Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients. The incidence of infection in renal transplant ...patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy. The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections. Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis.
Previously, membranous nephropathies were divided into primary and secondary categories when the exact mechanism or pathogenetic factor were unknown.
Approximately 70% accounted for primary ...membranous nephropathies. The
remaining 30% were called secondary because they developed due to well-known
diseases such as autoimmune diseases, tumours, infections, or drug assumptions.
The discoveries of the M-type phospholipase A2 receptor and of thrombospondin
type 1 domain containing 7A as causative antigens in a part of the so-called primary
membranous nephropathies opened new knowledge on the effective causes of
a large part of these diseases. The availability of novel techniques such as laser
micro-dissection and tandem mass spectrometry, as well as immunochemistry with
antibodies directed against novel proteins, allowed the confirmation of new antigens
involved. The use of confocal microscopy and Western blot allowed detection of the
new antigen on glomerular membrane, and the same antigen and relative antibodies
have been detected in serum samples.
Through these techniques, four new antigens were first detected, including neural
epidermal growth factor 1 and semaphorin 3B in the so-called primary membranous
nephropathy, and exostosin 1 and 2 and neural cell adhesion molecule 1 in lupus
membranous nephropathy.
The aim of this study is to describe the characteristics of the new antigens
discovered and their association with other diseases. In addition, new antigens
are on the horizon, and the story of primary membranous nephropathy is still to be
completely written and understood.
The gut microbial community may be associated with complications after kidney transplantation. The indigenous microbiota has a significant and protective function that influences the transplant ...recipient response. Genetic or environmental factors may modify the indigenous microbiota and pathobionts appear.
In this condition, several disturbances of the kidney graft may be observed. These include acute rejection, infection, diarrhoea, disturbance in the induction of tolerance, and modification of immunosuppressive drug metabolism.
Recently, the use of prebiotics, probiotics, and synbiotics has been demonstrated to be effective in normalising these conditions and in restoring the generation of the normal indigenous microbiota.
An improved understanding of the function and composition of the indigenous microbiota may help in finding further solutions to stabilise the microbiota after kidney transplantation.
Trapianto renale da donatore vivente Tsalouchos, Aris; Salvadori, Maurizio
Giornale di clinica nefrologica e dialisi,
03/2021, Letnik:
33
Journal Article
Recenzirano
Odprti dostop
Kidney transplant is the best therapy to manage end-stage kidney failure. The main barriers limiting this therapy are scarcity of cadaveric donors and the comorbidities of the patients with end-stage ...kidney failure, which prevent the transplant. Living kidney donor transplant makes it possible to obviate the problem of scarcity of cadaveric donor organs and also presents better results than those of cadaveric transplant. The principal indication of living kidney donor transplant is preemptive transplant. This allows the patient to avoid the complications of dialysis and it has also been demonstrated that it has better results than the transplant done after dialysis has been initiated. Priority indications of living donor transplant are also twins and HLA identical siblings. We also have very favorable conditions when the donor is young and male. On the contrary, the living donor transplant will have worse results if the donors are over 60-65 years and the recipients are young, and this can be a relative contraindication. There is an absolute contraindication for the living donation when the recipient has diseases with high risk of aggressive relapse in the grafts: focal and segmental hyalinosis that had early relapse in the first transplant; atypical hemolytic uremic syndrome due to deficit or malfunction of the complement regulatory proteins; early development of glomerulonephritis due to anti-glomerular basement membrane antibody in patients with Alport syndrome; primary hyperoxaluria.
Extreme caution should also be taken in the evaluation of the kidney donors. The risks of developing renal failure or other complications are low if an adequate pre-donation evaluation has been made according to the international guidelines.
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