Erythropoietin deficiency and relative resistance cause anaemia in post-renal transplant recipients with normal renal function

BACKGROUND: Following successful renal transplantation, blood erythropoietin(Epo) levels peak in two phases during the first 2–3 months,and blood haemoglobin/haematocrit (Hb/Hct) levels are restoredto normal in a period of 2–6 months. However, some transplantrecipients continue to remain anaemic in spite of normal graftfunction and in the absence of recognizable causes. The roleof endogenous Epo production in the causation of anaemia insuch patients is poorly understood and has been investigatedin this study. METHODS: Twenty-three post-renal transplant recipients with stable normalrenal function were studied. Eleven of these patients had normalHb/Hct levels (group 1) and served as control for the rest 12patients with anaemia (group 2). Patients included in group2 had no readily recognizable cause for their anaemia. Otherlaboratory and clinical findings were similar in both groups.Patients with erythrocytosis were excluded. Serum Epo levelswere measured in all patients. Five patients in group 2 weretreated with recombinant human erythropoietin (rHuEpo) and theirerythropoietic response was assessed. rHuEpo was discontinuedwhen the target Hb/Hct levels (lowest normal range) were achievedand the patients were followed up for a further period of 9–12months. RESULTS: Five patients in group 1 had normal expected serum Epo levelswhereas the other six patients had inappropriately high serumEpo levels with respect to their Hb/Hct status suggestive ofrelative ‘Epo resistance’. Serum Epo levels in allpatients except two in group 2 were low indicative of ‘Epodeficiency’. The two exceptional patients in group 2 hadhigher serum Epo levels in the presence of anaemia suggestiveof relative ‘Epo resistance’. All five patients treated with rHuEpo responded adequately byachieving normal Hb/Hct levels. Three of them were originally‘Epo deficient’ and they reached target Hb/Hct levelsin a mean period of 4 weeks, requiring a mean cumulative rHuEpodose of 428.3 units/kg. The other two patients with higher initialserum Epo levels, and considered to be ‘Epo resistant’,required an average of 11 weeks of treatment and a mean cumulativerHuEpo dose of 1582.5 units/ kg, indicating an increased Epodemand. On cessation of therapy the Hb/Hct levels fell in allfive patients to pretreatment values in 6 months. CONCLUSIONS: There are important variations in the endogenous Epo productionin renal transplant patients with normal renal function, thecause of which is not clear. Epo deficiency and relative Eporesistance play a causative role for anaemia in some post-renaltransplant recipients with stable normal renal function. Theyrespond adequately to rHuEpo administration.     

Post-Transplant Lymphoproliferative Disorders Occurring After Renal Transplantation in Adults: Report of 230 Cases From the French Registry

Post-transplant lymphoproliferative disorders (PTLD) are a rare but serious complication after organ transplantation. A French Registry of PTLD was set up in a nationwide population of kidney transplant recipients. We prospectively enrolled all adult kidney recipients developing PTLD between January 1, 1998, and December 31, 2003. We analyzed the incidence, risk and prognostic factors of PTLD by Kaplan-Meier and Cox analyses. Totally 230 cases of PTLD were referred to the French Registry. Cumulative incidence was 1.18% after 5 years. Older age (per year, AHR = 2.19, CI = 1.22-3.94) and recipient Epstein-Barr virus seronegativity (AHR = 3.01, CI = 1.57-5.08) were associated with an increased risk of PTLD. Patients with PTLD had a reduced survival rate (61% at 5 years). Graft PTLD had the best prognosis with an 81% survival rate after 5 years. Infection with hepatitis C or B virus (HCV or HBV), late-onset PTLD, multiple sites involvement and high Ann Arbor staging were risk factors for patient death. Use of azathioprine was associated with a poorer survival rate. PTLD incidence and risk factors in French recipients are in line with the international or American PTLD series. We highlighted the role of HBV or HCV in patient mortality and described the relevant prognosis factors for patients with post-transplant lymphoproliferations.     

