Transplant. Proc. [JOURNAL]
Sun
200 papers
Safety and Tolerability of Tocilizumab in a Case Series of Heart Transplant Recipients With Chronic Antibody-Mediated Rejection.
Fernández-Gordón Sánchez S, Palacios-Castelló C, Esteve-Ruiz I … +3 more , Villalba-Moreno AM, Grande-Trillo A, Rangel-Sousa D
Transplant Proc · 2026 Mar · PMID 41651728 · Publisher ↗
BACKGROUND: Chronic antibody-mediated rejection (AMR) after heart transplantation is associated with progressive graft dysfunction and increased mortality, and effective treatment options remain limited. Interleukin-6 (I...
BACKGROUND: Chronic antibody-mediated rejection (AMR) after heart transplantation is associated with progressive graft dysfunction and increased mortality, and effective treatment options remain limited. Interleukin-6 (IL-6) inhibition with tocilizumab has emerged as a potential therapeutic strategy, although evidence in cardiac transplantation is scarce and limited to small case series. OBJECTIVE: To describe the safety and clinical course of heart transplant recipients with chronic, treatment-refractory AMR treated with tocilizumab. METHODS: This retrospective case series included 2 adult heart transplant recipients with biopsy-proven chronic AMR refractory to plasmapheresis, intravenous immunoglobulin, and rituximab. Tocilizumab was administered intravenously at a dose of 8 mg/kg monthly for 6 months. Clinical outcomes, laboratory parameters, immunologic data, and echocardiographic findings were assessed before and after treatment (March-September 2024). RESULTS: Both patients completed 6 doses of tocilizumab. No serious adverse events occurred; 1 patient developed a single episode of transient febrile neutropenia. No infections, bleeding events, or clinically significant hepatic enzyme elevations were observed. Unplanned hospitalizations for heart failure decreased during treatment, and both patients reported subjective improvement in functional status (NYHA class III-II). No consistent reduction in donor-specific HLA antibody mean fluorescence intensity was observed. Left ventricular ejection fraction remained stable, while global longitudinal strain improved in 1 patient. CONCLUSION: In this small case series, tocilizumab was safe and well tolerated in heart transplant recipients with chronic refractory AMR. Although clinical improvement was observed, the extremely limited sample size precludes conclusions regarding efficacy. Larger, prospective studies are required to clarify the role of IL-6 inhibition in chronic cardiac AMR.
Beyond the Lungs: Antibody-Mediated Rejection Presenting as Neuropsychiatric Syndrome After Lung Transplant: A Case Report.
Riedi S, Crasta D, Narula N
Transplant Proc · 2026 Mar · PMID 41651727 · Publisher ↗
BACKGROUND: Antibody-mediated rejection (AMR) after lung transplantation is defined by allograft dysfunction, detection of donor-specific antibodies (DSAs), and exclusion of alternate etiologies. Extra-pulmonary manifest...
BACKGROUND: Antibody-mediated rejection (AMR) after lung transplantation is defined by allograft dysfunction, detection of donor-specific antibodies (DSAs), and exclusion of alternate etiologies. Extra-pulmonary manifestations are exceptionally uncommon. CASE PRESENTATION: We report a 47-year-old man, status post bilateral lung transplant for coal workers' pneumoconiosis, who presented with progressive hypoxemia, tremors, right-sided weakness, dysarthria, headaches, and personality changes over 2 months. Comprehensive neurologic, infectious, and oncologic evaluations-including magnetic resonance imaging (MRI) of the brain, cervical and thoracic spine; lumbar puncture; and positron emission tomography-computed tomography (PET-CT)-were unrevealing. Chest computed tomography (CT) demonstrated subtle interlobular thickening and ground-glass opacities, and spirometry revealed a 6.8% decline in forced expiratory volume in 1 second (FEV₁). DSA testing showed elevated DQA05:01 (mean fluorescence intensity [MFI] 25,239), DR17 (7582), and DRw52 (4635). After exclusion of infection and structural neurologic causes, AMR was diagnosed. Treatment with plasmapheresis, intravenous immunoglobulin, rituximab, and corticosteroids resulted in complete resolution of neurologic and psychiatric symptoms after the second cycle, concurrent with reduction in DSA levels (DQA05:01 16,322; DR17 3000; DRw52 undetectable). The patient completed 5 treatment cycles. CONCLUSION: This case broadens the clinical spectrum of AMR to include reversible neuropsychiatric manifestations likely mediated by systemic alloimmune inflammation. Prompt recognition and timely antibody-directed therapy can prevent misdiagnosis, preserve graft integrity, and improve outcomes in lung transplant recipients.
