Acute pancreatitis associated with everolimus after kidney transplantation: a case report

Background: Acute pancreatitis (AP) following KT is a rare and often fatal complication of the early post-transplant period. Common causative factors for AP are rare after KT; anti-rejection drugs as CyA, prednisone and MMF have been implicated, although evidence is not strong and we found no reports on possible causative role for mTOR inhibitors. Case presentation: A 55-year-old Caucasian man with end-stage renal disease due to idiopathic membrano-prolipherative glomerulonephritis underwent single kidney transplantation (KT) from cadaveric donor. Anti-rejection protocol was based on Basiliximab induction followed by prednisone and mycophenolate mophetil (MMF) and Cyclosporine; Everolimus (Eve) was scheduled to substitute MMF at week 3. At day 1 he had an asymptomatic elevation of pancreatic enzymes, spontaneously resolved. The further course was unremarkable and on day 19 he started Eve, with following asymptomatic rise in pancreatic enzymes. At day 33 the patient presented with abdominal pain and a marked elevation in serum amylase (1383 U/l) and lipase (1015 U/l), normal liver enzymes and bilirubin, no hypercalcemia, mild elevation in triglycerids; RT-PCRs for Cytomegalovirus or Epstein-Barr virus were negative. The patient had no history of alcohol abuse; ultrasound, CT and MRI found no evidence of biliary lithiasis. CT scans showed a patchy fluid collection in the pancreatic head area, consistent with idiopathic necrotizing pancreatitis. The patient was treated medically and Eve was withdrawn 1 week after. Patient underwent guided drainage of the fluid collection, but developed bacterial sepsis; surgical intervention was required with debridement of necrotic tissue, lavage and drainage; immunosuppression was totally withdrawn. Following course was complicated with multiple systemic infection. Transplantectomy for acute rejection was performed, and patient entered hemodialysis. Conclusions: Our patient had a presentation that is consistent for a causative role of Eve. A predisposing condition (acute pancreatic insult during transplant surgery) spontaneously resolved, relapsed and evolved rapidly in AP after the initiation of treatment with Eve with a consistent time latency. None of the well-known common causative factors for AP was present. We discourage the use of Eve in patients with recent episodes of sub-clinical pancreatitis, since it may represent a precipitating factor or interfere with resolution

La luce è ancora accesa nel Buckinghamshire. Love and Information di Caryl Churchill: un'analisi del teatro contemporaneo.

Analisi di Love and Information di Caryl Churchill e inserimento dell'opera all'interno del macrotesto della scrittrice

Reply to the letter of Dr Merdin

Dr Merdin kindly makes suggestions about the design of our study and asks for more information about the infectious and immunosuppressive history of our monoclonal B‐cell lymphocytosis (MBL) patients with monoclonal B‐cell lymphocytosis (MBL). In our study, we incidentally found the coexistence of five cases of MBL and monoclonal gammopathy of undetermined significance (MGUS) in a cohort of kidney transplant recipients at a median of 15 years after transplantation.1 MBL and MGUS are two pre‐malignant lymphoproliferative disorders of terminally differentiated B cells. Clinically, MBL and MGUS share common features, such as an indolent course, a late‐onset age distribution, a low rate of progression and an increased susceptibility to infections. MBL and MGUS are also the precursor states of two hematologic malignancies: chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), respectively

Pressure Ulcers due to a Tunneled Central Venous Catheter in a Patient on Chronic Maintenance Hemodialysis

We describe a rare complication given by tunneled central venous catheter (CVC) in a 95-years-old woman on chronic maintenance hemodialysis (HD)

Acute demyelinating neuropathy associated with rituximab treatment in a patient with relapsing nephrotic syndrome

We encountered a 63-year-old woman who experienced acute onset of demyelinating polyneuropathy (AIDP) after rituximab infusions to treat her nephrotic syndrome (NS

Geometria dell’anello di distribuzione e materiale utilizzato

La qualità chimica e microbiologica delle acque di dialisi è un requisito fondamentale per la biocompatibilità del trattamento emodialitico. Numerosi lavori in letteratura mostrano infatti come la composizione del liquido di dialisi rappresenti uno dei fattori responsabili dello stato microinfiammatorio cronico del paziente emodializzato con importanti conseguenze cliniche Al fine di garantire al paziente un trattamento dialitico con elevati standard di qualità e sicurezza si dovrebbe giungere oggi alla produzione di un dialisato che si definisce ultrapuro (carica batterica <0.1 UFC/ml e concentrazione endotossinica <0.03 UI/ml). Questo ha particolare importanza nelle metodiche “on-line” che consentono l’autoproduzione del liquido di sostituzione durante i trattamenti convettivi

Successful treatment of BK virus associated-nephropathy in a human immunodeficiency virus-positive kidney transplant recipient

BK virus (BKV) is an opportunistic pathogen in those with impaired immunity. Viral replication is generally asymptomatic but is able to induce cytopathic alterations in renal cells. If BKV infection is left untreated, it leads to BKV-associated nephropathy (BKVAN) and graft loss. There is scarce experience in the management of BKV infection in kidney transplant recipients living with HIV. We report the successful treatment of BKVAN in an HIV-positive kidney transplant recipient who experienced BKV replication in the immediate post-transplantation period. A change in therapy from calcineurin inhibitor to sirolimus, steroid withdrawal and a short course of an immunomodulatory agent (leflunomide) controlled BKV viremia in the absence of drug side-effects or impairment of graft function