فهرست مطالب
International Journal of Organ Transplantation Medicine
Volume:10 Issue: 1, Winter 2019
- تاریخ انتشار: 1398/02/01
- تعداد عناوین: 5
-
-
Pages 1-12BackgroundDespite a reduction in the incidence of cytomegalovirus (CMV) infections after kidney transplantation, less is known about late CMV infection in kidney transplant recipients.ObjectiveTo assess incidence of CMV infection in a cohort of patients under a high surveillance CMV prevention protocol and identify factors associated with late CMV infection.MethodsAnalysis of a consecutive cohort of 181 kidney allograft recipients between January 2012 and Aug 2015. CMV prevention-protocol consisted of 6-month universal prophylaxis and pre-emptive therapy for high-risk group (D+/R– or patients submitted to lymphocyte-depleting agent for induction or rejection treatment) and pre-emptive therapy for standard-risk group (D±/R+). Stopping valganciclovir was followed by CMV screening in the next two appointments.ResultsCMV infection was identified in 73 of 181 patients; the rate in high-risk group and standard-risk group was similar (p=0.443). However, in the latter group, the infection occurred mostly in the first 6 months. Late CMV infection occurred in 25 of 181 patients (5 of standard-risk group and 20 of high-risk group), after a median (IQR) of 253 (230.3–312.3) days after transplantation and 55 (41–89.5) days after the protocol period. Screening for CMV after valganciclovir discontinuation revealed 56% of late CMV infections. In high-risk group, D+/R– was associated with late CMV infection (HR 2.7, p=0.039) and in standard-risk group; lower age was associated with late CMV infection (HR 0.89, p=0.02).ConclusionThe incidence of CMV infection was similar to that reported in the literature. In high-risk patients, antigenemia surveillance during prophylaxis did not appear to reduce late CMV infections. Antigenemia screening after valganciclovir had limited results in the diagnosis of late CMV infection. D+/R– was associated to late CMV infection in high-risk group. Lower age appeared to influence late CMV infection in standard-risk group.Keywords: Late cytomegalovirus infection, Renal transplantation, Risk factor
-
Pages 15-29BackgroundThere is no consistent association between individual histological lesions and composite scores in donor kidney biopsy and transplant outcomes.ObjectiveTo evaluate which acute or chronic individual histological lesions and composite scores in donor kidney were associated with graft survival in the recipient.MethodsWe investigated the association of individual histological lesions and 8 composite scoring systems in implantation biopsies of cadaveric (n=101) and living (n=29) kidneys with 5-year death-censored graft survival.ResultsWe found a high frequency of chronic lesions in donor kidneys, mostly associated with arteriosclerosis, and less dependent from donor age. Acute, chronic, and total Banff scores for post-transplant biopsies, chronic and total Banff scores for pre-implant biopsies, donor damage score and chronic damage score predicted death-censored graft loss. However, only chronic and total Banff-scores had significant effects in multivariate model. Chronic pre-implant and total post-transplant Banff scores demonstrated the highest area under the curve (AUC) of 0.722 and 0.717, respectively. Among individual lesions, glomerulosclerosis ≥20%, interstitial inflammation >0, arteriosclerosis =3, arteriolar hyalinosis >0, and interstitial fibrosis >0, assessed with Banff-grading criteria, were associated with lower allograft survival. We created the Donor Kidney Damage Index (DKDI), by summing regression coefficients for these lesions, which yielded the AUC of 0.747. When combined with retransplantation, cold ischemia time and acute rejection, DKDI, chronic pre-implant and total post-transplant Banff scores further improved their predictive accuracy, yielding AUCs of 0.842, 0.807, and 0.802, respectively.ConclusionDKDI, chronic pre-implant and total post-transplant Banff scores alone and combined with clinical variables may facilitate decision making in post-transplant period.Keywords: Implantation biopsy histology, Individual, composite histological scores, Kidney allograft survival
-
Pages 30-35Background13%–43% of liver transplant (LT) recipients experience severe neurologic events with increased morbidity and mortality.ObjectiveTo evaluate the incidence of neurological complications after LT in pediatric patients in Namazi Hospital.MethodsThe medical records of 101 children aged between 1 and 18 years who underwent LT between May 2016 and May 2017 at Namazi Hospital were reviewed. Demographic data, the occurrence of neurological complications, and preoperative variables that may predict the complications and outcomes were evaluated. The mean±SD follow-up duration was 10.1±1.9 months.ResultsThe mean±SD age of patients at the time of LT was 8.2±5.3 years; 51.5% were male. The most common cause of LT was biliary atresia (16.8%), progressive familial intrahepatic cholestasis (16.8%), and Wilson’s disease (13.9%). The mean±SD PELD score was 18.2±1.1. After 1-year follow-up 74 73.3% patients were alive. 16 (15.8%) patients developed convulsion (2 had encephalopathy). 3 (3.0%) patients had signs of peripheral neuropathy, 3 (3.0%) complained from headache, and 1 developed dystonia.ConclusionCompared to other centers, neurological complications were less common in our center. The major neurological manifestation after LT was convulsion. There was no correlation between age, sex and the underlying disease and development of neurological complications.Keywords: Neurological complication, Pediatric, Liver transplant
-
Pages 37-45BackgroundCytokines are important factors determining the outcome of transplantation. The host ability in cytokine production may be affected by cytokine genes polymorphisms.ObjectiveTo investigate the effect of IL-12 and TNF-α gene polymorphisms on outcome of hematopoietic stem cell transplantation.Methods90 bone marrow transplant recipients were included in this study. 30 (33%) of 90 recipients experienced graft-versus-host disease (GVHD). IL-12 and TNF-α gene polymorphisms were evaluated by PCR-RFLP and ARMS-PCR method, respectively.ResultsNo significant difference in the distribution of IL-12 (rs3212227 +1188 A/C) and TNF-α (rs 1800629 -308 G/A) genotypes and alleles was observed between those with and without GVHD. There was no significant association between the distribution of genotypes and the recipient sex.ConclusionIL-12 (rs3212227 +1188 A/C) and TNF-α (rs 1800629-308 G/A) genotypes and alleles were not risk factors for development of GVHD.Keywords: Interleukin 12, TNF-α, Hematopoietic stem cell transplantation, Graft-versus-host disease, Polymorphism
-
Pages 46-50Candida infections are common diseases in immunocompromised patients. A 19-year-old boy with liver transplantation, necrotic skin lesion, jaundice, dyspnea, and ascites was admitted to Namazi Hospital, Shiraz, southern Iran. The mycological examination for the skin lesion was requested. The skin sample was cultured on Sabouraud dextrose agar and evaluated by direct microscopic smear. Identification of isolated yeast was performed with RFLP-PCR. In direct smear, pseudohyphae, blastopores and yeasts were observed. Candida species was isolated from the media and identified as Candida albicans by molecular method. He died before starting any treatments. A skin lesion may present as the only sign of a systemic fungal infection in immunocompromised people. Careful attention and follow up are therefore recommended.Keywords: Candida albicans, Liver transplantation, Fungal infection