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1.
Immune Reconstitution Inflammatory Syndrome Secondary to Mycobacterium kansasii Infection in a Kidney Transplant Recipient 下载免费PDF全文
M. Lemoine C. Laurent M. Hanoy J. Leporrier A. François D. Guerrot M. Godin D. Bertrand 《American journal of transplantation》2015,15(12):3255-3258
Nontuberculous mycobacteria (NTM) infection is a challenging diagnosis for clinicians in solid organ transplantation. Immune reconstitution inflammatory syndrome (IRIS) is so far unreported in this context. We report here the case of a renal transplant recipient who developed Mycobacterium kansasii–associated lymphadenitis complicated by IRIS while undergoing reduction of his immunosuppressive therapy. For IRIS, the patient required low‐dose steroids and an increase in global immunosuppression, in association with NTM antibiotherapy. 相似文献
2.
M. Maccario Antonio Tarantino Eduardo Nobile-Orazio Claudio Ponticelli 《Transplant international》1998,11(6):439-442
In patients who have not undergone transplantation, Guillain-Barré syndrome (GBS) is typically preceded by an acute infection
often sustained by Campylobacter jejuni. Thus far, in renal transplant recipients, only eight cases of GBS have been reported. In seven patients GBS was attributed
to cytomegalovirus infection and in the eighth patient to cyclosporin A neurotoxicity. We report here the case of a GBS in
a renal transplant recipient following C. jejuni bacteremia. The infection quickly disappeared after erythromycin and methronidazole therapy. GBS progressively evolved into
a paraparesis within 1 week. After reaching a plateau phase, the clinical status improved and the patient was able to walk
unassisted after 3 weeks. At his last check-up, 54 months later, the patient was doing well with a functioning graft and only
minimal weakness of the lower limbs.
Received: 17 February 1998 Received after revision: 7 July 1998 Accepted: 8 July 1998 相似文献
3.
G. Montagnino Antonio Tarantino Bruno Cesana Giuseppe Rossini Isabella Da Milano Adriana Arodi Attilio Elli Claudio Ponticelli 《Transplant international》1997,10(4):268-275
A total of 632 cyclosporin (CyA)-treated primary renal allograft recipients with a functioning graft at 6 months were retrospectively
evaluated for risk factors correlated with long-term allograft function. Mean follow-up after the 6th month was 68.4 ± 40.6
months. One hundred twenty-one of these patients (19 %) were lost: 29 died (23/29 with a functioning graft), 77 of the remaining
92 (83 %) lost their graft because of chronic allograft dysfunction, 9 due to recurrence of glomerulonephritis, 5 due to renal
artery thrombosis, and 1 due to chronic CyA toxicity. At univariate analysis, factors correlated with a better renal (R) and
pure renal (PR) allograft survival were: dialysis duration of less than 5 years, fewer than 2 rejections within the 6th post-Tx
month, immediate graft function recovery, plasma creatinine below 1.5 mg/dl at the 6th month, age at Tx above 15 years, and
receiving a living donor graft. Cox's regression analysis was also performed to obtain relative risks for the same parameters.
Long-term dialysis patients had more frequent late recoveries (P = 0.002) and reductions in therapy (P = 0.01) in order to reduce the side effects of steroids. In young patients receiving an initial oral CyA dose of 17 mg/kg
per day, steroids were stopped at the 6th month in order to achieve catch-up growth: only one such patient lost his graft.
In contrast, 72 % of the young patients who lost their grafts received an initial oral CyA dosage of 13 mg/kg per day. Thus,
young patients did worse not because of steroid withdrawal, but because of inadequate initial CyA dosage. These results suggest
that although we cannot exclude alloantigen-independent mechanisms as factors that stimulate progression of chronic allograft
dysfunction, it would appear that the initial lesions are induced by events mostly mediated by immunological mechanisms.
Received: 28 January 1997 Received after revision: 4 April 1997 Accepted: 8 April 1997 相似文献
4.
Incidence,characteristics, and treatment outcomes of mycobacterial diseases in transplant recipients 下载免费PDF全文
Jung‐Wan Yoo Kyung‐Wook Jo Sung‐Han Kim Sang‐Oh Lee Jae Joong Kim Su‐Kil Park Je‐Hwan Lee Duck Jong Han Shin Hwang SeungGyu Lee Tae Sun Shim 《Transplant international》2016,29(5):549-558
The incidence, clinical characteristics, and treatment outcomes of tuberculosis (TB) and nontuberculous mycobacterial (NTM) disease developed after transplantation (TPL) in transplant recipients were investigated retrospectively. Between 1996 and 2013, 7342 solid‐organ transplantation and 1266 hematopoietic stem cell transplantation were performed at a tertiary referral center in South Korea. Among them, TB and NTM disease developed in 130 and 22 patients, respectively. The overall incidence of TB was 257.4 cases/100 000 patient‐years (95% confidence interval [CI], 215.1–305.7) and that of NTM disease was 42.7 cases/100 000 patient‐years (95% CI, 26.8–64.7). The median interval from organ TPL to the development of mycobacterial disease was 8.5 months (95% CI, 6.3–11.4) in recipients with TB patients and 24.2 months (95% CI, 13.5–55.7) in those with NTM, respectively. Among NTM patients, Mycobacterium avium–intracellulare complex was the most common causative organism, and nodular bronchiectatic type (77.8%) was the most frequent radiologic feature. Favorable treatment outcome was achieved in 83.7% (95% CI, 76.4–89.1) and 68.8% (95% CI, 44.4–85.8) of TB and NTM patients, respectively (P = 0.166). In conclusion, the overall incidence of TB was higher than that of NTM disease in transplant recipients and treatment outcomes were favorable in both drug‐susceptible TB and NTM patients. 相似文献
5.
J.-P. Cosyns Jacques Malaise Geneviève Hanique Michel Mourad Alessandra Baldi Rose-Marie Goebbels Jean-Paul Squifflet 《Transplant international》1998,11(1):22-27
The aim of this study was to assess the influence of kidney-donor transmitted pathology on graft function. Light and immunofluorescent
microscopic findings from a surgical biopsy taken prior to transplantation from 114 cadaveric kidney donors were analyzed.
Moderate to severe mesangial IgA deposits were considered consistent with IgA nephropathy. Pathological abnormalities were
correlated together with donor age, number of mismatches, and type of immunosuppression by multivariate statistical analysis
with the serum creatinine values from patients who experienced no acute rejection at 1 year. Serum creatinine values (n = 52) were not correlated with either nonspecific light microscopic lesions or immunofluorescent deposits found in the majority
of kidney donors or with changes consistent with IgA nephropathy observed in 9 % of the cases. There was, however, a correlation
with donor age, which was also correlated with the extent of chronic lesions (P < 0.001).
Received: 5 March 1997 Received after revision: 8 July 1997 Accepted: 21 August 1997 相似文献
6.
E. F. de Maar A. M. Kas-Deelen T. W. van der Mark T. H. The A. M. Tegzess R. J. Ploeg W. J. van Son 《Transplant international》1999,12(1):56-62
In addition to life-threatening pneumonia, cytomegalovirus (CMV) may also cause subclinical pulmonary dysfunction after kidney
transplantation. To investigate the role of plugging of cytomegalic endothelial cells in the pulmonary capillary bed, we prospectively
determined specific carbon monoxide diffusion capacity (KCOc) and its components: the pulmonary diffusing membrane factor
(Dm) and pulmonary capillary blood volume (Vcap) before and during CMV infection in 13 kidney transplant recipients and 13
controls. During CMV infection, mean KCOc decreased significantly by 28 % of the initial value (mean KCOc 79 vs 109; P < 0.005 ) due to a decrease in both Vcap and Dm. The KCOc in controls showed a significantly smaller decrease due to a slightly
lower Vcap. We conclude that kidney transplant recipients with CMV infection have significant pulmonary diffusion disturbances
due to a combination of lower Vcap and lower Dm. The most likely explanation for this phenomenon is a local inflammatory process
due to CMV and not plugging of cytomegalic endothelial cells only.
Received: 25 February 1998 Received after revision: 26 June 1998 Accepted: 22 September 1998 相似文献
7.
P. Peeters J. Sennesael H. De Raeve M. De Waele D. Verbeelen 《Transplant international》1997,10(6):471-474
Lymphoma in immunocompromised transplant patients is a feared cause of morbidity and mortality. Superimposed on the lymphoma
and the transplantation immunosuppression is a rare condition: hemophagocytic syndrome (HS). HS is characterized by fever,
hepatosplenomegaly and lymphadenopathy, skin rashes, jaundice, coagulopathy, and phagocytosis of blood elements with pancytopenia.
Here we describe a rare but fatal case of a kidney transplant patient who developed T-cell lymphoma and HS, without evidence
of EBV replication. A short review of the diagnosis, treatment, and prognosis of HS is given.
Received: 4 March 1997 Received after revision: 6 June 1997 Accepted: 30 June 1997 相似文献
8.
E. Domínguez Fernández K. H. Albrecht U. Heemann M. Kohnle J. Erhard F. Stöblen F. W. Eigler 《Transplant international》1998,11(1):28-31
Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney
transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney
disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group. The aim of this study
was to evaluate the prevalence of diverticulosis in ADPKD patients awaiting renal transplantation and the incidence of bowel
perforation following allogenic kidney transplantation due to ADPKD. Within the group of 1128 patients who underwent transplantation
between January 1974 and January 1990, there were 46 patients (4.07 %) whose indication for transplantation was ADPKD. There
was one patient who developed a sigmoid perforation under postoperative immunosuppression. Surgical treatment was a discontinuity
resection of the sigmoid (Hartmann's procedure). The postoperative course was favorable, the bowel continuity has already
been restored, and the graft is still functioning well. Fifteen of the 28 (53.5 %) ADPKD patients awaiting transplantation
had colon diverticulosis (12 male and 3 female patients). No case of bowel perforation has thus far been observed in 15 of
these patients who have undergone transplantation. A sigmoid resection was necessary in one patient due to diverticulitis
without perforation. We did not find a higher prevalence of diverticulosis in patients with ADPKD, nor did we see a higher
incidence of sigmoid perforation during post-transplant immunosuppression in this study.
Received: 30 January 1997 Received after revision: 15 July 1997 Accepted: 19 August 1997 相似文献
9.
H. Vilca Melendez V. Vougas P. Muiesan P. Andreani G. Mieli-Vergani M. Rela N. D. Heaton 《Transplant international》1998,11(4):301-304
Bowel perforation is a well-recognized complication following orthotopic liver transplantation. Of 194 paediatric liver transplantations
performed in our hospital, 13 patients (6.7 %) developed bowel perforation post-transplantation. Contributory factors included
previous operation, steroid therapy and viral infection. The incidence was higher in children who underwent transplantation
for biliary atresia after a previous Kasai portoenterostomy. Seven patients (53 % of this group) reperforated. Diagnosis may
be difficult and a high index of suspicion is needed.
Received: 8 December 1997 Received after revision: 17 February 1998 Accepted: 2 March 1998 相似文献
10.
Management of lymphoceles after kidney transplantation 总被引:5,自引:0,他引:5
G. Bischof Susanne Rockenschaub Gabriela Berlakovich Fritz Längle Ferdinand Mühlbacher Reinhold Függer Rudolf Steininger 《Transplant international》1998,11(4):277-280
Post-transplant lymphoceles (LC) may lead to impaired graft function. Treatment modalities include fine-needle aspiration,
percutaneous drainage, and surgical internal drainage. Recently, laparoscopic fenestration has been performed with good results,
but experience is still limited. Between January 1991 and August 1996, 919 kidney transplantations were performed in 876 patients
at our department. There were 745 first, 133 second, 30 third, 9 fourth, and 2 fifth operations. Sixty-three symptomatic LCs
were detected in 62 patients (6.8 %) after 39 ± 31 days. In 44 % of the cases, graft function was impaired; in 29 % hydronephrosis
was documented and in 6 % infection of the LC. Forty-five of the 62 patients with LC (73 %) had histologically proven rejection.
Thirty-five of the 63 LCs were drained percutaneously, 20 LCs were internally drained by open surgery, and 8 LCs were drained
by laparoscopy. In 14 of the 47 patients (30 %) with primary percutaneous drainage, LC recurred; infection occurred in 17
%. Twelve of these patients underwent surgery. One surgical redrainage was necessary after open fenestration. No conversion
or complication was noted in the laparoscopy group. We conclude that surgery for post-transplant lymphoceles is safe and effective.
We favor the laparoscopic technique in selected patients.
Received: 17 October 1997 Accepted: 14 January 1998 相似文献
11.
Situs inversus of donor or recipient in liver transplantation 总被引:1,自引:0,他引:1
Felix Braun Burckhard Rodeck Thomas Lorf Ruben Canelo Perdita Wietzke Heinz Hartmann Giuliano Ramadori B. Ringe 《Transplant international》1998,11(3):212-215
Situs inversus is a rare anatomical abnormality that is often associated with multiple, complex malformations. In the past,
patients with situs inversus were considered unsuitable candidates for transplantation or organ donation because associated
visceral, and especially vascular, anomalies pose special technical difficulties. Recently, several cases of successful liver
transplantation in recipients with situs inversus have been published using modified surgical techniques. This report reviews
the literature and describes our own experience, including two liver graft recipients with complete and incomplete situs inversus,
and one patient who underwent successful transplantation using a liver from a donor with situs inversus.
