Aplasia midollare pura della serie rossa (PRCA) indotta da infezione da Parvovirus B19 in un paziente portatore di trapianto renale. Descrizione di un caso clinico

Il caso riguarda un soggetto di sesso maschile di 55 anni portatore di trapianto renale in terapia immunosoppressiva con steroidi, everolimus e tacrolimus. Nel mese di novembre 2010, dopo circa 45 giorni dal trapianto, il paziente ha presentato un'anemia non responsiva alla terapia con eritropoietina e scarsamente responsiva alle emotrasfusioni. Gli esami praticati durante il ricovero hanno permesso di escludere una forma di anemia secondaria e fatto sospettare una forma iporigenerativa (bassi valori di reticolociti). Nell'ipotesi che si trattasse di una forma indotta dalla presenza di anticorpi anti-eritropoietina fu sospeso il farmaco e dosata l'eritropoietina sierica i cui valori risultarono superiori alla norma. L'esame dell'agoaspirato midollare evidenziò un quadro compatibile con una aplasia midollare pura della serie rossa (PRCA) di tipo acquisito. è risultata positiva sia sul siero che sul sangue midollare la ricerca del parvovirus B19. Il paziente è stato quindi trattato con corticosteroidi (prednisone) e immunoglobuline endovena (IgVena) con una graduale e lenta risoluzione del quadro di aplasia midollare

Role of human leukocyte antigen-G 14-base pair polymorphism in kidney transplantation outcomes

BACKGROUND: Both the membrane-bound and soluble forms of human leukocyte antigen-G (HLA-G) molecules exhibit a multitude of immunomodulatory properties that can potentially obviate or delay graft rejection. The 14-base pair (14-bp) polymorphism in the 3'-untranslated region of the HLA-G gene is thought to have a role in soluble HLA-G (sHLA-G) expression. METHODS: In this study, we retrospectively investigated a large cohort of 418 kidney transplant recipients with the aim of establishing whether the HLA-G 14-bp insertion/deletion polymorphism could serve as an effective genetic risk marker for acute and/or chronic deterioration of transplanted kidney function. RESULTS: A statistically significant higher incidence of chronic kidney dysfunction leading to allograft loss was observed in transplant recipients homozygous for the HLA-G 14-bp deletion polymorphism. This difference increased over time and was confirmed by progressive decline in the glomerular filtration rate. CONCLUSIONS: These results suggest that alongside other factors previously consolidated in clinical practice, recipient HLA-G 14-bp genotype may serve as an adjuvant independent predictor of long-term outcome of kidney transplantation

Increased cancer risk in patients undergoing dialysis: A population-based cohort study in North-Eastern Italy

Background: In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy. Methods: A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998-2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). Results: During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15-1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42-2.45 for age 40-59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89-10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06-4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46-2.22), oral cavity (SIR = 2.42, 95% CI: 1.36-4.00), and Kaposi's sarcoma (SIR = 10.29, 95% CI: 1.25-37.16). Conclusions: The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients