La infección por el virus de la hepatitis C (VHC) es considerada un factor que reduce la supervivencia del paciente y del injerto en trasplante renal (TR). La disponibilidad de los nuevos antivirales ...de acción directa (AAD), muy eficaces y con un excelente perfil de seguridad, está permitiendo erradicar el VHC de los pacientes con enfermedad renal, y ello supone un revolucionario cambio radical en la evolución natural de esta infección, hasta ahora sin un tratamiento eficaz y seguro por la contraindicación del interferón en los trasplantados renales.
La eficacia de algunos AAD para todos los genotipos, incluso en pacientes con insuficiencia renal, constituye una enorme contribución para erradicar el VHC en la población con TR al margen del genotipo, del grado de insuficiencia renal, de la progresión de la hepatopatía y de la existencia previa de tratamiento anti-VHC.
Todo ello está planteando, aunque con controversias, la posibilidad de utilizar riñones de donantes infectados VHC+ para trasplante en receptores no infectados y poder tratarse y curarse tras el TR precoz, aumentando así el pool total de riñones para TR.
Hepatitis C virus (HCV) infection is a factor that reduces the survival of the patient and the graft in renal transplant (RT). The availability of directly acting antivirals agents (DAAs), very effective and with an excellent safety profile, it allows eradicate HCV from patients with kidney disease, and this is a revolutionary radical change in the natural evolution of this infection, until now without effective and safe treatment for the contraindication use of interferon in kidney transplant patients.
The efficiency of some DAAs for all genotypes, even in patients with renal insufficiency constitutes a huge contribution to eradicate HCV in the RT population independently the genotype, severity of kidney failure, progression of liver disease and previous anti HCV therapy.
All this is raising, although with controversies, the possibility of use kidneys from infected HCV+ donors for transplant in uninfected receptors and can be treated successfully in the early post-TR, thus increasing the total “pool” of kidneys for RT.
Hepatitis C virus (HCV) infection is a factor that reduces the survival of the patient and the graft in renal transplant (RT). The availability of directly acting antivirals agents (DAAs), very ...effective and with an excellent safety profile, it allows eradicate HCV from patients with kidney disease, and this is a revolutionary radical change in the natural evolution of this infection, until now without effective and safe treatment for the contraindication use of interferon in kidney transplant patients. The efficiency of some DAAs for all genotypes, even in patients with renal insufficiency constitutes a huge contribution to eradicate HCV in the RT population independently the genotype, severity of kidney failure, progression of liver disease and previous anti HCV therapy. All this is raising, although with controversies, the possibility of use kidneys from infected HCV+ donors for transplant in uninfected receptors and can be treated successfully in the early post-TR, thus increasing the total "pool" of kidneys for RT.
Hepatitis C virus (HCV) infection is a factor that reduces the survival of the patient and the graft in renal transplant (RT). The availability of directly acting antivirals agents (DAAs), very ...effective and with an excellent safety profile, it allows eradicate HCV from patients with kidney disease, and this is a revolutionary radical change in the natural evolution of this infection, until now without effective and safe treatment for the contraindication use of interferon in kidney transplant patients.
The efficiency of some DAAs for all genotypes, even in patients with renal insufficiency constitutes a huge contribution to eradicate HCV in the RT population independently the genotype, severity of kidney failure, progression of liver disease and previous anti HCV therapy.
All this is raising, although with controversies, the possibility of use kidneys from infected HCV+ donors for transplant in uninfected receptors and can be treated successfully in the early post-TR, thus increasing the total “pool” of kidneys for RT.
La infección por el virus de la hepatitis C (VHC) es considerada un factor que reduce la supervivencia del paciente y del injerto en trasplante renal (TR). La disponibilidad de los nuevos antivirales de acción directa (AAD), muy eficaces y con un excelente perfil de seguridad, está permitiendo erradicar el VHC de los pacientes con enfermedad renal, y ello supone un revolucionario cambio radical en la evolución natural de esta infección, hasta ahora sin un tratamiento eficaz y seguro por la contraindicación del interferón en los trasplantados renales.
La eficacia de algunos AAD para todos los genotipos, incluso en pacientes con insuficiencia renal, constituye una enorme contribución para erradicar el VHC en la población con TR al margen del genotipo, del grado de insuficiencia renal, de la progresión de la hepatopatía y de la existencia previa de tratamiento anti-VHC.
Todo ello está planteando, aunque con controversias, la posibilidad de utilizar riñones de donantes infectados VHC+ para trasplante en receptores no infectados y poder tratarse y curarse tras el TR precoz, aumentando así el pool total de riñones para TR.
Coronavirus disease 2019 (COVID‐19) predisposes patients to bacterial and fungal superinfections due to the impairment of the immunological system. Among the associated opportunistic fungal ...infections, mucormycosis is one of the least frequent but with the highest mortality. We describe two cases of mucormycosis in two kidney transplant recipients, while they were hospitalized for SARS‐CoV‐2 pneumonia, with rhinosinusal and musculoskeletal involvement, respectively.
Monoclonal immunoglobulin deposition disease (MIDD) usually leads to kidney failure. Treatment of patients with a bortezomib-based regimen followed by autologous stem cell transplantation (SCT) has ...been increasingly used, with improvements in the response rates and allograft outcomes in kidney transplant recipients. The objective of this report was to analyze the outcomes of 6 patients who underwent kidney transplantation in our institution after treatment of MIDD between 2010 and 2019. Monoclonal immunoglobulin deposition disease was initially treated with bortezomib-based therapy followed by high-dose melphalan and autologous SCT with complete hematologic response, although all patients remained on dialysis. During a median follow-up of 20.5 months from kidney transplant (54 months from SCT), 1 patient experienced hematologic relapse and 2 had hematologic progression (one of them with MIDD relapse in the allograft) requiring treatment. The patient with organ relapse received daratumumab monotherapy, achieving complete hematologic response but with graft failure. The other 5 patients had functional grafts with median serum creatinine 1.68 mg/dL. These results support that, in patients with MIDD and sustained complete hematologic response, a kidney transplant can be considered. The optimal approach to treatment of hematologic relapse or recurrence of MIDD after kidney transplant remains to be determined.
Introduction
The current pool of organs available for transplantation does not cover requirements, for this reason non-standard risk donors need to be incorporated into the pool. In this way, donors ...with small renal tumour are considered for transplantation after bench tumour excision. The aim of our study was to analyse our experience in using these grafts for transplantation.
Materials and methods
Retrospective analysis from our prospective accrued database of donors with incidental renal mass used for kidney transplantation between January 2007 and August 2018.
Results
Twenty kidney transplantations were performed, thirteen cases received the affected kidney (after tumour removal) and seven the contralateral kidney; from six living and eleven deceased donors. Donor and recipient median age was 58 years (range 22–82) and 56.5 years (range 38–74), respectively. Mean tumour diameter was 12.7 mm (SD 9.5). Tumours resulted in two benign lesions and fifteen renal cell carcinoma. Surgical margins were negative. Two cases presented with bleeding after reperfusion was solved without repercussion. One case presented with immediate vein thrombosis. None of them present delayed graft function. After a 69 month follow-up none of the donors or the recipients presented tumour recurrence.
Conclusions
Kidneys with small incidental tumours seem to be a good option for kidney transplantation in selected patients after bench surgery excision with good functional and oncologic results. More studies and longer follow-up are needed to confirm these results.
Historically, donor infection with hepatitis-C virus (HCV) has been a barrier to kidney transplantation. However, in recent years, it has been reported that HCV positive kidney donors transplanted ...into HCV negative recipients offer acceptable mid-term results. However, acceptance of HCV donors, especially viremic, has not broadened in the clinical practice. This is an observational, multicenter, retrospective study including kidney transplants from HCV positive donors into negative recipients reported to the Spanish group from 2013 to 2021. Recipients from viremic donors received peri-transplant treatment with direct antiviral agents (DAA) for 8-12 weeks. We included 75 recipients from 44 HCV non-viremic donors and 41 from 25 HCV viremic donors. Primary non function, delayed graft function, acute rejection rate, renal function at the end of follow up, and patient and graft survival were not different between groups. Viral replication was not detected in recipients from non-viremic donors. Recipient treatment with DAA started pre-transplant avoids (
= 21) or attenuates (
= 5) viral replication but leads to non-different outcomes to post-transplant treatment with DAA (
= 15). HCV seroconversion was more frequent in recipients from viremic donors (73% vs. 16%,
< 0.001). One recipient of a viremic donor died due to hepatocellular carcinoma at 38 months. Donor HCV viremia seems not to be a risk factor for kidney transplant recipients receiving peri-transplant DAA, but continuous surveillance should be advised.
Los pacientes trasplantados de riñón de gemelo monocigótico reciben en un 60% de los casos algún tipo de inmunosupresión estándar a pesar de la imposibilidad teórica para generar una respuesta ...aloinmune. El objetivo de este estudio es evaluar la respuesta clínica de los receptores renales de donante vivo de gemelo monocigoto sin tratamiento inmunosupresor.
Estudio observacional retrospectivo entre 1969 y 2013 de pacientes trasplantados renales de donante vivo entre gemelos monocigotos. Se ha recogido edad y enfermedad primaria del receptor, función renal, supervivencia renal y global. El protocolo inmunosupresor consistía en la administración de una dosis única intraoperatoria de 500mg de metilprednisolona sin otra inmunosupresión de mantenimiento.
Se identificó a 5 receptores renales de gemelos idénticos en nuestro centro. Edad media en el momento del trasplante 33 años (27-39). La supervivencia a un año de los pacientes y el injerto fue del 100%. La creatinina media al año fue de 0,96±0,2 y al último seguimiento de 1,2±0,37mg/dl. Dos pacientes fallecieron con injerto funcional más de 15 años después del trasplante (uno debido a melanoma y otro debido a un evento cardiovascular). Se perdió el seguimiento de un paciente al año del trasplante. Los 2 pacientes restantes están vivos 18 meses y 42,5 años después del trasplante, respectivamente, con injerto funcionante.
El trasplante renal entre gemelos monocigotos ofrece excelentes resultados clínicos. Probablemente el tratamiento inmunosupresor para inhibir la respuesta aloinmune es innecesario en estos casos cuando se haya comprobado la cigosidad.
Standard immunosuppression is used in about 60% of patients receiving kidney grafts from their monozygotic twins living donor although an alloimmune response can not take place. The aim of the study was to asses the clinical response in patients receiving renal grafts from a monozygotic twin living donor when no immunosuppressive therapy is used.
This is a retrospective observational study of patients receiving kidney grafts from their monozygotic twins from 1969 to 2013. The following data were recorded: age, renal graft recipient's primary disease, renal function, renal survival and overall survival. Immu- nosuppressive therapy included a single intraoperative dose of methylprednisolone 500 mg and no maintenance immunosuppression.
Five patients with kidney grafts from their monozygotic twins were dentified in our centre. Mean age at transplantation was 33 years (27-39). One-year overall survival and graft survival were 100%. Mean creatinine level was 0.96 ± 0.2 one year after transplantation, and 1.2 ± 0.37 mg/dl at most recent follow-up. Two patients died with a functional graft more than 15 years after kidney transplantation (causes were melanoma and cardiovascular event respectively). Follow-up was lost in a patient one year after transplantation. Two patients are alive with a functioning graft at 18 months and 42.5 years after transplantation respectively.
Kidney transplantation from a monozygotic twin living donor is associated with excellent clinical outcomes. Immunosuppressive therapy to suppress alloimmune response is probably unnecessary if zygosity has been confirmed.
C3 glomerulopathy is a rare disease caused by fluid phase dysregulation of the alternative complement pathway. Currently, treatment depends on clinical and histological severity and includes ...nephroprotection, unspecific immunosuppression, and terminal complement blockers (C5), without having an etiological treatment approved. C3 glomerulopathy has high recurrence rates after kidney transplantation with a high risk of graft loss. Fortunately, new molecules are being developed that specifically target the proximal alternative complement pathway, such as iptacopan, a factor B inhibitor that showed promising results in native kidneys and cases of transplant recurrence in a phase 2 clinical trial. We present 2 “real-world” cases of C3 glomerulopathy recurrence in kidney allografts treated with iptacopan, with initial excellent clinical response and safety profile, especially with early introduction. We also present follow-up biopsies that showed no C3 deposition during factor B inhibition. Our cases suggest that proximal blockade of the alternative complement pathway can be effective and safe in the treatment of C3 glomerulopathy recurrence in kidney transplantation, bringing other questions such as dual blockade (eg, in C3 and C5), the optimal patient profile to benefit from factor B inhibition or treatment duration and its potential use in other forms of membranoproliferative glomerulonephritis (eg, immune complex-mediated).
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