Received: 10 October 1997 Received after revision: 22 December 1997 Accepted: 9 January 1998 相似文献
12.
Complications due to ureteric obstruction are an occasional cause for renal transplant dysfunction. Here we report an unusual
case of orthostatic renal failure in a renal transplant recipient. Our patient had the previously reported predisposing risk
factors including: female sex, obesity, and lax abdominal musculature. It is important to recognize this unusual complication
of renal transplantation early in order to preserve long-term graft function.
Received: 23 December 1996 Received after revision: 6 May 1997 Accepted: 13 May 1997 相似文献
13.
Long-term follow-up of renal transplant recipients treated with losartan for post-transplant erythrosis 总被引:1,自引:0,他引:1
D. Ducloux Véronique Fournier Catherine Bresson-Vautrin Jean-Marc Chalopin 《Transplant international》1998,11(4):312-315
Post-transplant erythrosis (PTE) develops in 9 %–22 % of all renal transplant recipients. Defined as a persistently elevated
hematocrit (> 0.51), it occurs most commonly during the first 2 years post-transplantation in hypertensive males with excellent
allograft function. Several studies have focused on a major role for angiotensin II in PTE pathogenesis, and some case reports
have suggested that losartan is an effective treatment for PTE. Nevertheless, its long-term safety and efficiency have not
been reported in renal transplant recipients suffering from PTE. We describe four patients successfully treated with losartan
for PTE. Hematocrit remained normal for 21, 18, 15, and 15 months, respectively, after the beginning of losartan therapy.
Mean erythropoietin concentration was not modified by treatment (17 ± 3.7 mU/ml vs 17 ± 3.8 mU/ml) and serum creatinine concentration
remained stable. We conclude that losartan is a safe and effective long-term treatment for PTE.
Received: 18 December 1997 Received after revision: 6 March 1998 Accepted: 16 March 1998 相似文献
14.
J. M. A. Smits Frans H. J. Claas Hans C. van Houwelingen Guido G. Persijn 《Transplant international》1998,11(2):82-88
To test the hypothesis that noninherited maternal antigens (NIMA) can modulate the alloreactivity of infant cells and provide
protection for renal transplant recipients, a study of renal transplantations performed between 1980 and 1991 was undertaken.
The survival rate of grafts with a mismatched antigen identical to the NIMA was compared to that of grafts in which the mismatched
antigen was not identical to the NIMA. In the case of HLA-A mismatches, graft survival rates were significantly better for
NIMA-mismatched transplants: 94 % and 83 % at 1 and 3 years, respectively, for single NIMA HLA-A mismatched transplants, and
83 % and 67 % when both HLA-A antigens were mismatched, compared to 76 % and 68 % (one non-NIMA HLA-A mismatch) and 67 % and
45 % (two non-NIMA HLA-A mismatches). Our results suggest that some class I NIMA-mismatched antigens are not harmful to renal
transplant recipients.
Received: 16 May 1997 Received after revision: 8 October 1997 Accepted: 19 November 1997 相似文献
15.
Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure 总被引:15,自引:0,他引:15
J. Erhard Reinhard Lange Ursula Rauen Ralf Scherer Jürgen Friedrich Michael Pietsch Herbert de Groot Friedrich Wilhelm Eigler 《Transplant international》1998,11(4):266-271
Six adult patients suffering from acute hepatic failure and with a high urgent status underwent heterotopic auxiliary liver
transplantation. In four of these patients, the portal vein of the liver graft was arterialized in order to leave the native
liver and the liver hilum untouched and to be able to place the liver graft wherever space was available in the abdomen. The
arterial blood flow via the portal vein was tapered by the width of the anastomosis. Two patients died, one of sepsis on postoperative
day 17 (POD), the other after 3 months due to a severe CMV pneumonia. There were no technically related deaths. The native
liver showed early regeneration in all cases. In one patient, the auxiliary graft was removed 6 weeks after transplantation.
Four weeks later, he had to undergo orthotopic retransplantation due to a recurrent fulminant failure of the recovered native
liver. This patient is alive more than 1 year after the operation. We conclude that heterotopic auxiliary liver transplantation
with portal vein arterialization is a suitable approach to bridging the recovery of the acute failing native liver.
Received: 15 September 1997 Received after revision: 4 February 1998 Accepted: 2 March 1998 相似文献
16.