Carbon Dioxide Elimination With Flow-Controlled Ventilation in Lung Transplantation: A Case Report.
Erkılınc A, Karaca Baysal P, Gurcu ME … +2 more , Girgin Dinc E, Urkut N
Transplant Proc · 2026 Mar · PMID 41651726 · Publisher ↗
BACKGROUND: Lung transplantation represents the most definitive treatment option for patients with advanced-stage lung diseases. In recent years, improvements in anesthetic techniques, medical technologies, and coordinat...
BACKGROUND: Lung transplantation represents the most definitive treatment option for patients with advanced-stage lung diseases. In recent years, improvements in anesthetic techniques, medical technologies, and coordinated perioperative care have contributed to better survival outcomes. CASE PRESENTATION: A 37-year-old male patient with a height of 168 centimeters and a weight of 70 kilograms, diagnosed with cystic fibrosis, was scheduled for bilateral lung transplantation. Shortly after transitioning to single-lung ventilation, a rapid and severe increase in carbon dioxide levels was observed, reaching 136 mm Hg, accompanied by a decrease in blood pH to 7.0, indicating pronounced respiratory acidosis. In response, flow-controlled ventilation was applied for 6 hours during the eleven-hour surgical procedure. CONCLUSIONS: Although the patient's respiratory profile initially suggested the need for extracorporeal membrane oxygenation, the application of flow-controlled ventilation appeared to improve carbon dioxide elimination and may have reduced the risk of complications related to extracorporeal support. This case indicates that flow-controlled ventilation could be considered a supportive ventilation strategy to avoid extracorporeal membrane oxygenation in selected patients undergoing lung transplantation who develop isolated intraoperative respiratory insufficiency.
Emergency Deceased Donor Liver Transplantation Using a PTFE Graft for Complex Arterial Reconstruction: A Technical Note.
Barzola E, Marín-Gómez L, Laga I … +1 more , Padillo-Ruíz J
Transplant Proc · 2026 Mar · PMID 41651725 · Publisher ↗
Hepatic artery reconstruction is technically challenging and a critical step in liver transplantation, particularly in patients with anatomical variations or compromised arterial flow. The present technical note describe...
Hepatic artery reconstruction is technically challenging and a critical step in liver transplantation, particularly in patients with anatomical variations or compromised arterial flow. The present technical note describes an emergency liver transplantation for hepatitis B virus-induced acute liver failure, where standard vascular reconstruction options, including autologous grafts, were exhausted. Given the recipient's small-caliber hepatic arteries, vasospasm, and hemodynamic instability, a 6 × 40 mm polytetrafluoroethylene (PTFE) vascular graft was utilized to restore arterial flow. The reconstruction involved anastomosis between the infrarenal aorta and the donor's celiac trunk at splenic artery bifurcation, ensuring adequate graft perfusion with adjusted arterial and portal flow rates. To prevent passage between the small bowel which could increase the risk of intestinal obstruction, the PTFE graft was positioned retroperitoneally. This technical note highlights the feasibility of PTFE grafts as a salvage solution for arterial reconstruction in emergent liver transplantation when standard options are unavailable.
Recurrence of Atypical Anti-Glomerular Basement Membrane Disease in Kidney Transplantation.
Temprado Collado A, Roca Oporto FJ, Suárez Benjumea A … +3 more , Cabrera Pérez R, Cabello Chaves VI, Pérez Valdivia MÁ
Transplant Proc · 2026 Mar · PMID 41644410 · Publisher ↗
Anti-glomerular basement membrane (anti-GBM) disease is a rare entity. The classic presentation includes circulating autoantibodies and rapidly progressive glomerulonephritis. However, there are atypical variants, which...
Anti-glomerular basement membrane (anti-GBM) disease is a rare entity. The classic presentation includes circulating autoantibodies and rapidly progressive glomerulonephritis. However, there are atypical variants, which constitute 5% to 10% of cases. These variants are characterized by the absence of circulating antibodies, a more indolent clinical course, and the potential to recur in a kidney transplant. We present the case of a woman with chronic kidney disease initially diagnosed as unclassified glomerulonephritis. After the first transplant, a biopsy revealed linear IgG deposits with lambda chain restriction, leading to a diagnosis of atypical anti-GBM disease. The patient developed progressive chronic allograft dysfunction, which required a return to dialysis and, subsequently, a second transplant. The disease recurred again. This case highlights the diagnostic difficulty of atypical anti-GBM disease and the possibility of its recurrence after kidney transplantation. The recurrence of the monotypic variant may be associated with a plasma cell clone that is undetectable by conventional methods, suggesting a lower sensitivity to immunosuppression. The case also demonstrates the slow evolution of this disease, which underscores the need for long-term histological follow-up.
Survival After Liver Transplantation in Recipients Aged ≥65 Years: A Single-Center Cohort and Contextualization With the Spanish National Registry.
Rodríguez-Mogollo JI, Bravo-Raton P, Bernal-Bellido C … +6 more , Cepeda-Franco C, Álamo-Martínez JM, Marín-Gómez LM, Suárez-Artacho G, Padillo-Ruíz FJ, Gómez-Bravo MÁ
Transplant Proc · 2026 Mar · PMID 41644409 · Publisher ↗
INTRODUCTION: Liver transplantation (LT) is increasingly performed in recipients ≥65 years. However, indications in this age group remain variably defined and long-term survival data are limited. OBJECTIVE: To evaluate s...
INTRODUCTION: Liver transplantation (LT) is increasingly performed in recipients ≥65 years. However, indications in this age group remain variably defined and long-term survival data are limited. OBJECTIVE: To evaluate survival in patients ≥65 years undergoing LT at a tertiary care center. MATERIALS AND METHODS: We conducted a retrospective observational study of 114 recipients aged ≥65 years who underwent LT. The primary outcome was median overall survival (months). Secondary variables included underlying liver disease, ABO blood group, hospital length of stay, and cause of death. For context, outcomes were compared with the 2023 "Memoria General de Resultados" of the Spanish Liver Transplant Registry (RETH). RESULTS: Median overall survival was 112.0 ± 22.6 months, with a median follow-up of 42.5 months. Survival did not differ significantly by underlying disease or ABO group. Compared with age-matched data from RETH, our cohort showed a similar survival trajectory without statistically significant differences. When contrasted with the nationwide overall LT population, survival in recipients ≥65 years was lower at 3 years (70.0% vs 81.0%; p < .05), 5 years (64.9% vs 76.1%; p < .05), and 10 years (48.2% vs 64.7%; p < .05). CONCLUSIONS: Survival outcomes in recipients ≥65 years at our center are consistent with the national registry data for this age group. LT, in carefully selected older adults, appears to be an appropriate therapeutic option, offering substantial life-expectancy gains for patients with advanced liver disease, despite lower survival compared with the overall national LT population.
Continuous Epidural Anesthesia for Living-related Renal Transplant in a Patient With Malignant Hyperthermia and Reduced Cardiac Function: A Case Report and Narrative Review of the Literature.
Parrino CR, Yin S, Dorsey N … +2 more , Maluf D, Mondal S
Transplant Proc · 2026 Mar · PMID 41644408 · Publisher ↗
Kidney transplantation is most often performed under general anesthesia, with or without regional anesthesia for adjunctive pain control. Select patients may benefit from neuraxial anesthesia as their primary anesthetic,...
Kidney transplantation is most often performed under general anesthesia, with or without regional anesthesia for adjunctive pain control. Select patients may benefit from neuraxial anesthesia as their primary anesthetic, especially when their comorbidities preclude the safe provision of general anesthesia. In this report, we describe the case of a 75-year-old man with malignant hyperthermia and ischemic cardiomyopathy who underwent a living-related kidney transplant under epidural anesthesia. Intraoperative hemodynamics were stable, and pain control was excellent; the surgeon reported no difficulties during the procedure. Allograft function was immediate and robust, and postoperative pain was well-controlled. The patient denied any side effects from the epidural block. We then summarize relevant literature from the 1960s through the present time regarding neuraxial blocks as the primary anesthetic for kidney transplantation and address considerations around the performance of neuraxial anesthesia in patients with end-stage renal disease. We also discuss common hesitations with neuraxial anesthesia and summarize the available data on patient-centered outcomes. Neuraxial anesthesia affords benefits of similar hemodynamics, similar allograft function, and improved postoperative pain control for patients undergoing kidney transplantation, compared to general anesthesia. Spinal, epidural, or combined spinal-epidural techniques should be given consideration when designing an anesthetic for patients with certain comorbidities that heighten the risk of a general anesthetic.
Simultaneous Liver and Kidney Transplantation for Cirrhosis Directly Attributed to Disseminated Hepatic Coccidioidomycosis.
Barnhill MS, Chascsa DM, McHugh K … +3 more , Nagarakanti SR, Me HM, Vikram HR
Transplant Proc · 2026 Mar · PMID 41644407 · Publisher ↗
Disseminated coccidioicomycosis can have devastating consequences following immunosuppression. Herein, we describe a kidney transplant recipient with subsequent allograft rejection and graft loss, who developed dissemina...
