We report the case of a patient with an optic neuropathy induced by neurotoxicity in the setting of methylmalonic acidemia. The patient responded with a significant and long-term improvement in ...visual acuity, perimetry, and chromatic function after a neuroprotective treatment with vitamin E and coenzyme Q10 was started. Coenzyme Q10 levels had been proven to be normal before starting treatment. This case report is particularly important because it describes a possible treatment for optic neuropathy in methylmalonic patients. Although the response might be, in part, specific to the individual, it suggests the existence of a cause–effect relationship between the treatment undergone by our patient and the improvement in her visual acuity. To date, no other treatments with beneficial effects have been reported for the few optic neuropathies caused by methylmalonic acidemia. Further studies should determine the applicability of coenzyme Q10 and vitamin E for the treatment of optic neuropathies in methylmalonic acidemia.
Summary
This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1‐year kidney transplant (KT) outcomes. Of 3992 ...deceased donor KT performed in 2014–2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower‐bound‐95%CI OR upper‐bound‐95%CI) were male gender (1.0661.2491.463), diabetic kidney disease (1.0531.2961.595), time on dialysis (1.0051.0071.009), retransplantation (1.0351.3971.885), preformed anti‐HLA antibodies (1.0111.3831.892), HLA mismatches (1.0061.0661.130), donor age (1.0111.0171.023), donor final serum creatinine (sCr) (1.2391.3171.399), cold ischemia time (CIT) (1.0311.0431.056), machine perfusion (0.4010.5420.733), and induction therapy with rabbit antithymocyte globulin (rATG) (0.6580.8000.973). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.
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