We report herein the case of a patient who initially underwent right radical mastectomy for breast carcinoma in 1988, followed
by left breast-conserving surgery in 1997. On both occasions she was given postoperative radiation therapy of 50 Gy. Repeated
dressings and the administration of antibiotics failed to heal ulcerative infected lesions that had formed on the anterior
chest wall in early 1998. In 1999, the sternum and surrounding tissue were debrided and the anterior chest wall was reconstructed
by omentum transposition and mesh skin grafting. The patient is currently well and alive without any evidence of recurrence
of either infection or breast cancer.
Received: March 7, 2001 / Accepted: September 11, 2001 相似文献
17.
Demirag A Elkhammas EA Henry ML Davies EA Pelletier RP Bumgardner GL Dorner B Ferguson RM 《Clinical transplantation》2000,14(1):8-10
Infectious complications after renal transplantation remain a major cause of morbidity and mortality. Mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. Risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). Life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary Rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with Amphotericin B and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; Amphotericin B and, in selected cases, surgical resection are the mainstays of therapy. 相似文献
18.
Luis Carlos Feitosa Tajra Marwan Dawhara Mehdi Benchaib Nicole Lefrançois Xavier Martin J. M. Dubernard 《Transplant international》1998,11(4):295-300
To date there is no general consensus as to the best surgical technique for pancreas transplantation. Patients with a pancreas
transplant functioning for 3 years or more were retrospectively investigated to compare three surgical techniques: segmental
graft with duct obstruction (DO), whole graft with bladder drainage (BD), and whole graft with enteric drainage (ED). Several
parameters were studied: patient and graft survival, rejection, long-term surgical and medical complications, and endocrine
function. The best results in terms of graft survival and quality of metabolic control were obtained in the group that underwent
whole graft transplantation with ED. At 3 years, overall pancreas graft survival was 65 % for ED, 60 % for BD, and 47 % for
DO. This surgical method has become the preferred technique in our unit.
Received: 9 October 1997 Received after revision: 29 January 1998 Accepted: 30 March 1998 相似文献
19.
An immunosuppressive regimen using FTY720 combined with cyclosporin in canine kidney transplantation
S. Suzuki Toshihiro Kakefuda Hiroshi Amemiya Kenji Chiba Yukio Hoshino Takafumi Kawaguchi Hirotoshi Kataoka Fazlur Rahman 《Transplant international》1998,11(2):95-101
FTY720 induces apoptosis, specifically in lymphocytes, and prolongs allograft survival in rats and dogs. The purpose of this
study was to define an effective range of FTY720 doses that could be combined with a suboptimal dose (10 mg/kg) of cyclosporin
for canine kidney allograft recipients. The combination significantly prolonged allograft survival in all groups receiving
FTY720 at a dose of 0.1, 0.3, 1.0, or 3.0 mg/kg. None of the recipients died due to notable side effects of the drug. In peripheral
blood, the number of lymphocytes was extremely low, whereas the percentage of granulocytes increased during FTY720 administration.
No significant difference in cyclosporin trough levels was observed between the cyclosporin-alone group and the combination
groups. We conclude from the present study that FTY720 has a potent effect at an extremely low dose and a wide therapeutic
window when combined with cyclosporin in canine kidney transplants.
Received: 16 May 1997 Received after revision: 6 October 1997 Accepted: 19 November 1997 相似文献
20.
M. H. Kirschner Frithjof D. Wagner Andreas Nerlich Walter Land Volker Bühren Gunther O. Hofmann 《Transplant international》1998,11(3):195-203
Trauma surgery lack, substitute, for the reconstruction of large defects of the long bones. Encouraged by the promising results
of bone allotransplantation in animal models, we successfully performed vascularized bone transplantation in humans. Vascularized
femoral diaphyses were allogenically transplanted into three patients suffering from chondrosarcoma or post-traumatic osteomyelitis
with postoperative immunosuppression. The bone segments were harvested from multi-organ donors and perfused with UW solution.
After back-table preparation, the grafts were transplanted into the defect zone. Interlocking devices were used in these operations.
Vascular anastomoses were performed in end-to-side technique. The early clinical course of the patients was not free of anatomical,
technical, or immunological complications. However, all patients are currently free of malignancy and infection. They are
also free of pain and full weight bearing. We conclude that allogenic grafting of vascularized bone segments has the potential
to become an alternative for the replacement of large bone defects.
Received: 21 July 1997 Received after revision: 17 December 1997 Accepted: 9 January 1998 相似文献