Disseminated coccidioicomycosis can have devastating consequences following immunosuppression. Herein, we describe a kidney transplant recipient with subsequent allograft rejection and graft loss, who developed disseminated hepatic cocccidioidomycosis that led to progressive hepatic fibrosis and cirrhosis. He then underwent simultaneous liver and kidney transplantation while maintaining antifungal therapy. No other etiology for cirrhosis was determined following extensive testing that included his explanted liver.
Analysis of Liver Retransplantation in a Reference Center in Southern Spain: 27 Years of Experience.
Ortega SL, Belmonte CA, Sánchez MIS … +5 more , Aranda AB, Leiva IS, Lombardo JC, Grande RG, Pérez MJ
Transplant Proc · 2026 Mar · PMID 41644406 · Publisher ↗
INTRODUCTION: Liver retransplantation (LRT) is the only therapeutic option in cases of irreversible graft failure. It is a technically complex procedure associated with high morbidity and mortality and worse survival out...
INTRODUCTION: Liver retransplantation (LRT) is the only therapeutic option in cases of irreversible graft failure. It is a technically complex procedure associated with high morbidity and mortality and worse survival outcomes compared to primary liver transplantation. OBJECTIVE: To analyze the indications, outcomes, and survival rates of LRT in a referral hospital in southern Spain over a 27-year period. METHODS: A retrospective descriptive study of all LRTs performed between 1997 and 2024 at the Regional University Hospital of Málaga. Solid organ transplants other than liver were excluded. Qualitative variables were expressed as percentages and quantitative variables as medians and interquartile ranges. A P-value < .05 was considered statistically significant. RESULTS: A total of 1.362 liver transplants (LTs) were performed during the study period, of which 76 were LRTs (5.6%). The median age of recipients was 53 years; 63.2% were male. The main indications for LRT were hepatic artery thrombosis (HAT) (28.9%), primary nonfunction (PNF) (23.7%), and chronic rejection (18.4%). Overall mortality was 55.3%, with the main cause being perioperative complications (28.6%). One-year and five-year survival rates were 59.2% and 46.1%, respectively. Urgent LRT (≤7 days) was associated with worse five-year survival compared to nonurgent LRT (33.3% vs 62.8%; P = .02). CONCLUSION: LRT, though infrequent, carries high morbidity and mortality. Long-term survival was significantly better in nonurgent cases, emphasizing the importance of proper timing and clinical stabilization before surgery.
Liver Transplantation in Patients With Hepatocarcinoma. Does the Donor Characteristics Influence the Risk of Tumor Recurrence and Survival?
Rejón-López R, Santidrián-Zurbano M, Vico-Arias AB … +6 more , Mohamed-Chairi MH, Pérez-Alonso AJ, Zambudio-Carroll N, Adel-Del-Fresno ME, Villegas-Herrera MT, Villar-Del-Moral JM
Transplant Proc · 2026 Mar · PMID 41644405 · Publisher ↗
BACKGROUND: The shortage of ideal liver donors (ID) has led to increased use of marginal donors (MD), characterized by factors such as advanced age, macrosteatosis, anti-HBc positivity, or controlled donation after circu...
BACKGROUND: The shortage of ideal liver donors (ID) has led to increased use of marginal donors (MD), characterized by factors such as advanced age, macrosteatosis, anti-HBc positivity, or controlled donation after circulatory death. In hepatocellular carcinoma (HCC), this raises concerns regarding tumor recurrence and post-transplant survival. METHODS: A retrospective, single-center observational study was conducted, including all patients transplanted for HCC between 2010 and 2023. Patients were classified into two groups: ID and MD, with MD defined by at least 1 marginality criterion. Survival analyses were performed using Kaplan-Meier curves, and statistical significance was set at P < .05. RESULTS: Of 99 patients, 76% received grafts from MD. Among MD, 31.3% derived from circulatory death donors and 53.5% were over 60 years old. No significant differences were found in biliary or vascular complication rates between groups. Tumor recurrence occurred in 7 patients-6 in the MD group-but without statistical significance in disease-free survival (P = .79). Overall survival at 12, 24, and 36 months was 72%, 63%, and 58% for ID vs 92%, 80%, and 74% for MD, respectively (P = .06). CONCLUSIONS: In this series, liver grafts from marginal donors were not associated with higher recurrence rates or reduced survival in HCC patients compared to ideal donors. Although larger, multicenter studies are needed to confirm these findings, the use of MD may safely increase organ availability without compromising clinical outcomes.
Roxadustat for Refractory Anemia Associated to Cytomegalovirus Infection in Kidney Transplantation.
Serrano B, Villanego F, Alonso M … +6 more , Amaro JM, Arnaiz M, Vigara LA, Orellana CD, García T, Mazuecos A
Transplant Proc · 2026 Mar · PMID 41644404 · Publisher ↗
Anemia is a common complication after kidney transplantation (KT), often multifactorial and worsened by cytomegalovirus (CMV) infection, which promotes inflammation and erythropoiesis resistance through hepcidin elevatio...
Anemia is a common complication after kidney transplantation (KT), often multifactorial and worsened by cytomegalovirus (CMV) infection, which promotes inflammation and erythropoiesis resistance through hepcidin elevation and HIF-2α inhibition. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), has shown promise in treating ESA-resistant anemia, though evidence in transplant recipients remains limited. We report 2 cases of ESA-refractory anemia post-KT with concurrent CMV infection successfully treated with roxadustat. Case 1: A 72-year-old woman developed anemia (Hb 8 g/dL) during asymptomatic CMV viremia despite valganciclovir, everolimus switch, and escalating ESA doses (up to 18,000 IU/wk). Roxadustat was started, and Hb recovered (11 g/dL) in 1 month. After a second anemia episode, dose adjustment restored Hb to 11.3 g/dL. The patient later died of unrelated causes. Case 2: A 78-year-old woman with recurrent CMV and inflammatory anemia (Hb 8.9 g/dL; ferritin 673 ng/mL) showed no ESA response. Roxadustat was stated and Hb raised to 14.2 g/dL in 1 month, allowing dose reduction and temporary withdrawal. Anemia recurred with new CMV viremia and responded again to roxadustat (Hb 11.6 g/dL). In both patients, we did not observe any side effects related to the use of the drug, and renal function remained stable during the follow-up. These cases support roxadustat as a valuable option in managing post-KT anemia with CMV-associated ESA resistance, by stimulating endogenous EPO, reducing hepcidin, and improving iron utilization. Further prospective studies are needed to establish its safety and efficacy in this population.
Case Report: Rare Presentation of Nocardia cyriacigeorgica Pleural Nocardiosis in a Kidney Transplant Patient.
Kim TM, Bang JB
Transplant Proc · 2026 Mar · PMID 41644403 · Publisher ↗
BACKGROUND: Nocardia species are gram-positive, filamentous bacteria causing opportunistic infections in immunocompromised patients. Nocardiosis in kidney transplant recipients is rare, with Nocardia cyriacigeorgica bein...
BACKGROUND: Nocardia species are gram-positive, filamentous bacteria causing opportunistic infections in immunocompromised patients. Nocardiosis in kidney transplant recipients is rare, with Nocardia cyriacigeorgica being an emerging pathogen first identified in 2001. CASE PRESENTATION: A 55-year-old male with end-stage renal disease underwent deceased-donor kidney transplantation with standard immunosuppression including tacrolimus, corticosteroids, and mycophenolate mofetil. Five months post-transplantation, he presented with cough, fever, and dyspnea. Initial chest computed tomography showed pleural effusion without consolidation. Despite percutaneous drainage and empirical antibiotics, symptoms persisted for 3 weeks. Repeat imaging revealed multiloculated pleural masses mimicking post-transplant lymphoproliferative disease. Surgical excision of the mass revealed inflamed granulation tissue, and cultures identified Nocardia cyriacigeorgica. Treatment was changed to intravenous imipenem/cilastatin and oral trimethoprim-sulfamethoxazole, with concurrent reduction of immunosuppression. The patient showed significant clinical improvement, with follow-up imaging demonstrating marked reduction in pleural masses. He was discharged after 10 weeks without graft dysfunction. CONCLUSION: This rare case of pleural nocardiosis caused by Nocardia cyriacigeorgica in a kidney transplant recipient highlights diagnostic challenges, as the presentation mimicked malignancy. High clinical suspicion is crucial when standard antimicrobial therapy fails in immunosuppressed patients. Early diagnosis through tissue culture and aggressive treatment with appropriate antibiotics, combined with immunosuppression adjustment, led to successful outcomes. This report adds valuable insights to the limited literature on this emerging pathogen in transplant recipients and emphasizes the importance of considering rare opportunistic infections in the differential diagnosis.
Differences in Circadian Sleep Parameters as a Function of Gender in Patients on the Waiting List for Liver Transplantation.
Martínez-Alarcón L, Jover-Aguilar M, Sáez-Sánchez J … +2 more , Romero PR, Vidal GR
Transplant Proc · 2026 Mar · PMID 41633865 · Publisher ↗
Sleep is a critical component of health, yet its role is underexplored in patients awaiting organ transplantation. This study examined sex-based differences in circadian sleep indicators among liver transplant candidates...
