Current Issue : October - December Volume : 2020 Issue Number : 4 Articles : 7 Articles
Background: Extra-gastric (particularly colonic) lymphoma of mucosa-associated lymphoid tissue in the\nimmunosuppressed solid organ transplant recipient is rare. We report a case of low-volume mucosa-associated\nlymphoid tissue lymphoma with colonic and bone marrow involvement in a renal transplant recipient that has\nbeen managed conservatively.\nCase presentation: A 62-year-old Caucasian man, 14 years after kidney transplantation, was diagnosed as having\nextra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue with bone marrow and colonic\ninvolvement, after a colonoscopy identified mucosa-associated lymphoid tissue lymphoma in a sessile sigmoid\npolyp following surveillance fecal occult blood testing that returned a positive result. A gastric biopsy showed no\nevidence of Helicobacter pylori, but Helicobacter pylori immunoglobulin G was positive. He received Helicobacter\npylori eradication treatment and is being managed expectantly. Immunosuppression was unchanged with prednisolone,\nmycophenolate mofetil, and cyclosporine A. Renal allograft function has remained stable.\nConclusions: This case highlights the unexpected occurrence of colonic mucosa-associated lymphoid tissue lymphoma\nin a kidney transplant recipient. The case emphasizes the importance of histopathological diagnosis of colonic lesions in\nthis patient cohort because the unusual diagnosis of low-volume mucosa-associated lymphoid tissue lymphoma can be\nmanaged expectantly as it does not appear to be clinically aggressive in the immunosuppressed solid organ transplant....
The development of pluripotent stem cell (PSC)-based technologies provides us a new therapeutic approach that\ngenerates grafts for transplantation. In order to minimize the risk of immune reaction, the banking of induced\npluripotent stem cells (iPSCs) from donors with homozygous human leukocyte antigen (HLA) haplotype is planned\nin Japan. Even though pre-stocked and safety validated HLA-homozygous iPSCs are selected, immunological\nrejection may potentially occur because the causes of rejection are not always due to HLA mismatches. A couple of\nstudies concerning such immunological issues have reported that genetic ablation of HLA molecules from PSC\ncombined with gene transduction of several immunoregulatory molecules may be effective in avoiding immunological\nrejection. Also, our research group has recently proposed a concept that attempts to regulate recipient immune\nsystem by PSC-derived immunoregulatory cells, which results in prolonged survival of the same PSC-derived allografts.\nPSC-based technologies enable us to choose a new therapeutic option; however, considering its safety from an\nimmunological point of view should be of great importance for safe clinical translation of this technology....
Hepatic hemangioma (HH) is the most common benign tumor of the liver. In special conditions such\nas rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs exist\ntreatment is indicated. Surgical management is the most common treatment for HH.\nCase presentation: A 38-year-old male patient was diagnosed with HH for 7 years. The initial presentation of the\nmass was progressive abdominal distention causing early satiety, gastro-esophageal reflux disease, vomiting,\ndysphagia and weight loss. Later, the patient developed bilateral lower extremity edema. Imaging with computed\ntomography (CT scan) showed a large mass measuring 32.4*26*3.1 cm which was considered unresectable. The\npatient underwent a deceased donor liver transplantation. The excised mass was 9 kg. After nine days of hospitalization\nthe patient was discharged in good condition. Three months later, the patient was admitted due to fever and\ncytomegalovirus infection for which he received intravenous ganciclovir and was discharged. In the latest follow-up\nthe patient had no liver or kidney dysfunction eight months after the transplantation.\nConclusion: With appropriate patient selection, liver transplantation can be considered as a treatment option for\npatients with huge HHs which are life-threatening and surgically unresectable....
Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and\nend-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was\ncompletely reversible after pericardectomy.\nCase presentation: A 43-year-old female caucasian patient received a living kidney donation from her mother. She\nhad developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease\nafter allogenic stem-cell transplantation for aplastic anemia.\nThe graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery,\nbut the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography\nshowed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion\nprofiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem\non ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive\nacute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused\nby severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis,\nwhich could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been\napparent on previous x-rays, computed tomography scans, or echocardiographies, including those for\ntransplantation evaluation.\nConservative management of the constrictive pericarditis was not successful and the graft remained anuric.\nEventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the\ngraft started urine production again, which significantly increased within a few days. The clearance improved and 2\nweeks later, the patient was free from dialysis.\nConclusions: This case illustrates that special attention should be given to the pericardium during transplant\nevaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation....
Growth differentiation factor-15 (GDF15) is associated with inflammatory conditions,\nchronic kidney disease, cardiovascular disease and mortality. There is very limited data on GDF15\nafter kidney donation and transplantation. We analyzed serum samples of patients who donated a\nkidney (54 living donors) or who underwent kidney transplantation (104 recipients) at the University\nHospital of Münster (Germany) between 2013 and 2015, for GDF15 levels immediately prior and\none year after surgery. GDF15 levels were significantly elevated in end-stage renal disease patients....................
An optimal donor work-up to exclude preexisting conditions is recommended, but urgency and\ntechnical equipment in donor centers must be considered. We report a case of two coronary stents present in the\ndonor heart and the related long-term outcome.\nCase presentation: A 59-year-old European male patient suffering from dilated cardiomyopathy with severely\nreduced left ventricular function and presenting with NYHA III underwent cardiac transplantation in 2004. At the\none-year follow-up, during routine cardiac catheterization, two stents were found, one in the right coronary artery\nand one in the circumflex artery, in the patientâ??s transplanted heart. As no stent implantation was performed since\ntransplantation, these were present prior to transplantation and had been transplanted without causing clinical\nsigns. One of the stents showed in-stent restenosis, and the patient received an additional stent 7 years after\ntransplantation. The other stent still showed a good result, and no further intervention has been required so far.\nThe patient is currently in good clinical condition.\nConclusion: This is the first case report of favorable long-term stented coronary arteries prior to transplantation.\nThis case highlights the importance of the donor work-up and meticulous palpation of the coronary arteries during\ndonor evaluation....
Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a\nchallenging situation.\nMethods: We retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis\ntwice, reviewed the relevant literature, and summarized the characteristics of this disease.\nResults: We retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The\nsummarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was\n33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous\nnephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%)\nand conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years\nposttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure\n(ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed.\nThe patient recovered well after surgery, except for a 3mm residual stone in the calyx after the second surgery. He\nhad normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict\nfollow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later.\nConclusions: Due to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may\nhave delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two\nor more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders\nand avoiding UIT are key measures to prevent the recurrence of lithiasis....
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