samuel Chan, Michael T Burke, David W Johnson, Ross S Francis, David W Mudge
The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-year-old combined liver and kidney transplant recipient, who developed acute biliary obstruction leading to tacrolimus toxicity with very high blood tacrolimus levels. Despite a careful evaluation, no alternative cause was found for her acute kidney injury, and her kidney function returned to previous baseline within several days following treatment of the biliary obstruction and temporary withdrawal of tacrolimus...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28097036/urinary-obstruction-of-transplanted-kidney-caused-by-uterine-adenomyosis-and-2-year-posthysterectomy-psoas-abscess-in-conjunction-with-transplanted-kidney
#8
Yuta Takezawa, Yoshifumi Kadono, Takahiro Nohara, Atsushi Mizokami
Urinary obstruction of the transplanted kidney caused by uterine leiomyoma is an extremely rare condition. To the best of our knowledge, there are only two reports in English literature. Psoas abscess secondary to renal graft pyelonephritis is also uncommon. We present this unusual case and its treatment course. A 43-year-old female presented with renal dysfunction. She was started on peritoneal dialysis from the age of 26 years and received kidney transplantation from her mother (living donor) at the age of 27 years...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28070442/emergent-management-of-intracardiac-thrombosis-during-liver-transplantation
#9
Caroline Protin, Dmitri Bezinover, Zakiyah Kadry, Thomas Verbeek
Intraoperative thromboembolism is a well-documented complication associated with orthotopic liver transplantation (OLT) but its identification and intraoperative treatment are still an emerging topic in anesthesia. Intracardiac thrombus during OLT is associated with a high mortality rate. There are only a few reports describing the successful management of thromboembolism during OLT. We describe a case where routine intraoperative transesophageal echocardiography during a live donor liver transplantation enabled early detection of an intracardiac thrombus with subsequent successful heparin treatment...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28070441/scedosporiosis-in-a-combined-kidney-and-liver-transplant-recipient-a-case-report-of-possible-transmission-from-a-near-drowning-donor
#10
Rachael Leek, Erika Aldag, Iram Nadeem, Vikraman Gunabushanam, Ajay Sahajpal, David J Kramer, Thomas J Walsh
Scedosporium spp. are saprobic fungi that cause serious infections in immunocompromised hosts and in near-drowning victims. Solid organ transplant recipients are at increased risk of scedosporiosis as they require aggressive immunosuppression to prevent allograft rejection. We present a case of disseminated Scedosporium apiospermum infection occurring in the recipient of a combined kidney and liver transplantation whose organs were donated by a near-drowning victim and review the literature of scedosporiosis in solid organ transplantation...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28018703/successful-stem-cell-transplantation-in-a-patient-with-pretransplant-hepatic-inflammatory-pseudotumour
#11
Sanjay de Mel, Zarni Soe, Benjamin Wong, Ching Ching Ong, Lynette Teo, Lip Kun Tan
Inflammatory pseudotumours (IPT) are rare benign neoplasms of unknown aetiology. We present a case of hepatic IPT which was incidentally discovered in a patient with relapsed B-acute lymphoblastic leukaemia (B-ALL) undergoing pretransplant workup. After investigation to exclude an infective cause she underwent a reduced intensity conditioning stem cell transplant (SCT) successfully and currently remains well and in remission. On repeat liver MRI after SCT, the IPT was seen to be resolving. To the best of our knowledge this is the first report of an adult patient with hepatic IPT successfully undergoing SCT...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27980873/st-elevation-infarction-after-heart-transplantation-induced-by-coronary-spasms-and-mural-thrombus-detected-by-optical-coherence-tomography
#12
Tor Skibsted Clemmensen, Niels Ramsing Holm, Hans Eiskjær, Steen Hvitfeldt Poulsen, Michael Maeng, Christian Juhl Terkelsen, Evald Høj Christiansen
The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27891288/massive-ascites-in-a-renal-transplant-patient-after-laparoscopic-fenestration-of-a-lymphocele
#13
Shohei Kawaguchi, Takahiro Nohara, Takashi Shima, Satoko Matsuyama, Chikako Nose, Junya Yamahana, Yoshifumi Kadono, Chikashi Seto, Masahiko Kawabata, Atsushi Mizokami
Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27822401/fatal-donor-derived-carbapenem-resistant-klebsiella-pneumoniae-infection-in-a-combined-kidney-pancreas-transplantation
#14
Giovanni Varotti, Ferdinando Dodi, Anna Marchese, Alessia Terulla, Massimo Bertocchi, Iris Fontana
Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant recipients are associated with high morbidity and mortality. We report a case of a fatal donor-derived CR-KP infection in a combined kidney-pancreas transplant. Given the short interval of time between donor hospitalization and organ procurement, information concerning the donor CR-KP positivity arrived only 72 hours after transplant. Based on this experience, we believe that knowledge of the donor's CR-KP status should be mandatory before procurement and, if positive, pancreas donation should be contraindicated...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27800206/immune-complex-mediated-glomerulonephritis-with-acute-thrombotic-microangiopathy-following-newly-detected-hepatitis-b-virus-infection-in-a-kidney-transplant-recipient
#15
Tracey Salter, Hannah Burton, Sam Douthwaite, William Newsholme, Catherine Horsfield, Rachel Hilton
Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27703835/strongyloides-hyperinfection-syndrome-combined-with-cytomegalovirus-infection
#16
Fatehi Elnour Elzein, Mohammed Alsaeed, Sulafa Ballool, Ashraf Attia
The mortality in Strongyloides hyperinfection syndrome (SHS) is alarmingly high. This is particularly common in bone marrow, renal, and other solid organ transplant (SOT) patients, where figures may reach up to 50-85%. Immunosuppressives, principally corticosteroids, are the primary triggering factor. In general, the clinical features of Strongyloides stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and starting appropriate therapy. Although recurrent Gram-negative sepsis and meningitis have been previously reported, the combination of both cytomegalovirus (CMV) and strongyloidiasis had rarely been associated...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27595035/high-on-cannabis-and-calcineurin-inhibitors-a-word-of-warning-in-an-era-of-legalized-marijuana
#17
Naomi Hauser, Tanmay Sahai, Rocco Richards, Todd Roberts
Tacrolimus, a potent immunosuppressant medication, acts by inhibiting calcineurin, which eventually leads to inhibition of T-cell activation. The drug is commonly used to prevent graft rejection in solid organ transplant and graft-versus-host disease in hematopoietic stem cell transplant patients. Tacrolimus has a narrow therapeutic index with variable oral bioavailability and metabolism via cytochrome P-450 3A enzyme. Toxicity can occur from overdosing or from drug-drug interactions with the simultaneous administration of cytochrome P-450 3A inhibitors and possibly P-glycoprotein inhibitors...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27579209/preserved-renal-function-in-kidney-transplantation-over-a-thrombosed-aortobifemoral-bypass-graft-the-role-of-retrograde-flow-and-early-thrombolysis
#18
Saúl Pampa-Saico, Sara Jiménez-Alvaro, Fernando Caravaca-Fontán, Ana Fernández-Rodríguez, Maite Rivera-Gorrín, Juan Sánchez, Antonio Chinchilla, Roberto Marcén
Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27478676/eculizumab-for-the-treatment-of-severe-antibody-mediated-rejection-a-case-report-and-review-of-the-literature
#19
Duy Tran, Anne Boucher, Suzon Collette, Alexis Payette, Virginie Royal, Lynne Senécal
In renal transplantation, treatment options for antibody-mediated rejection are limited. Here, we report a case of severe AMR treated with eculizumab. A 50-year-old woman known for end stage kidney disease secondary to IgA nephropathy received a kidney transplant from a 50-year-old deceased donor. At 5 months after transplantation, she presented with acute graft dysfunction and biopsy showed a severe antibody-mediated rejection associated with thrombotic microangiopathy. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted and the patient was treated with 3 doses of eculizumab...
2016: Case Reports in Transplantation
https://www.readbyqxmd.com/read/27340588/rapid-resolution-of-cholangitic-abscess-and-biliary-sepsis-in-a-liver-transplant-recipient-after-hepatic-artery-revascularization
#20
Sushrut Trakroo, Kamran Qureshi
Hepatic arterial flow is paramount in preserving biliary integrity. We present an interesting clinical scenario of a liver transplant recipient with biliary anastomotic stricture who developed biliary abscess and sepsis after Endoscopic Retrograde Cholangiopancreatography. The abscess did not respond to maximal medical management, percutaneous drainage, and adequate endoscopic biliary drainage. Clinically, patient continued to deteriorate and imaging identified hepatic artery stenosis which was treated with percutaneous intra-arterial stenting...
2016: Case Reports in Transplantation
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