High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation

BACKGROUND: Although gastrointestinal (GI) symptoms are very frequent in organ transplant patients, there is a paucity of data about the endoscopic findings of kidney recipients. METHODS: Two thousand one hundred and thirty-five kidney transplants were performed between 1994 and 2007. During that period, 672 gastroscopies were performed in 543 of those patients. Their mean age was 49.5 years and 56.9% were male. Immunosuppressive combinations included cyclosporine-mycophenolate-steroids, cyclosporine-steroids and tacrolimus-mycophenolate mofetil-steroids. Ninety-eight percent of the patients received acid suppression therapy. RESULTS: The rate of clinically significant endoscopic findings was 84%. Macroscopic findings included inflammation in 46.7%, oesophagitis in 24.7%, ulcer in 16.9% and erosions in 14.8% of cases. Twenty-nine percent of endoscopies showed ulcer disease more frequently in the first 3 months (P=0.0014) after transplantation than later, and 45.7% of all ulcers developed in the first year. The presence of Helicobacter pylori was verified in 20.9% of cases, less than in the general, and also in the uraemic population (P<0.0001). There was no association between the presence of H. pylori and ulcers (P=0.28). Steroid pulse treatment for rejection was not associated with more ulcers (P=0.11); the use of mycophenolate mofetil increased the risk of erosions by 1.8-fold. CONCLUSION: More than 25% of all kidney recipients required upper endoscopy in their 'post-transplant life'; the prevalence of 'positive findings' and ulcer disease was higher than in the general population (P<0.0001). The most vulnerable period is the first 3 months. Mycophenolate mofetil had an impact on GI complications, whilst the presence of H. pylori in the transplant population is not associated with the presence of ulcers

Efficacy of early biopsy in kidney allograft recipients with delayed graft function.

t is accepted that kidney transplants that display delayed graft function (DGF) show poorer survival and function, particularly when an acute rejection episode (ARE) occurs. A diagnostic biopsy to establish the reason for DGF, or acknowledge an ARE, even if borderline, can improve short- and long-term graft survivals. From January 2002 to September 2006 we retrospectively evaluated 358 kidney transplant recipients. We performed a biopsy to evaluate the cause of DGF in all patients who required dialysis, or had serum creatinine levels that increased, remained unchanged, or decreased less than 10% per day on three consecutive days during the first week after transplantation. An ARE was found in 18.8% (n = 19) of the biopsies. Early biopsy for patients with DGF is a safe method that allows uncovering of an ARE that would otherwise be undetected. The immediate recognition and treatment of rejection episodes can certainly increase long-term survival and function of renal transplants

Polar nephrectomy in a transplanted kidney: a case report.

After renal transplantation, infarction of the lower pole may be observed. We report an unusual case of lower pole infarction and perforation of the lower calyx due to thrombosis of a lower polar artery. This was managed successfully with partial nephrectomy (nephron-sparing surgery)

The influence of socioeconomic deprivation on outcomes following renal transplantation in the United Kingdom

Socio-economic deprivation is an important determinant of poor health and is associated with a higher incidence of end-stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio-economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p=0.01) and increasing overall deprivation correlated with increasing rates of rejection (p=0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p=0.046). Among patients who experienced acute rejection 5-year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio-economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival

SARS-CoV-2 in kidney transplant and waitlisted patients during the first peak: the Welsh experience

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic has led to many health care services, including transplantation, being temporarily suspended. For transplantation to safely recommence, there is a need to understand the effects of SARS-CoV-2 in transplant and waitlist patients. We identified 21 patients with proven SARS-CoV-2 infection (13 transplant; 8 waitlist) during the first peak of coronavirus disease 2019 in Wales. Median patient age was 57 years (range, 24-69), 62% were male, and all were white. Median body mass index was 29 kg/m2 (range, 22-42), and 81% had 1 or more significant comorbidities. Median time from transplant to SARS-CoV-2 infection was 135 months (range, 9-356) and median time since being listed was 17.5 months (range, 5-69) for waitlisted patients. Seventeen patients were admitted to the hospital (81%), 18% (n = 3) in intensive care unit, and 5 patients died (4 transplant recipients and 1 waitlist patient; 24%). Two of the 4 transplant patients who died had recent malignancy. Although the mortality of hospitalized transplant patients was high, their infection rate of 0.87% meant that the overall mortality of transplant patients due to SARS-CoV-2 was low and comparable to that of patients on the waitlist. These data provide confidence in restarting the transplant program, provided that a series of measures aiming to avoid infections in newly transplanted patients are taken

In vitro production of IFN-gamma correlates with CA repeat polymorphism in the human IFN-gamma gene.

The DNA sequence of the human IFN-γ gene shows the presence of a variable-length CA repeat in the first intron of the gene. We investigated the allele distribution of this microsatellite region in 164 unrelated healthy individuals, and the association with interferon-γ (IFN-γ) production. In vitro production of IFN-γ showed a significant correlation with the presence of allele #2

Nitric oxide levels following perfusion differ in donation after circulatory death and donation after brain death transplants.

Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah