Renal Allograft Rupture: A Clinicopathologic Review

Transplantation Proceedings Volume 32, Issue 8, December 2000, Pages 2597-2598 -------------------------------------------------------------------------------- doi:10.1016/S0041-1345(00)01801-7 | How to Cite or Link Using DOI Copyright © 2000 Elsevier Science Inc. All rights reserved. Cited By in Scopus (4) Permissions & Reprints Renal allograft rupture: a clinicopathologic review M Ramosa, , L Martinsa, L Diasa, A.C Henriquesa, J Soaresa, J Queirósa and A.M Sarmentoa aDepartments of Urology and Nefrology, Hospital Geral de Santo António, Oporto, Portugal Available online 19 December 2000. Article Outline Patients and methods Results Discussion References Renal allograft rupture (RAR) is a rare but very serious complication of renal transplantation, requiring emergency surgery. The most common cause is acute allograft rejection, but other causes such as renal vein thrombosis (RVT), acute tubular necrosis (ATN), renal biopsy, and lymphatic obstruction have been reported.[1] and [2] We reviewed our experience with the aim of identifying RAR predisposing conditions. Patients and methods In a consecutive series of 934 renal transplants performed between July 1983 and September 1999, 11 patients (1.2%) had RAR. In these cases we studied donor and recipient characteristics, preservation conditions, clinical signs and symptoms, treatment, and pathology findings. This group of patients was then compared with their paired cohort. Data analysis was computer-based. In the statistical analysis t test and Fisher’s exact test were used. Results All 11 kidneys that suffered RAR were from cadaver donors, nine male and two female. The mean age was 29.5 years with good terminal serum creatinine (mean 1.1 mg/dL). All organs were stored in Eurocollins solution and the mean cold ischemia time was 21 hours and 25 minutes (range, 10 hours to 29 hours and 20 minutes). Excluding one black patient, all recipients were Caucasian. Eight were female and 3 were male, with a mean age of 33.8 years. The mean HLA match was 1.7, and the mean peak panel reactive antibody (PRA) was 22% (range 0 to 93%) and current was 15% (range 0 to 67%). All patients had cyclosporine treatment, eight had delayed graft function requiring dialysis, and three underwent renal allograft biopsy. In two patients rupture occurred in the second allograft; the others were first transplants. The day of RAR was a mean of 5.3 (range 2 to 13). All patients had new onset of severe allograft pain, eight had a drop in daily hematocrit, and six had hypotension. The four patients with more precocious ruptures had sudden onset of bleeding through the drainage tube. Transplant nephrectomy was performed in 10 patients, and surgical conservative treatment with fibrin glue and collagen foam was performed in one. All patients survived RAR. Three had a second transplant and currently have functioning allografts. Pathology examination revealed RVT in three patients and some degree of rejection in the remaining eight. One patient had a rupture on the second day because of hyperacute rejection, and three had severe acute cellular rejection, but in four patients the dominant figure was ATN with minimal rejection. Excluding the patient with hyperacute rejection, the day of rupture was later for those with severe acute rejection, a mean of 9.6 days (range 6 to 13). In those with ATN, the day of RAR was a mean of 4.5 (range 3 to 6) and the patients with RVT had ruptures even sooner, on mean third day (range 2 to 4). Variables associated with RAR were: sex mismatch (P = .004), current PRA (P = .012), and a need for dialysis (P = .042). Age of the recipient, transplant number, cold ischemia time, total HLA match, and peak PRA were not associated with RAR. Discussion Higher current PRA and a need for dialysis are variables associated with rejection and ATN. Therefore they are expected to be related to rupture. The well-documented conditions that are associated with ATN and rejection3 must be the same, which in extreme conditions predispose to RAR. We find no explanation for the statistically significant association of sex mismatch and RAR, other than random error. Acute allograft rejection is the most frequent cause of graft rupture in the literature (60 to 80%),3 but ATN has received little note. In our series, ATN was responsible for 36% of the ruptures, as much as severe acute rejection. ATN alone can cause RAR,4 because of interstitial edema and rise in intrarenal pressure. But when associated with rejection, it seems that these two conditions can act synergistically to cause allograft rupture. Our data suggests that rupture occurs later when caused by rejection, rather than when RVT is responsible. To our knowledge this finding had never been reported in world literature. Perhaps the timing of RVT is related to technical problems, such as twisting and kinking of the vein or intima tear, although the thrombogenic effect of cyclosporine can also have a role in this process.5 All these patients were on cyclosporine therapy, which may explain the small number of RAR caused by rejection alone and the significant number of patients that had RVT (27%). It appears that cyclosporine therapy is changing the etiology of the graft rupture.6 References 1 T. Grochowiecki, J. Szmidt and K. Madej et al., Transplantation Proc 28 (1996), p. 3461. View Record in Scopus | Cited By in Scopus (2) 2 R.S. Lord, D.J. Effeney and J.M. Hayes et al., Ann Surg 177 (1973), p. 268. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (4) 3 G.J. Azar, A. Zarifian and G.D. Frentz et al., Clin Transplantation 10 (1996), p. 635. View Record in Scopus | Cited By in Scopus (12) 4 Y.H. Chan, K.M. Wong and K.C. Lee et al., Am J Kidney Dis 34 (1999), p. 355. Abstract | Article | PDF (86 K) 5 R.M. Jones, J.A. Murie and A. Ting et al., Clin Transplant 2 (1988), p. 122. 6 A.J. Richardson, R.M. Higgins and A.J. Jaskowski et al., Br J Surg 77 (1990), p. 558. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (19

Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus.

Transpl Int. 2007 Mar;20(3):291-6. Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus. Pedroso SL, Martins LS, Sousa S, Reis A, Dias L, Henriques AC, Sarmento AM, Cabrita A. Nephrology Department, Hospital Geral de Santo António, Porto, Portugal. [email protected] Abstract The aim of our paper is to describe an unusual pulmonary toxicity of sirolimus (SRL) in a kidney transplant recipient. We present a 34-year-old woman with a second renal transplantation, complicated with steroid-resistant acute rejection and chronic allograft dysfunction. Two years after initiating SRL, she presented complaints of progressive dyspnoea, nonproductive cough, chest pain and low-grade fever of 1 month duration. She had chronic allograft nephropathy and slight elevation of lactic dehydrogenase levels. After exclusion of common reasons of this condition, a computed tomography (CT) of the thorax and bronchoscopy was performed, revealing ground-glass opacification with polygonal shapes on CT and an opaque appearance with numerous macrophages on bronchoalveolar lavage. The alveolar macrophages stained positive by Periodic acid-Schiff. Diagnosis of pulmonary alveolar proteinosis (PAP) was made and drug-induced toxicity was suspected. SRL was withdrawn with marked improvement in the patients' clinical and radiological status. PAP resolved within 3 months without further therapy. PAP is a very rare complication of SRL therapy with only a few cases described. Withdrawal of SRL with conversion to another immunosuppressant seems to be an appropriate procedure in this condition. PMID: 17291222 [PubMed - indexed for MEDLIN

Aneurismas Toracoabdominais Rotos [ruptured Thoracoabdominal Aneurysms]

Objective: To evaluate the pre-, intra- and postoperative data of ruptured thoracoabdominal aneurysms operated at Hospital de Clínicas da Universidade Estadual de Campinas. Methods: A retrospective study of five patients submitted to repair of ruptured thoracoabdominal aneurysm at Hospital de Clínicas da Universidade Estadual de Campinas from September 2000 to April 2004. All patients presented a ruptured type IV thoracoabdominal aneurysm, and four of them were hemodynamically stable. Three patients were operated by the simple supraceliac aortic clamping and saline solution infusion at 4°C in the renal arteries; one patient died during the surgery before the aneurysm was opened; and one patient was operated by perfusion of oxygenated blood in the visceral arteries. Results: Of the five patients operated, two died (40%). One of them presented hemodynamic instability and died during the surgery; the other patient died on the 26 th postoperative day due to multiple organ failure. All three surviving patients progressed well, with no sequelae. Among patients who were taken to the operating room hemodynamically stable, the mortality rate was 25%. Conclusions: Patients with ruptured type IV thoracoabdominal aneurysm, hemodynamically stable, achieved satisfactory surgical results, similar to infrarenal ruptured aneurysms. Copyright © 2006 by Sociedade Brasileira de Angiologia e de Cirurgia Vascular.513741Bradbury, A.W., Bulstrode, N.W., Gilling-Smith, G., Stansby, G., Mansfield, A.O., Wolfe, J.H., Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases (1999) Eur J Vasc Endovasc Surg, 17, pp. 160-165Lewis, M.E., Ranasinghe, A.M., Revell, M.P., Bonser, R.S., Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms (2002) Br J Surg, 89, pp. 442-445Cowan Jr., J.A., Dimick, J.B., Wainess, R.M., Henke, P.K., Stanley, J.C., Upchurch Jr., G.R., Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998 (2003) J Vasc Surg, 38, pp. 319-322LeMaire, S.A., Rice, D.C., Schmittling, Z.C., Coselli, J.S., Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation (2002) J Vasc Surg, 35, pp. 1171-1178Rocha, E.F., Luccas, G.C., Baldini Neto, L., Aneurisma tóracoabdominal inflamatório (2005) J Vasc Br, 4, pp. 301-306Rocha, E.F., Guillaumon, A.T., Antunes, N., Vieira, R.W., Aneurisma toracoabdominal roto: Modificação do circuito de perfusão visceral (2004) Rev Bras Cir Cardiovasc, 19, pp. 413-416Mastroroberto, P., Chello, M., Emergency thoracoabdominal aortic repair: Clinical outcome (1999) J Thorac Cardiovasc Surg, 118, pp. 477-481Cota, A.M., Omer, A.A., Jaipersad, A.S., Wilson, N.V., Elective versus ruptured abdominal aortic aneurysm repair: A 1-year cost-effectiveness analysis (2005) Ann Vasc Surg, 19, pp. 858-861Girardi, L.N., Krieger, K.H., Altorki, N.K., Mack, C.A., Lee, L.Y., Isom, O.W., Ruptured descending and thoracoabdominal aortic aneurysms (2002) Ann Thorac Surg, 74, pp. 1066-1070Schepens, M.A., Defauw, J.J., Hamerlijnck, R.P., De Geest, R., Vermeulen, F.E., Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results (1994) J Thorac Cardiovasc Surg, 107, pp. 134-142Cambria, R.P., Davison, J.K., Zannetti, S., L'Italien, G., Atamian, S., Thoracoabdominal aneurysm repair: Perspectives over a decade with the clamp-and-sew technique (1997) Ann Surg, 226, pp. 294-303Anacleto, A., Anacleto, J.C., Aneurismas da aorta torácica e toracoabdominal (2002) Cirurgia Vascular: Cirurgia Endovascular, Angiologia, pp. 439-459. , Brito CJ. Rio de Janeiro: RevinterSantos, V.P., Ignácio, M.R., Da Silveira, D.R., Caffaro, R.A., Aneurisma toracoabdominal roto: Relato de um caso com o uso de anel rígido sulcado de Delrin intraluminal na anastomose proximal (2004) J Vasc Br, 3, pp. 383-38