Sleep is a critical component of health, yet its role is underexplored in patients awaiting organ transplantation. This study examined sex-based differences in circadian sleep indicators among liver transplant candidates. Fifty patients (40 men (M) and 10 women (W)) on the waiting list at Hospital Clínico Universitario Virgen de la Arrixaca (Murcia, Spain) wore the Kronowise K6 wrist device on their nondominant wrist for 1 week pre-transplantation. Data were analysed using Kronowise 100 software (Kronohealth, Spain). Forty-two variables related to sleep quality and circadian rhythms were assessed via Student's t-test. Significant differences between sexes emerged in actual sleep time (p = .03), sleep efficiency (p = .022), total movement time (p = .011), and blue light exposure before sleep (p = .04). Men exhibited longer sleep duration, greater movement, and higher pre-sleep light exposure, whereas women demonstrated superior sleep efficiency. The midpoint of sleep-related peak values occurred later in women. Despite shorter sleep duration, women achieved better sleep quality, potentially due to reduced exposure to blue light before sleep, which was up to 2.5 times less than that of men. This disparity likely reflects differing pre-sleep behaviors, such as screen use. Additionally, women's core sleep phase was delayed by approximately 30 minutes. These findings suggest sex-specific differences in circadian sleep profiles among liver transplant candidates. Given men's less favorable sleep hygiene, targeted interventions may be warranted to improve pre-transplant sleep health.
Successful Bilateral-Lung Transplantation With Long Survival Time for Multicentric Castleman Disease With Fatal Pulmonary Involvement.
Zhang J, Peng G, Su G … +1 more , Ju C
Transplant Proc · 2026 Mar · PMID 41633864 · Publisher ↗
We present a rare case of multicentric Castleman disease (MCD) complicated by severe respiratory failure, which was successfully managed through bilateral lung transplantation. A 31-year-old male patient exhibited progre...
We present a rare case of multicentric Castleman disease (MCD) complicated by severe respiratory failure, which was successfully managed through bilateral lung transplantation. A 31-year-old male patient exhibited progressive dyspnea attributed to MCD associated with bronchiolitis obliterans. Pretransplant evaluations indicated severe hypercapnia and markedly impaired pulmonary function. Despite the administration of steroid therapy, the patient's respiratory status continued to decline. Consequently, he underwent bilateral lung transplantation, which resulted in significant alleviation of hypercapnia and considerable improvement in pulmonary function. Four years posttransplant, the patient remains alive and does not require supplemental oxygen. This case highlights the potential efficacy of bilateral lung transplantation in addressing severe respiratory complications associated with MCD.
Limb Mucormycosis in the Early Postoperative Period Following Kidney Transplantation: A Case Report.
Li F, He L, Wang X
Transplant Proc · 2026 Mar · PMID 41633863 · Publisher ↗
Post-transplant mucormycosis is a rare but life-threatening complication with high mortality. We report a severe case of upper limb mucormycosis in a 58-year-old diabetic kidney transplant recipient. Despite standard imm...
Post-transplant mucormycosis is a rare but life-threatening complication with high mortality. We report a severe case of upper limb mucormycosis in a 58-year-old diabetic kidney transplant recipient. Despite standard immunosuppression, progressive skin lesions developed on the left forearm. Initial debridement failed to arrest progression, revealing extensive muscle necrosis and vascular thrombosis. Rhizopus oryzae was confirmed by histopathology and culture. Surgical management required mid-humeral amputation followed by shoulder disarticulation due to persistent fungal invasion. Antifungal therapy included liposomal amphotericin B and isavuconazole alongside immunosuppression reduction. This case underscores the aggressive nature of mucormycosis in immunocompromised hosts, highlighting the critical need for early diagnosis, radical surgical intervention, combined antifungal therapy, and most importantly sustained vigilance by transplant teams for this fungal infection, as delayed intervention could lead to catastrophic consequences.
Case Report: Intra-abdominal Mucormycosis Diagnosed at the Time of Liver Transplantation for Surgically Induced Acute Liver Failure.
Boothankad Sharath D, Shoucair S, Nadeem MA … +2 more , Fujiki M, Koval CE
Transplant Proc · 2026 Mar · PMID 41633862 · Publisher ↗
Mucormycosis is an aggressive fungal infection associated with high mortality, particularly among recipients of solid organ transplants. Gastrointestinal involvement is rare but can be fatal due to delayed diagnosis and...
Mucormycosis is an aggressive fungal infection associated with high mortality, particularly among recipients of solid organ transplants. Gastrointestinal involvement is rare but can be fatal due to delayed diagnosis and limited therapeutic options. We report on a 59-year-old female who developed intra-abdominal mucormycosis that was diagnosed during orthotopic liver transplantation. She initially presented with a perforated duodenal ulcer requiring emergent surgical repair and subsequently developed acute liver failure due to an iatrogenic transection of the portal triad. She underwent urgent orthotopic liver transplantation and was found to have multiple gastric ulcers. Tissue biopsies from the stomach and abdomen revealed broad, nonseptate hyphae consistent with Mucorales, which was later identified as Mucor circinelloides. Postoperatively, she required eight reexplorations with extensive debridement and amphotericin B irrigation of the abdominal cavity. She received systemic antifungal therapy with liposomal amphotericin B and azoles guided by susceptibility testing. Immunosuppression was minimized, with tacrolimus maintained at low trough levels and a rapid corticosteroid taper. Fungal cultures cleared up 25 days posttransplant. She completed 6 months of antifungal therapy and remains free from infection with excellent graft function at 1 year. This case underscores the importance of early diagnosis of intra-abdominal mucormycosis and highlights that aggressive surgical debridement, tailored antifungal therapy, and careful immunosuppression management are essential to achieving a successful outcome.
A Successful Lung Transplantation in a Patient With Active Coronavirus Disease 2019: A Case Report.
Divithotawela C, Lee ZS, Hopkins PMA … +2 more , Burke A, Fiene A
Transplant Proc · 2026 Mar · PMID 41633861 · Publisher ↗
BACKGROUND: An active Coronavirus disease 2019 (COVID-19) infection is considered a contraindication for lung transplantation. However, missing a lung transplant opportunity for patients with end-stage pulmonary disease...
BACKGROUND: An active Coronavirus disease 2019 (COVID-19) infection is considered a contraindication for lung transplantation. However, missing a lung transplant opportunity for patients with end-stage pulmonary disease can lead to increased morbidity and mortality. This case report focuses on a successful lung transplantation performed on a patient with an active COVID-19 infection and aims to contribute valuable insights to the limited existing literature on this topic. METHODS: After obtaining institutional ethics approval and patient consent, medical records were reviewed to prepare the case report. RESULTS: A 45-year-old patient with chronic rejection after her first lung transplant was on mechanical ventilation while waiting for a donor. When a suitable donor became available, she tested positive for COVID-19 right before surgery. Despite the risks, the decision was made to proceed with the transplant. She received remdesivir and intravenous immunoglobulin therapy. Her recovery was uneventful, and 3 months posttransplant, she showed excellent graft function with no signs of rejection. CONCLUSION: In carefully selected patients with limited donor availability, lung transplantation may be considered in active COVID-19 infected patient, accompanied by a tailored regimen of antiviral therapy and immunosuppression.
Kidney Transplantation as Curative Therapy for Refractory Dialysis-induced Hypotension: A Case Report and Literature Review.
El Hennawy H, Yousef H, Qahtani AA … +7 more , Atta EA, Sarhan MA, Attia M, Zaitoun MF, Safar O, Alqahtani MM, Mahedy A
Transplant Proc · 2026 Mar · PMID 41633860 · Publisher ↗
OBJECTIVE: Persistent chronic hypotension (PCH) is a debilitating condition in patients undergoing long-term hemodialysis that is often deemed a relative contraindication to kidney transplantation. We present a high-risk...
OBJECTIVE: Persistent chronic hypotension (PCH) is a debilitating condition in patients undergoing long-term hemodialysis that is often deemed a relative contraindication to kidney transplantation. We present a high-risk case demonstrating the feasibility and curative potential of transplantation under a stringent, multidisciplinary protocol. CASE PRESENTATION: A 26-year-old woman with end-stage renal disease after 16 years of hemodialysis presented with severe, refractory PCH (70/50 mm Hg at rest, dropping to 50/30 mm Hg during dialysis), superior vena cava obstruction, anuria, and a microscopic bladder capacity of 15 cc. Following multidisciplinary evaluation and preoperative bladder training, the patient underwent living-related kidney transplantation. A dual renal artery graft, necessitating back-table side-to-side reconstruction, complicated the procedure. Intraoperative management included invasive hemodynamic monitoring, transesophageal echocardiography (TEE), and preemptive norepinephrine infusion. RESULTS: The allograft achieved immediate function upon reperfusion. Vasopressor support was weaned and discontinued early postoperatively, with concurrent cessation of all pretransplant antihypotensive medications. The patient's blood pressure rapidly normalized to the reference ranges without pharmacological support. The patient was discharged on postoperative day 7 with excellent and sustained graft function. CONCLUSION: Kidney transplantation is the only curative treatment for refractory dialysis-induced hypotension. The successful outcome, even in the presence of major comorbidities, was contingent on a proactive, protocol-driven, and multidisciplinary perioperative strategy. Consequently, PCH should not be a barrier to transplantation but rather an indication for referral to a specialized center capable of providing this level of care.
Contained Colonic Perforation Following Sclerotherapy and Laparoscopic Fenestration for a Post-Transplant Lymphocele: A Case Report and Review.
El Hennawy H, Hassan F, Aesh RA … +9 more , Sadagah LF, Kotbi E, Safar O, Aboalsamh GA, Almalki AH, Hennawy ME, Kheder AA, Ibrahim M, Jaber TM
Transplant Proc · 2026 Mar · PMID 41633859 · Publisher ↗
BACKGROUND: Symptomatic lymphoceles are a frequent complication following kidney transplantation and are commonly managed with percutaneous drainage and sclerotherapy using agents such as povidone-iodine or ethanol. Refr...
BACKGROUND: Symptomatic lymphoceles are a frequent complication following kidney transplantation and are commonly managed with percutaneous drainage and sclerotherapy using agents such as povidone-iodine or ethanol. Refractory cases often require laparoscopic peritoneal fenestration. Although these interventions are generally effective, their cytotoxic properties and cumulative effects may predispose to rare but severe delayed complications. CASE PRESENTATION: A 71-year-old man underwent living-donor kidney transplantation, followed by postoperative wound dehiscence requiring mesh repair and the subsequent development of a symptomatic peri-graft lymphocele. Management progressed from percutaneous drainage with povidone-iodine sclerotherapy to ethanol sclerotherapy and, ultimately, laparoscopic peritoneal fenestration on postoperative day 46. The patient was readmitted 4 days after discharge with sepsis. Imaging demonstrated a retroperitoneal collection communicating with the ascending colon. Surgical exploration confirmed a contained colonic perforation, necessitating right hemicolectomy with end ileostomy to preserve allograft function. CONCLUSION: This case describes a rare, life-threatening delayed colonic perforation following sequential lymphocele interventions. Histopathological findings were most consistent with delayed chemical ischemic necrosis, strongly implicating ethanol diffusion as a major contributing factor, likely exacerbated by altered anatomy from prior surgery and repeated interventions. The delayed presentation underscores the cumulative risk associated with sequential minimally invasive therapies. It highlights the need for meticulous technique, individualized risk assessment, prolonged post-procedural surveillance, and early surgical readiness in high-risk transplant recipients.
A Case of Persistent Candida Keyfr Bloodstream Infection in a Lung Transplant Recipient.
Yavuzkilic H, Jokomo-Nakayabau R, Tager D … +3 more , Lum J, Koval C, Mehta AC
Transplant Proc · 2026 Mar · PMID 41633858 · Publisher ↗
A 67-year-old female underwent an en-bloc double lung transplantation for idiopathic pulmonary fibrosis. The post-transplant course was complicated by refractory septic shock. Despite empiric antimicrobial coverage with...
A 67-year-old female underwent an en-bloc double lung transplantation for idiopathic pulmonary fibrosis. The post-transplant course was complicated by refractory septic shock. Despite empiric antimicrobial coverage with vancomycin, meropenem, micafungin, and posaconazole, she continued to require high-dose vasopressors and remained unable to wean from veno-venous extracorporeal membrane oxygenation (ECMO). Blood cultures were positive for Candida Kefyr (teleomorph: Kluyveromyces marxianus), the same organism that had been isolated from donor bronchoalveolar lavage cultures 5 days prior to transplant. Micafungin and posaconazole doses were increased, and intravenous (IV) liposomal amphotericin B was added. Within 2 days, her hemodynamics improved, allowing successful weaning from ECMO. However, repeat blood cultures demonstrated persistent candidemia. Chest computed tomography revealed pericardial and bilateral pleural effusions, suspicious for mediastinitis and empyema. Transesophageal echocardiography confirmed pericardial effusion but showed no vegetations. Chorioretinal lesions were noted bilaterally without vitritis. Micafungin and posaconazole were discontinued and IV voriconazole was started for eye penetration. Amphotericin B was continued for 4 weeks and voriconazole for 3 months. Repeat blood cultures showed clearance of fungemia, and ophthalmology eye exam showed no further signs of chorioretinitis. Donor-derived infections are a rare complication of solid organ transplantation, with fungal infections posing a unique challenge due to their high morbidity and mortality. To our knowledge, there are no documented cases in the literature of possible donor-derived C. kefyr leading to blood stream infection in the recipient. This case highlights the need for heightened clinical vigilance and prompt multidisciplinary management to mitigate the impact of post-transplant complications.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe