Fideicomisso irregular, litisconsórcio necessário e redução de contrato promessa de partilha – A propósito de um caso concreto

O presente estudo – partindo do presuposto da existência de um testamento, pelo qual o testador institui um fideicomisso irregular previsto na alínea a) do n.º 1 art. 2195º do Código Civil português – analisa a necessidade da existência de litisconsórcio (litisconsórcio necessário natural) numa ação judicial entre fiduciários e fideicomissários, se os primeiros ainda estiverem vivos. Defende-se que, neste tipo de fideicomissos “irregulares”, os fideicomissários, descendentes de fiduciários ainda vivos, não têm que (nem podem) ser partes (ou interessados) no processo de inventário judicial que esteja a tramitar no tribunal competente para a partilha dos bens deixados aos fiduciários. Por outro lado, pode ser objeto de execução específica o contrato de promessa de partilha dos bens da herança, ainda que um dos bens prometido partilhar não possa ser fracionado nos termos das leis urbanísticas ou de fracionamento de terrenos agrícolas. Neste tipo de situações a execução específica apenas se realiza relativamente aos demais bens hereditários, operando-se a redução (judicial) do referido contrato promessa

Treatment of Hepatitis C Virus Infection in Kidney Transplant Recipients: Case Report

Chronic hepatitis C virus (HCV) infection exists in a large proportion of patients undergoing renal transplantation. Nowadays it is not considered to be an absolute contraindication to transplantation; however, it is associated with an increased risk for the patient and accounts for a shorter half-life of the renal allograft. We present three transplant recipients who displayed serious hepatic dysfunction after renal transplantation due to an HCV infection. In two of these cases, the liver biopsies established the diagnosis of FCH. In the third case, the liver biopsy was compatible with the early stages of FCH. All patients were started on peg-interferon alfa 2-b and ribavirin with subsequent normalization of hepatic function and early complete viral responses

Doença Ateroembólica Como Causa de Disfunção Primária do Enxerto Renal

Atheroembolic renal disease, also referred to as cholesterol crystal embolization, is a rare cause of renal failure, secondary to occlusion of renal arteries, renal arterioles and glomerular capillaries with cholesterol crystals, originating from atheromatous plaques of the aorta and other major arteries. This disease can occur very rarely in kidney allografts in an early or a late clinical form. Renal biopsy seems to be a reliable diagnostic test and cholesterol clefts are the pathognomonic finding. However, the renal biopsy has some limitations as the typical lesion is focal and can be easily missed in a biopsy fragment. The clinical course of these patients varies from complete recovery of the renal function to permanent graft loss. Statins, acetylsalicyclic acid, and corticosteroids have been used to improve the prognosis. We report a case of primary allograft dysfunction caused by an early and massive atheroembolic renal disease. Distinctive histology is presented in several consecutive biopsies. We evaluated all the cases of our Unit and briefly reviewed the literature. Atheroembolic renal disease is a rare cause of allograft primary non -function but may become more prevalent as acceptance of aged donors and recipients for transplantation has become more frequent

Biópsias Renais Protocoladas Precoces: Uma Ferramenta Útil em Alguns Mas Não em Todos os Transplantados Renais?

Subclinical rejection following renal transplant is associated with worse outcomes, which can be prevented if recognized early. Protocol allograft biopsies have emerged as an option to identify and allow treatment of subclinical rejection, but optimal timing for their performance is not established. We retrospectively evaluated a cohort of 52 low immunological risk patients, who were submitted, from 2007 to 2010, to de novo renal transplant. We separated them into two groups depending on performing an early graft protocol biopsy before hospital discharge: Group A – 32 patients (61.5%) performed a protocol biopsy, and group B – 20 patients (38.5%) did not, the biopsy being considered not essential for various reasons. We analysed patients’ demographics, biopsy complications, graft function, rejection episodes, and patient and graft survival for a median follow-up time of 63.3 months (50.3-83.7). Group A and group B differed in gender (more female patients were biopsied), dialysis vintage (higher in group A), human leucocyte antigen mismatch (higher in group A), and induction protocol (more patients submitted to thymoglobulin than to basiliximab in group A). Protocol biopsy detected histological changes in four patients (12.5%) in group A (2 cellular and 2 borderline rejections), and all were treated accordingly. Moderate peri-graft hematoma was reported in two cases (3.9%). Despite the increased risk in group A, renal function at discharge was better than in group B (p < 0.05 for serum creatinine and eGFR). During follow-up, rejection episodes were similar in the two groups. By the end of follow-up (median 63.3 months), proteinuria and renal function were similar between the two groups. Using a multivariate regression model, and despite the initial differences, at the end of follow-up, patients submitted to early protocol biopsies had similar excellent prognosis as the very low-risk patients who were not biopsied. (p = 0.5). Following our results, we propose that timing of early protocol biopsy should be individualized according to the patient’s clinical and immunological risk.info:eu-repo/semantics/publishedVersio

ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study

INTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes

A Rare Malignancy in the Post -Transplant Period: Myeloma Cast Nephropathy

Myeloma-associated renal disorders are rare events among renal transplants and can occur as recurrent or de novo disease. We describe an unusual case of renal allograft dysfunction due to myeloma cast nephropathy occurring 19 years after having received a renal transplant in a patient with no prior history of multiple myeloma or monoclonal gammopathy preceding transplantation. Our patient was treated with five cycles of chemotheraphy(bortezomib, melphalan and steroids), which resulted in short-term improvement in allograft dysfunction and complete haematological remission. The longer patient and graft survival after renal transplantation make post-transplant lymphoproliferative disease more frequent. Multiple myeloma after kidney transplant is rare and an elevated index of suspicion is necessary to make a timely diagnosis of this serious disease. Further work is needed to identify the best treatment options for these patients.info:eu-repo/semantics/publishedVersio

Predicting Function Delay with a Machine Learning Model: Improve the Long-term Survival of Pancreatic Grafts

The impact of delayed graft function on outcomes following various solid organ transplants is well documented and addressed in the literature. Delayed graft function following various solid organ transplants is associated with both short- and long-term graft survival issues. In a retrospective cohort study including 106 patients we evaluated whether pancreas graft survival differs according to moment of insulin therapy following simultaneous pancreaskidney transplant. As a result, we aimed to identify possible risk factors and build a machine-learning-based model that predicts the likelihood of dysfunction following SPK transplant patients based on day zero data after transplant, allowing to enhance pancreatic graft survival. Feature selection by Relief algorithm yielded donor features, age, cause of death, hemoglobin, gender, ventilation days, days in ICU, length of cardiac respiratory arrest and recipient features, gender, long-term insulin, dialysis type, time of diabetes mellitus, vPRA pre-Tx, number of HLA-A mismatches and PRDI, all contributed to the models' strength.info:eu-repo/semantics/publishedVersio