Medium-chain triglyceride supplementation may increase working memory in older adults: A pilot study

Poster presentatio

Facts related to the collection of biological samples in the National Health Examination Survey - Portuguese Component of the European Health Examination Survey

Abstrat disponível em: http://www.ichg2011.org/cgi-bin/showdetail.pl?absno=11013The objective of the National Health Examination Survey (NHES), which corresponds to the Portuguese component of the European Health Examination Survey (EHES), is to collect health data, related risk factors and biological samples of the Portuguese population, using the EHES recommended methodology. These surveys involve an interview, clinical and physical measurements and blood collection. In this context, we herein describe the pilot study performed in S. Brás de Alportel in the Algarve region. For this pilot study, we have recruited 221 individuals (95 males and 126 females), between 25 and 91 years old, who were enrolled in the Health Centre of S. Brás de Alportel (Algarve). For each participant, we have collected 16.5 ml of total blood, in five different Vacutainer® tubes, which was later processed into serum, plasma and DNA. We have performed several biochemical analyses(total cholesterol, LDL,HDL, glucose, tryglicerides, creatinine, ALT, AST, -GT, CRP and iron) and a complete blood count. From the 221 participants in this pilot study, we were able to collect blood to 219 (99.5%). To 185 of these (84.5%) we were able to collect the total amount of blood. The biochemical analyses were performed in all the samples. The total blood count was performed in 103 samples (47%) due to transport constraints. We have also collected DNA from 210 participants (95.9%). We have created a biobank comprising 1847 serum aliquots and 959 plasma aliquots, which have been stored at - 80°C and 210 DNA aliquots which have been stored at 4°C. In conclusion, during this study, we have optimized the logistics and procedures to perform the large scale study for the NHES and EHES. In addition, we have created a biobank comprising detailed questionnaire data, physical and clinical data and biological samples from a representative sample of S. Brás de Alportel in Algarve, Portugal. This biobank will allow us to perform future studies, including the determination of the prevalence of gene variants of public health interest, the characterization of gene-environment interactions in the development of chronic diseases and the genetic structure of the Portuguese population. The success rate, the quality of the data and of the biological samples was high and comparable to similar studies.Fundação para a Ciência e Tecnologia e European Commission/DG Sanc

Soil cover plants on water erosion control in the South of Minas Gerais

Water erosion is responsible for soil, water, carbon and nutrient losses, turning into the most important type of degradation of Brazilian soils. This study aimed to evaluate the influence of three cover plants under two tillage systems on water erosion control in an Argisol at south of Minas Gerais state, Brazil. The cover plants utilized in the study were pigeon pea, jack bean and millet, under contour seeding and downslope tillage. Experimental plots of 4 x 12 m, with 9% slope, under natural rainfall were used for the quantification of losses of soil, water, nutrients, and organic matter. One experimental plot was kept without plant cover (reference). Higher erosivity was observed in December and January, although a great quantity of erosive rainfall was detected during the whole raining period. Contour seeding provided a greater reduction of water erosion than downslope tillage, as expected. The jack bean under contour seeding revealed the lowest values of soil, water, nutrients and organic matter losses