OBJECTIVE: This study aims to explore the therapeutic role of polydeoxyribonucleotide (PDRN) in lung ischemia-reperfusion injury (LIRI). METHODS: A mouse model of LIRI was established. Experimental groups included the co...OBJECTIVE: This study aims to explore the therapeutic role of polydeoxyribonucleotide (PDRN) in lung ischemia-reperfusion injury (LIRI). METHODS: A mouse model of LIRI was established. Experimental groups included the control group, model group, model + low-dose PDRN group, model + high-dose PDRN group, and model + high-dose PDRN combined with AKT inhibitor group. Pathological changes in mouse lung tissues were observed using H&E staining, and cell apoptosis was detected via TUNEL assay. Serum levels of malondialdehyde (MDA) and interleukin-1β (IL-1β) were measured, while protein expression levels of BCL-2, BAX, cleaved-Caspase-3, and p-AKT/AKT were determined using Western blot. RESULTS: Compared with the control group, the model group showed bronchial wall thickening in lung tissues, with extensive red blood cell infiltration and inflammatory cell accumulation in the lung interstitium, indicating significant tissue damage. Additionally, levels of IL-1β, MDA, BAX, and cleaved-Caspase-3 were elevated, while BCL-2 expression and p-AKT/AKT ratio were reduced. In contrast, the model + low-dose PDRN group and model + high-dose PDRN group exhibited alleviated lung tissue damage, reduced inflammatory cell infiltration, decreased levels of IL-1β, MDA, BAX, and cleaved-Caspase-3, and increased BCL-2 expression and p-AKT/AKT ratio, suggesting therapeutic effects. However, in the model + high-dose PDRN + AKT inhibitor group, lung tissue damage, inflammatory responses, and cell apoptosis were aggravated, with increased IL-1β, MDA, BAX, and cleaved-Caspase-3 levels, and decreased BCL-2 expression and p-AKT/AKT ratio. CONCLUSIONS: PDRN exerts a therapeutic effect on LIRI by reducing cell apoptosis and inflammatory responses through the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway.
BACKGROUND: Hypercalcemia with persistent hyperparathyroidism after kidney transplantation is an important risk of cardiovascular disease and allograft dysfunction in kidney transplant recipients (KTRs). Cinacalcet, a ca...BACKGROUND: Hypercalcemia with persistent hyperparathyroidism after kidney transplantation is an important risk of cardiovascular disease and allograft dysfunction in kidney transplant recipients (KTRs). Cinacalcet, a calcium-sensing receptor agonist, is commonly used in chronic hemodialysis recipients with secondary hyperparathyroidism; however, its effect and safety in kidney transplant recipients are not established. METHODS: A prospective cohort study was conducted in KTRs with persistent hyperparathyroidism (intact parathyroid hormone [iPTH] >65 pg/mL) for at least 1 year post-transplantation. Participants received cinacalcet 25 mg/day for 3 months. Primary outcomes were changes in serum calcium, serum phosphate, and iPTH concentrations; the secondary outcome was the effect on tacrolimus trough level. RESULTS: Thirty KTRs (mean age, 46.5 years; median time since transplantation, 3 years; mean serum creatinine, 1.5 ± 0.4 mg/dL, mean estimated glomerular filtration rate, 55.4 ± 14.6 mL/min/1.73 m) completed the study. Administration of cinacalcet significantly reduced serum calcium levels (mean, 9.2 ± 0.7 mg/dL vs 10.1 ± 0.6 mg/dL; P < .001) and increased serum phosphate levels (mean, 3.0 ± 0.6 mg/dL vs 2.7 ± 0.5 mg/dL; P = .006). iPTH levels showed no significant change (median, 178.3 pg/mL vs 176.2 pg/mL; P = .35). Tacrolimus trough levels remained stable (mean, 5.7 ± 1.3 vs 5.9 ± 2.8 ng/mL; P = .68). CONCLUSION: Cinacalcet use can normalize serum calcium levels and maintain tacrolimus levels in KTRs with persistent hyperparathyroidism. However, long-term data, especially for cardiovascular outcomes, merit further exploration.
BACKGROUND: Living donor kidney transplantation (LDKT) is the definitive treatment for end-stage renal disease (ESRD), yet locally generated economic data remain limited. This single-center study provides a primary micro...BACKGROUND: Living donor kidney transplantation (LDKT) is the definitive treatment for end-stage renal disease (ESRD), yet locally generated economic data remain limited. This single-center study provides a primary micro-costing comparison of LDKT, hemodialysis (HD), and peritoneal dialysis (PD) from a hospital finance perspective in a central Saudi tertiary-care facility. METHODS: A retrospective micro-costing analysis was conducted from the healthcare provider perspective, capturing all direct medical costs from 2020 to 2023 over a 1-year horizon. Detailed cost components for HD (156 sessions/year), PD, and LDKT (donor and recipient pathways) were extracted from institutional financial records. A deterministic one-way sensitivity analysis was conducted to assess robustness. RESULTS: HD incurred the highest annual cost ($67,311.96), primarily due to personnel, consumables, and vascular access interventions. PD costs $58,946.50 annually, attributable principally to dialysate procurement. LDKT required an initial combined donor-recipient first-year investment of $60,693 (donor: $7942; recipient: $52,751), followed by a substantially lower annual maintenance cost of $12,150. Cumulative analysis demonstrated that LDKT achieves financial break-even with HD within the first 12 months and becomes the dominant long-term strategy, a result consistent across all sensitivity scenarios. CONCLUSIONS: LDKT provides rapid and sustained economic advantages over dialysis modalities within the Saudi hospital context. HD entails the highest ongoing cost, whereas PD offers a more cost-effective dialysis option. The immediate break-even point and long-term cost savings of LDKT provide strong evidence to support the expansion of LDKT and PD programs as essential components of sustainable ESRD care in Saudi Arabia.
Different surgical techniques of kidney procurement exist, for example, simultaneous en-bloc and sequential nephrectomy. After warm dissection, cross-clamping of the large vessels and perfusion of the organs, the cold di...Different surgical techniques of kidney procurement exist, for example, simultaneous en-bloc and sequential nephrectomy. After warm dissection, cross-clamping of the large vessels and perfusion of the organs, the cold dissection and extraction of organs is done. During the extraction time, organs are cut off from blood supply and, despite the cold flush, are not adequately cooled, which can result in ischemic damage. We propose that en-bloc kidney procurement shortens extraction time. We analyzed 242 cases of kidney procurement in Germany between January 2017 and December 2023 from donations after brain death (DBD) and compared the influence of the surgical techniques (en-bloc and sequential nephrectomy) on the extraction time of the first retrieved kidney. Kidneys procured with the en-bloc technique had significantly lower extraction times (median 44 vs. 60 minutes; p < .001), which was further confirmed in the multivariate linear regression analysis with a shortening of extraction time by approximately 14 minutes. In conclusion, en-bloc kidney procurement significantly shortens the organ extraction time in DBD organ procurement.
BACKGROUND: Healthcare professionals occupy a central position in influencing societal attitudes and ethical decision-making concerning organ donation. Understanding how cultural virtues, such as helpfulness, spiritualit...BACKGROUND: Healthcare professionals occupy a central position in influencing societal attitudes and ethical decision-making concerning organ donation. Understanding how cultural virtues, such as helpfulness, spirituality, and conviction, shape these attitudes provides valuable insights for ethics education and policy development. This study aimed to examine the relationship between healthcare professionals' attitudes toward organ donation and their cultural virtues. METHODS: A descriptive, cross-sectional, and correlational design was adopted. The sample consisted of 201 healthcare professionals (72.1% nurses, 27.9% physicians) employed in a state hospital in Türkiye between April and July 2024. Data were gathered using the Identifying Features Form, the Post-Mortem Organ Donation Attitude Scale, and the Cultural Virtues Scale. Statistical analyses included descriptive statistics, Pearson's correlation, and multiple regression. RESULTS: Participants' mean score on the Organ Donation Attitude Scale (67.31 ± 14.48) reflected generally positive attitudes. Significant correlations emerged between the Organ Donation Attitude Scale and Spirituality (p = .019), between Family Approval and Spirituality (p < .001), between Positive Attitude and Conviction (p = .029), and between Family Approval and Conviction (p = .026). Regression analysis identified spirituality (β = 0.159; p < .05) as a significant predictor of organ donation attitudes. CONCLUSION: Healthcare professionals exhibited favorable ethical attitudes toward organ donation, with spirituality exerting a particularly strong influence. These findings suggest that spiritual and cultural virtues guide moral reasoning and altruistic motivation in clinical decision-making. Integrating cultural and spiritual perspectives into professional ethics and training programs may enhance healthcare professionals' engagement with organ donation practices.
