Acute kidney injury (Aki) before and after kidney transplantation: Causes, medical approach, and implications for the long-term outcomes

Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short-and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short-and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient

Chemotherapy, targeted therapy and immunotherapy: Which drugs can be safely used in the solid organ transplant recipients?

In solid organ transplant recipients, cancer is associated with worse prognosis than in the general population. Among the causes of increased cancer-associated mortality, are the limitations in selecting the optimal anticancer regimen in solid organ transplant recipients, because of the associated risks of graft toxicity and rejection, drug-to-drug interactions, reduced kidney or liver function, and patient frailty and comorbid conditions. The advent of immunotherapy has generated further challenges, mainly because checkpoint inhibitors increase the risk of rejection, which may have life-threatening consequences in recipients of life-saving organs. In general, there are no safe or unsafe anticancer drugs. Rather, the optimal choice of the anticancer regimen results from a careful risk/benefit assessment, from the awareness of potential pharmacokinetic and pharmacodynamic drug-to-drug interactions, and of the risk of drug overexposure in patients with kidney or liver dysfunction. In this review, we summarize general principles that may help the oncologists and transplant physicians in the multidisciplinary management of recipients of solid organ transplantation with cancer who are candidates for chemotherapy, targeted therapy, or immunotherapy

Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

Facial aesthetic and childhood

AIM: The aim of the study is to evaluate attention and perception of parents about children's facial aesthetics, the paediatrician's role in early diagnosis of these problems and the areas of the face considered as the most important from an aesthetic point of view. METHODS: The study was carried out collecting 1214 questionnaires at paediatricians waiting room in the North of Italy. RESULTS: Most parents showed attention toward craniofacial deformities of their children and considered the paediatrician's role as very important in early diagnosis. Profile was considered more important than the front view and face's areas felt as the most important were denture, eyes and nose. CONCLUSION: Despite public opinion, adults are concerned not only about the general health and growth of their children, but also about their facial aesthetics. They, in fact, not only judge aesthetics of the whole face, but also discriminate different views and specific areas of the face. They require, for early diagnosis of dentofacial problems, skilled attention from the paediatrician

Facial aesthetics and childhood

IM: The aim of the study is to evaluate attention and perception of parents about children's facial aesthetics, the paediatrician's role in early diagnosis of these problems and the areas of the face considered as the most important from an aesthetic point of view. METHODS: The study was carried out collecting 1214 questionnaires at paediatricians waiting room in the North of Italy. RESULTS: Most parents showed attention toward craniofacial deformities of their children and considered the paediatrician's role as very important in early diagnosis. Profile was considered more important than the front view and face's areas felt as the most important were denture, eyes and nose. CONCLUSION: Despite public opinion, adults are concerned not only about the general health and growth of their children, but also about their facial aesthetics. They, in fact, not only judge aesthetics of the whole face, but also discriminate different views and specific areas of the face. They require, for early diagnosis of dentofacial problems, skilled attention from the paediatrician