Esquistossomose hepática como achado ocasional de fígado de doador para transplante

Introduction: The prevalence of cryptogenic cirrhosis ranges from 5% to 30% of cirrhotic patients in past series (CADWELL et al, 1999). Liver transplantation represents the only option to revert the hepatic insufficiency and its complications in cirrhotic patients in advanced stage. In Brazil, Mansonic Schistosomiasis is a public health problem and endemic disease, particularly in the Northeast of the country. Methods: Case report of a male patient, admitted to Hospital Geral de Fortaleza, Ceará, Brazil, with cryptogenic hepatic cirrhosis, classified as Child-Turcotte-Pugh C, with a MELD of 25, submitted to a liver transplantation, and found to have schistosomal hepatic disease on biopsy report. We reviewed the patient's medical history and physical examination on admission, prescription, results of laboratory tests and follow up data. Survey of the literature in national and international scientific journals helped in collecting information on this disease. Conclusions: Parasitic infections in solid organ transplant has increased in the recent years. It is very important to keep a strict control of the quality of the organs and tissues used in transplantations, as well as an improvement in diagnosis, treatment and prophylaxis techniques, especially in liver transplantation, in view of a high prevalence of parasitic infections in our country, in order to prevent the development of other comorbidities, and to increase the survival of transplanted patients. In endemic countries, potential donors or recipients who have active schistosomal infection should be preventively treated.Introdução: A prevalência de cirrose criptogênica varia de 5% a 30% dos pacientes cirróticos nas séries históricas. O transplante hepático representa a única opção em reverter a insuficiência hepatica e suas complicações em pacientes cirróticos em estágio avançado. A esquistossomose mansônica no Brasil é um problema endêmico de saúde pública,particularmente na região nordeste do país.Apresenta-se relato de caso de paciente do sexo masculino admitido ao Hospital Geral de Fortaleza, Ceará , Brasil,com cirrose criptogênica classificada como Child Turcotte-Pugh C, com MELD 25, submetido a transplante hepático com fígado de doador portador de esquistossomose como achado ocasional da biópsia padrão. Foi revisada a história clínica e exame físico na admissão, resultados de exames laboratoriais e dados do seguimento clínico.Como conclusão, as infecções parasitárias em órgãos sólidos transplantados tem aumentado nos últimos anos. É muito importante realizar o controle da qualidade dos órgãos e tecidos utilizados em transplantes, assim como desenvolver técnicas de diagnóstico, tratamento e profilaxia, especialmente em transplante hepático, em vista da alta prevalência de infecções parasitárias em nosso país, com intuito de prevenir outras co-morbidades e aumentar a sobrevida dos pacientes transplantados. Em regiões endêmicas, os potenciais doadores de receptores que têm esquistossomose ativa devem ser preventivamente tratados

12-month safety and efficacy of everolimus with reduced exposure cyclosporine in de novo renal transplant recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74645/1/j.1432-2277.2006.00414.x.pd

Everolimus with Optimized Cyclosporine Dosing in Renal Transplant Recipients: 6-Month Safety and Efficacy Results of Two Randomized Studies

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74668/1/j.1600-6143.2004.00389.x.pd

Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil

Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population

Post-transplant anemia and associated risk factors: the impact of steroid-free therapy

CONTEXT AND OBJECTIVE: The prevalence of post-renal transplant anemia (PTA) reported in the literature is variable and several factors contribute towards its pathophysiology. This study aimed to investigate the prevalence of PTA, its associated risk factors and the impact of therapy without steroids. DESIGN AND SETTING: Retrospective cohort study in a renal transplantation unit at a tertiary hospital. METHODS: Anemia was defined as hemoglobin (Hb) 50 years was associated with greater risks of PTA at M6 (odds ratio (OR) = 4.68) and M24 (OR = 6.57), as well as with therapy without steroids at M6 (OR = 2.96). Delayed graft function was independently associated with PTA at M6 (OR = 3.66) and M12 (OR = 2.85). CONCLUSION: The lowest prevalence of PTA was observed between M9 and M24 after renal transplantation. Delayed graft function, donor age and therapy without steroids were the most important factors associated with PTA

Severe dengue in the early postoperative period after kidney transplantation: two case reports from Hospital Geral de Fortaleza

Abstract: Dengue is an arbovirosis that ranges from an asymptomatic presentation to a more severe disease, which is characterized by a vascular leakage syndrome where abdominal pain is a major symptom. Transplant recipients are immunosuppressed and are less likely to develop a severe form of the disease because of a reduction in immune-mediated responses that trigger plasma extravasation events. Herein, we report two cases of severe dengue in the early postoperative period of two kidney transplant recipients. Considering the severity of the cases, we emphasize the importance of dengue screening immediately before transplantation in areas endemic for the disease