OBJECTIVE: The establishment of an optimal preparative regimen for haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in patients with aplastic anemia remains a matter of investigation. This study aimed...OBJECTIVE: The establishment of an optimal preparative regimen for haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in patients with aplastic anemia remains a matter of investigation. This study aimed to assess whether reducing the total dose of cyclophosphamide to 160 mg/kg could decrease toxicity while maintaining engraftment and achieving survival rates comparable to or better than those observed with the conventional Bu/Cy regimen using a cyclophosphamide dose of 200 mg/kg for haplo-HSCT. METHODS: A retrospective analysis was conducted on 157 patients who underwent myeloablative haplo-HSCT with a Bu/Cy-based conditioning regimen for aplastic anemia. Of the 157 patients, the median age of the recipients was 29 years (range: 7-56), and the median age of the donors was 40 years (range: 9-63). The patients were divided into 2 groups based on the dose of cyclophosphamide in the conditioning regimen: the Cy 160mg group (n = 41, 160 mg/kg) and the Cy 200mg group (n = 116, 200 mg/kg). Subsequent analyses were conducted on patients who were separately divided into 2 groups , using the median age of the donors, 40 years ,as the cutoff. RESULTS: In the overall cohort, there were no significant differences in 1-year overall survival (OS) and 1-year failure-free survival (FFS) between patients transplanted from the Cy 160 mg group and the Cy 200mg group (p = .32 and p = .55, respectively), despite the Cy 160mg group exhibited significantly delayed neutrophil engraftment compared to the Cy 200mg group (p = .043). What's more, when selecting donors below the age of 40, patients in the Cy 160mg group showed a lower rate of TRM (p = .046) and a higher rate of OS and FFS compared to those in the Cy 200mg group (p = .027 and p = .027, respectively), although when donors were above 40 years of age, the cumulative incidence of graft failure was higher in the Cy 160mg group compared to the Cy 200mg group in these people (p = .012). As for transplant-related complications, such as infections, GVHD and TMA, no significance were found between the Cy 160mg group and Cy 200mg group mainly, furthermore, the Cy 160mg group had a trend to a lower incidence of severe cardiotoxicity, despite the difference was still not statistically significant (0% vs. 6.1%, p = .11). CONCLUSION: Our results suggest that a reduced dose of cyclophosphamide in the Bu/Cy conditioning regimen should be selected for AA patients to obtain a better prognosis when donors are younger than 40 years.
INTRODUCTION: Although liver biopsy in patients with acute cellular rejection (ACR) is the gold standard for diagnosis, its invasive nature highlights the need for reliable noninvasive biomarkers. With evidence suggestin...INTRODUCTION: Although liver biopsy in patients with acute cellular rejection (ACR) is the gold standard for diagnosis, its invasive nature highlights the need for reliable noninvasive biomarkers. With evidence suggesting that peripheral blood eosinophil levels may be associated with rejection, we evaluated the relationship between eosinophil levels and ACR to determine whether eosinophil dynamics reflect rejection severity. METHODS: We retrospectively analyzed 151 liver transplant recipients who underwent 398 liver biopsies between 2012 and 2022. To analyze eosinophil changes, we collected data on eosinophil counts, eosinophil percentages, liver enzymes, bilirubin, international normalized ratio, and rejection activity index (RAI) scores from biopsy day (day 0) and day 5 after treatment; patients with and without rejection (established histopathologically with RAI) were compared. We analyzed correlations between RAI severity and eosinophil levels. RESULTS: Liver enzyme levels were significantly higher in patients with versus without ACR (P < .05). In the rejection group, eosinophil count and percentage decreased markedly after treatment (P < .001), whereas no significant change was observed in the non-rejection group. Higher RAI scores were associated with increased eosinophil count (P = .029) and percentage (P = .021) on day 0 and a more pronounced decline on day 5 (both P < .001). CONCLUSION: Peripheral blood eosinophil levels were associated with ACR and exhibited characteristic changes that reflected rejection severity and therapeutic response. Eosinophil monitoring may be a useful noninvasive adjunct in the early detection and follow-up of ACR. Larger prospective multicenter studies are needed to validate these findings.
INTRODUCTION: Glucagon-Like Peptide-1 (GLP-1) analogues are increasingly being used to manage diabetes and obesity. However, their use in liver transplant (LT) recipients remains understudied. This study aimed to evaluat...INTRODUCTION: Glucagon-Like Peptide-1 (GLP-1) analogues are increasingly being used to manage diabetes and obesity. However, their use in liver transplant (LT) recipients remains understudied. This study aimed to evaluate the clinical outcomes associated with GLP-1 use following LT. METHODS: We conducted a retrospective cohort study of adult LT recipients between 2019-2023 at a single tertiary care center. Patients were divided into 2 groups based on GLP-1 use after transplant. Baseline demographics, comorbidities, transplant characteristics, and post-transplant outcomes were compared. Categorical variables were analyzed using Chi-square tests, and continuous variables using t-tests. RESULTS: Among 368 LT recipients, 73 (19.8%) were prescribed GLP-1 analogues post-transplant and 295 (80.2%) were not. There was no difference in demographics. GLP-1 users had higher rates of diabetes (79.5% vs. 31.2%, p < .0001), hyperlipidemia (50.7% vs. 29.8%, p = .0012), and BMI at transplant (31.9 ± 6.3 vs. 28.5 ± 12.6, p = .0015). MASH was the leading indication for transplant in the GLP-1 group (61.9% vs. 38.1%, p < .0001). At year 1, GLP-1 users had lower rejection rates (12.3% vs. 23.1%, p = .0635), with a similar trend at 3 years (6.8% vs. 9.5%, p = .6322). At 3 years, mortality was lower in GLP-1 users (1.4% vs. 4.7%, p = .3293). DISCUSSION: GLP-1 analogues were commonly used post-LT in patients with MASH and obesity. Despite higher metabolic burden at baseline, GLP-1 use was associated with similar or improved trends in BMI, rejection, and mortality. Larger prospective studies are needed to strengthen the evidence supporting the use of GLP-1 analogues in this high-risk population.
BACKGROUND: Malakoplakia is a rare granulomatous inflammatory disorder caused by impaired macrophage bactericidal activity, most often occurring in immunocompromised patients and commonly associated with chronic bacteria...BACKGROUND: Malakoplakia is a rare granulomatous inflammatory disorder caused by impaired macrophage bactericidal activity, most often occurring in immunocompromised patients and commonly associated with chronic bacterial infection. Reports in lung transplant recipients remain limited. METHODS: We performed a retrospective review of lung transplant recipients diagnosed with malakoplakia at our center. Clinical presentation, microbiology, management strategies, and outcomes were analyzed descriptively. RESULTS: Five lung transplant recipients developed 6 episodes of malakoplakia between 5 and 19 months post-transplant. Organ involvement was heterogeneous and included bladder, lung, sigmoid colon, mesenteric lymph nodes, vulvar and labial soft tissues, and prostate. One patient experienced recurrent pulmonary malakoplakia 77 months after the initial episode, representing the first reported recurrence in a solid organ transplant recipient. Chronic bacterial infection was present in all cases. CONCLUSIONS: Malakoplakia is an uncommon but important complication after lung transplantation with diverse clinical presentations and potential for recurrence. Early tissue diagnosis, targeted antimicrobial therapy, and individualized immunosuppression adjustment are critical for optimal management.
INTRODUCTION: Liver transplantation (LT) is the main treatment for liver cirrhosis and other conditions. Hepatic artery thrombosis (HAT) is a complication described in up to 15% of LTs in adults. OBJECTIVE: To evaluate t...INTRODUCTION: Liver transplantation (LT) is the main treatment for liver cirrhosis and other conditions. Hepatic artery thrombosis (HAT) is a complication described in up to 15% of LTs in adults. OBJECTIVE: To evaluate the characteristics of patients who developed HAT, describe the different treatments performed in a tertiary center, and compare outcomes. METHODS: This study is a retrospective cohort study based on medical record review of patients who underwent LT between January 2013 and December 2023. RESULTS: A total of 548 LTs were evaluated, of which 88 patients (16.05%) developed HAT. The proposed treatments were: expectant management in 7 patients (7.95%); endovascular treatment in 14 patients (15.90%); and LrT in 59 patients (67.05%). All patients in the expectant management group died, with a mean survival of 672.8 days (range 93-1583); 1- and 5-year mortality 40% and 100%, respectively. In the endovascular treatment group, 9 patients (69.23%) died, with a mean survival of 132 days (range 4-571); 1- and 5-year survival rates were 38.46% and 30.76%, respectively. Among patients indicated for LrT, 23 (26.13%) died before undergoing the procedure; thus, LrT was performed in 36 patients (40.9% of diagnosed HAT and 61.01% of those listed for re-LT). Of these, 22 (61.11%) died, with a post-LrT mean survival of 1290.45 days (range 1-4184); 1- and 5-year survival rates were 55.55% and 38.88%, respectively. CONCLUSION: HAT after LT represents a therapeutic challenge. Endovascular management was associated with positive outcomes; however, Lrt demonstrated the greatest long-term survival benefit.
INTRODUCTION: Hepatic actinomycosis is a rare infection caused by anaerobic, gram-positive Actinomyces bacteria. Liver involvement represents 5% of all actinomycosis cases and usually occurs secondary to intra-abdominal...INTRODUCTION: Hepatic actinomycosis is a rare infection caused by anaerobic, gram-positive Actinomyces bacteria. Liver involvement represents 5% of all actinomycosis cases and usually occurs secondary to intra-abdominal infections, spreading via the porto-mesenteric venous system. Clinical symptoms and imaging findings are typically heterogeneous and nonspecific, often mimicking malignant tumors, which makes diagnosis difficult and frequently one of exclusion. Immunosuppressed patients, including liver transplant recipients, have increased risk and the disease should be considered when a solitary or atypical hepatic mass is detected. CASE REPORT: The case discussed involves a female patient who underwent living-donor liver transplantation and biliodigestive anastomosis in 2018 for cirrhosis secondary to hepatitis B virus infection. She developed chronic biliary stenosis managed with periodic exchanges of percutaneous transhepatic biliary drain. In 2024, she presented with catheter displacement and peri-drain bile leakage. An abdominal computed tomography scan revealed a 150 mL hepatic collection compatible with abscess. Percutaneous drainage and antibiotics were started, but poor clinical and radiologic response raised suspicion for post-transplant lymphoproliferative disorder. A guided liver biopsy ultimately identified Actinomyces sp., confirming hepatic actinomycosis. Treatment with intravenous ampicillin for 1 month led to major improvement and 90% lesion resolution. She was discharged on oral amoxicillin-clavulanate for additional 3 months, with outpatient follow-up demonstrating favorable clinical response. CONCLUSION: Although uncommon, hepatic actinomycosis should be considered a possible cause of hepatic masses in liver transplant recipients. Management is mainly conservative with prolonged antibiotics and drainage may be used for refractory cases. Prognosis is generally positive when the condition is adequately treated.
BACKGROUND: Bronchial stenosis is a common airway complication following lung transplantation. Complete obstruction may result in "vanishing bronchus syndrome," a rare occurrence that typically affects the bronchus inter...BACKGROUND: Bronchial stenosis is a common airway complication following lung transplantation. Complete obstruction may result in "vanishing bronchus syndrome," a rare occurrence that typically affects the bronchus intermedius and causes the collapse of the right middle and lower lobes. While the condition predominantly involves the right lung, it can affect any bronchopulmonary segment. We present a case where bronchial stenosis led to the subsequent collapse of 2 independent lobes - the right upper and middle lobes. The volume loss resulted in ex vacuo pleural effusion. CASE REPORT: A 61-year-old male underwent a bilateral sequential lung transplant for rheumatoid arthritis-induced interstitial lung disease. A month later, he was hospitalized with shortness of breath. Imaging revealed bilateral pleural effusion for which he underwent decortication and pleurodesis. Follow-up surveillance bronchoscopies identified narrowing of the right upper and middle lobe bronchi, necessitating balloon dilation and lobar stent placement. During the subsequent 5-year period, the patient underwent several balloon dilations and stent replacements, which were complicated by the distal migration of the stents. This eventually led to the collapse of the right upper and middle lobes, as well as the development of ex vacuo pleural effusion. CONCLUSION: This case demonstrates an unusual anatomic pattern of vanishing bronchus affecting 2 independent lobes despite treatment of early acute rejection. Although aggressive multimodal bronchoscopic management, including balloon dilation and stenting, failed to prevent complete lobar collapse complicated by stent migration and ex vacuo pleural effusion, the patient has achieved 87-month survival with FEV1 maintained at 79% predicted, demonstrating that acceptable long-term outcomes remain possible.
Granulomatous amoebic encephalitis (GAE) caused by Acanthamoeba spp. is a rare, nearly universally fatal central nervous system infection that predominantly affects immunocompromised individuals, including solid organ tr...Granulomatous amoebic encephalitis (GAE) caused by Acanthamoeba spp. is a rare, nearly universally fatal central nervous system infection that predominantly affects immunocompromised individuals, including solid organ transplant (SOT) recipients. Early diagnosis is essential but often delayed due to nonspecific symptoms and the limited sensitivity of conventional diagnostic tests. We describe the case of a 58-year-old man who presented with fever and diarrhea one month after a simultaneous pancreas-kidney transplant. Despite broad-spectrum antimicrobial therapy, he developed status epilepticus and rapid neurologic deterioration. Extensive infectious workup, including cerebrospinal fluid studies, was non-diagnostic, and neuroimaging revealed multifocal infarcts and cerebral edema. Plasma microbial cell-free DNA sequencing identified Acanthamoeba spp., leading to a presumptive diagnosis of GAE that was later confirmed postmortem. This case represents the first reported use of plasma-based next-generation sequencing to diagnose Acanthamoeba GAE and highlights the clinical utility of noninvasive molecular diagnostics in immunocompromised hosts with unexplained encephalopathy. Earlier recognition of rare pathogens using these tools may facilitate more timely interventions and improve outcomes in transplant recipients with rapidly progressive neurologic syndromes.
Cytomegalovirus (CMV) infection is one of the most significant complications after solid organ transplantation, particularly in high-risk D+/R- patients. Letermovir, a CMV terminase complex inhibitor, was approved by the...Cytomegalovirus (CMV) infection is one of the most significant complications after solid organ transplantation, particularly in high-risk D+/R- patients. Letermovir, a CMV terminase complex inhibitor, was approved by the FDA in 2017 for prophylaxis in CMV-seronegative hematopoietic stem cell transplant recipients. Its off-label use in solid organ transplant recipients has gained traction due to its favorable hematologic profile compared to valganciclovir. However, resistance development, particularly involving the UL56 V236M mutation, has been reported with the increased use of letermovir. Few articles discussed the clinical significance of letermovir resistance, especially in transplant recipients with breakthrough viremia. In this case report, we describe a rare de novo letermovir resistance in a kidney transplant patient, requiring a switch to valganciclovir.
BACKGROUND: HLA-G is a non-classical HLA class I molecule with immunomodulatory properties and has been proposed as a biomarker of immune tolerance in kidney transplantation. However, the clinical meaning of circulating...BACKGROUND: HLA-G is a non-classical HLA class I molecule with immunomodulatory properties and has been proposed as a biomarker of immune tolerance in kidney transplantation. However, the clinical meaning of circulating HLA-G remains controversial. METHODS: We conducted a cross-sectional, single-center study including kidney transplant recipients with available clinical data and serum samples. Soluble HLA-G levels were quantified by enzyme-linked immunosorbent assay. We tested associations between HLA-G levels and immunosuppressive regimen, acute rejection episodes, cytomegalovirus (CMV) infection, and early post-transplant need for hemodialysis. Statistical significance was defined as P < .05. RESULTS: A total of 114 kidney transplant recipients were analyzed. Use of a regimen including corticosteroids, a calcineurin inhibitor, and azathioprine was associated with lower HLA-G levels (P < .001). Lower HLA-G levels were also associated with acute rejection (P < .001) and CMV infection (P = .006). In contrast, recipients requiring 6-10 hemodialysis sessions in the early post-transplant period showed higher HLA-G levels (P = .02). CONCLUSIONS: Serum HLA-G levels were significantly associated with clinically relevant outcomes after kidney transplantation. Lower HLA-G levels were linked to acute rejection and CMV infection, whereas higher HLA-G levels were observed among recipients requiring more hemodialysis early after transplantation. These findings support further evaluation of HLA-G as a prognostic biomarker.
Hematuria and renal dysfunction after kidney transplantation often indicate acute rejection, vascular complications, or infection. Ultrasonography, being non-invasive, convenient, and radiation-free, is a primary imaging...Hematuria and renal dysfunction after kidney transplantation often indicate acute rejection, vascular complications, or infection. Ultrasonography, being non-invasive, convenient, and radiation-free, is a primary imaging tool. Contrast-enhanced ultrasound (CEUS) is a sensitive technique for assessing microcirculatory perfusion in the renal allograft. This report describes a 43-year-old male presenting with fever and elevated creatinine six years post-transplant. Color Doppler showed no significant abnormality in the allograft, and CEUS revealed normal perfusion. However, the patient had reached end-stage renal disease (blood urea nitrogen 35.59 mmol/L, serum creatinine 1023.70 μmol/L, cystatin C 7.80 mg/L) and had been on maintenance hemodialysis for over 4 months. The 24-hour urine output at admission was minimal (∼10 mL, used for testing), showing significant hematuria and infection (red blood cells 2700.00/μL, white blood cells 1528.00/μL, urinary microalbumin 103.10 mg/L, urinary creatinine 1287.20 μmol/L). Allograft ultrasound revealed no stones, masses, or obvious lesions. This case highlights a potential dissociation between allograft perfusion status and functional outcome - specifically, normal perfusion despite severe dysfunction and failure - suggesting a unique scenario that warrants further investigation into the mechanisms of transplant kidney dysfunction.
INTRODUCTION: Dengue is the most prevalent arboviral disease in Brazil, and patients on kidney replacement therapy (KRT), such as chronic dialysis (CKD-5D) or kidney transplant recipients (KTx), may present more severe c...INTRODUCTION: Dengue is the most prevalent arboviral disease in Brazil, and patients on kidney replacement therapy (KRT), such as chronic dialysis (CKD-5D) or kidney transplant recipients (KTx), may present more severe clinical manifestations. OBJECTIVE: This study aimed to compare clinical and laboratory aspects, as well as outcomes of dengue infection, between patients on CKD-5D and KTR. METHODS: A prospective, analytical, single-center study involving patients diagnosed with dengue (positive NS1 and/or IgM) between November 2024 and April 2025. RESULTS: Fifty-eight patients were included (33 CKD-5D and 25 KTx). The median age was higher in CKD-5D patients (67 vs 59 years; p = .0066). The incidence of dengue was 2 times higher in CKD-5D patients (6% vs 2,9%). Hospitalization was more frequent in KTR (92% vs 36.3%; p < .0001), and 56% of them developed acute kidney injury. Lower platelet counts (p = .0164) and being a KTx were independent predictors of hospitalization. CONCLUSION: Despite the higher incidence, advanced age, and presence of comorbidities, patients on CKD-5D presented a lower risk of hospitalization than KTx.