Pediatric intestinal transplantation

Advancements in donor management, organ preservation and operative techniques, as well as immunosuppressive therapies, have provided children with intestinal failure and its complications a chance not only for enteral autonomy but also long-term survival through intestinal transplantation (ITx). First described in the 1960’s, experience has grown in managing these complex patients both pre- and post-transplant. The goals of this review are to provide a brief history of intestinal transplantation and intestinal rehabilitation in pediatric patients, followed by focused discussions of the indications for ITx, induction and maintenance immunosuppression therapies, common post-operative complications, and outcomes/quality of life post-transplant.     

Hodgkin's disease occurring in a child after liver transplantation

Here we describe the case of a 14-year-old boy who underwent livertransplantation for post-Kasai biliary atresia when aged 4. Antirejectiontreatment consisted of prednisone and cyclosporine. At the age of 11 years thepatient developed left cervical lymphadenopathy; the biopsy showed classicalHodgkin's disease(HD) of the mixed cellularity (MC) type. Neoplastic cellsexpressed CD30 and CD15, and were negative for CD45, CD20, CD3, CD43, andCD79a. Furthermore, they carried the EBV-related products LMP1 and EBER1/2.Treatment consisted of three cycles of adriamycin, bleomycin, vinblastine andDTIC (ABVD), followed by radiotherapy (2,000 cGys) on involved fields. Atpresent, 42 months after the diagnosis of HD, the patient is still in completeremission. This is, to the best of our knowledge, the first reported case ofclassical HD following liver transplantation. The positivity of neoplasticcells for LMP1 and EBER1/2 indicates a possible role for immunosuppression inthe development of the tumor, and whether a reduction in immunosuppressionmight have influenced the course of the disease is open to question.     

Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.     

肝移植术后糖尿病的发病率和危险因素分析

目的：探讨影响肝移植术后糖尿病（PTDM）发生的危险因素,为有效地预防和治疗PTDM提供参考证据。方法：回顾性分析2018年1月1日-2019年3月1日在某院移植中心进行同种异体原位肝移植术的91例移植受者。根据ADA糖尿病诊断指标,将肝移植受者分为PTDM组（18例）与non-PTDM组（73例）。基于统计学分析方法,筛选出影响PTDM发生的危险因素。结果：该院肝移植中心PTDM的1年内累积发生率为19.78%。多因素非条件Logistic回归分析结果显示,肥胖（BMI ≥ 25 kg·m^-2）（OR=8.754,95% CI：2.113~36.273,P<0.05）、术前空腹血糖受损（IFG）（OR=4.713,95% CI：1.305~17.027,P<0.05）和ICU停留时间（OR=1.367,95% CI：1.013~1.843,P<0.05）是肝移植受者发生PTDM的独立危险因素。结论：肥胖、术前IFG和ICU停留时间与PTDM的发生存在相关性。为减少PTDM的发生率,针对与PTDM发生相关的危险因素,尽早采取预防和干预措施是关键。     

Post-immunosuppressive and immunomodulatory therapy lymphoproliferative disorders of the gastrointestinal tract

Post-immunosuppressive and immunomodulatory therapy lymphoproliferative disorders occur during immunosuppressive treatment following allogeneic solid organ or stem cell transplant (post-transplant lymphoproliferative disorder, PTLD) or for autoimmune disorders. These disorders commonly initially present in the gastrointestinal tract, and up to 30% of patients have been shown to have GI involvement. Post-immunosuppressive therapy lymphoproliferative disorders are frequently associated with Epstein–Barr virus (EBV) and encompass a wide spectrum of morphologic and clinical presentation. EBV-negative and T-cell lymphoproliferations occur to be increasing, and a high index of suspicion is required on the part of the pathologist for timely diagnosis and treatment.     

Granulocytic sarcoma of the heart: extramedullary relapse of acute myeloblastic leukemia after allogeneic stem cell transplantation successfully treated by chemotherapy alone

We present a case of granulocytic sarcoma (GS) of the heart. A 28-year-old man with relapsed acute myelogenous leukemia (AML-M2) had undergone a non-myeloablative allogeneic peripheral stem cell transplantation. Three years following transplantation, masses were evidenced in his heart by echocardiography but had completely disappeared following a common chemotherapy etoposide, mitoxantrone, ara-C (EMA) regimen for relapsed AML. The involvement of the heart with GS is very rare and this is the first case of extramedullary disease in the heart after allogeneic transplantation. Here we present the case history and related literature has been reviewed.