Diagnostic performance of multidetector computed tomography for symptomatic lymphoceles in kidney transplant recipients

Background : To evaluate the size of a postoperative lymphocele in the coronal and axial reconstruction planes using multidetector computed tomography (MDCT) in kidney transplantation recipients. Methods : We evaluated 92 recipients who underwent MDCT of the abdominopelvis at 1 month after kidney transplantation. The axial short axis, axial surface area, coronal short axis, and coronal surface area of the lymphocele were measured using the reconstructed MDCT coronal and axial images. Depending on the clinical manifestations and radiologic findings of the recipients, all lymphoceles were classified into symptomatic and asymptomatic. We compared the suitability of the size measurement on coronal and axial planes of MDCT reconstruction for symptomatic lymphocele in kidney transplant recipients using Spearman's correlation analysis and comparisons of receiver operating characteristic (ROC) curves. Results : Areas under the ROC curves were 0.957 and 0.928 for the axial short axis and axial surface area and 0.968 and 0.966 for the coronal short axis and coronal surface area, respectively. In pairwise comparison of the ROC curve of the parameters of the symptomatic lymphoceles, the coronal measurement was significant in contrast to the axial measurement (short axis, P=0.357; surface area, P=0.047). Conclusions: For the prediction of symptomatic lymphoceles using MDCT, the coronal measurement of postoperative lymphoceles can significantly improve diagnostic performance over axial measurement in kidney transplant recipients

An idiopathic congenital abdominal aortic aneurysm with impending rupture in a 23-month-old boy

Abdominal aortic aneurysms are distinctly uncommon in infants and children. These aneurysms, which are idiopathic in nature without any definite predisposing factors, are exceedingly rare. We present the case of a giant idiopathic congenital infrarenal abdominal aortic aneurysm with impending rupture in a 23-month-old boy, which was successfully treated with surgical repair using a cryopreserved cadaveric allograft. To the best of our knowledge, this is the oldest case and the third successful treatment of an idiopathic congenital abdominal aortic aneurysm repaired with a cryopreserved allograft in infants and children. Continued follow-up with multimodality imaging is required. © 2013 by the Society for Vascular Surgery

Eculizumab as rescue therapy in a kidney transplant recipient with atypical hemolytic uremic syndrome: a case report

A 61-year-old female patient with chronic kidney disease due to diabetes mellitus and hypertension–induced nephropathy received a deceased donor kidney transplant in March 2020. In July 2020, she was transferred from a local hospital due to the exacerbation of general weakness and diarrhea. Upon her arrival, we noticed a high level of serum creatinine (sCr) of 1.5 mg/dL and a decrease in urine output. Her laboratory results indicated significant hemolysis, with a hemoglobin level of 7.0 g/dL, platelet count of 20 ×103/µL, and a lactate dehydrogenase level of 3,207 IU/L. Kidney biopsy showed severe thrombotic microangiopathy without any evidence of acute rejection. Under the impression of atypical hemolytic uremic syndrome (aHUS), we immediately started plasmapheresis and hemodialysis for anuria. Eculizumab was considered as a kidney graft rescue therapy since her sCr level was not effectively decreased, and her anuria continued despite hemodialysis and plasmapheresis. Eculizumab (900 mg) was administered weekly for 4 weeks. An additional 600 mg of eculizumab was administered on the day of plasmapheresis. Since the patient’s laboratory data gradually improved, hemodialysis and plasmapheresis were ceased on admission day 37. After that, eculizumab was administered biweekly (1,200 mg) two more times. The patient’s sCr and platelet count normalized after 2 months of eculizumab treatment. Based on our experience, a shorter interval between the clinical diagnosis of aHUS and administration of eculizumab increases the likelihood of rescuing the kidney

Determining the etiology of small bowel obstruction in patients without intraabdominal operative history: a retrospective study

Purpose Most of the causes of small bowel obstruction (SBO) in patients without a history of abdominal surgery are unclear at initial assessment. This study was conducted to identify the etiology and clinical characteristics of SBO in virgin abdomens and discuss the proper management. Methods A retrospective review involving operative cases of SBO from a single institute, which had no history of abdominal surgery, was conducted between January 2010 and December 2020. Clinical information, including radiological, operative, and pathologic findings, was investigated to determine the etiology of SBO. Results A total of 55 patients were included in this study, with a median age of 57 years and male sex (63.6%) constituting the majority. The most frequently reported symptoms were abdominal pain and nausea or vomiting. Neoplasm as an underlying cause accounted for 34.5% of the cases, of which 25.5% were malignant cases. In patients aged ≥60 years (n=23), small bowel neoplasms were the underlying cause in 12 (52.2%), of whom 9 (39.1%) were malignant cases. Adhesions and Crohn disease were more frequent in patients aged <60 years. Coherence between preoperative computed tomography scans and intraoperative findings was found in 63.6% of the cases. Conclusion There were various causes of surgical cases of SBO in virgin abdomens. In older patients, hidden malignancy should be considered as a possible cause of SBO in a virgin abdomen. Patients with symptoms of recurrent bowel obstruction who have no history of prior abdominal surgery require thorough medical history and close follow-up

Outcomes of kidney transplantation from elderly deceased donors of a Korean registry.

To overcome organ shortage, expanded criteria donors, including elderly deceased donors (DDs), should be considered. We analyzed outcomes of kidney transplantation (KT) from elderly DDs in a nationwide study. In total, data of 1049 KTs from DDs using the database of Korean Organ Transplantation Registry (KOTRY) were retrospectively analyzed based on the age of DDs: age ≥60 years vs. <60 years. Clinical information, graft status, and adverse events were reviewed in DDs and recipients. The mean age of the 1006 DDs was 51.04±10.54 years, and 21.5% of donors were aged ≥60 years. Elderly DDs had a significantly higher prevalence of diabetes and hypertension and higher Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI). The mean age of the recipients was 47.45±14.87 years. Patients who received KT from elderly DDs were significantly older (53.12±15.14 vs. 45.88±14.41, P<0.001) and had a higher rate of diabetes (41.9 vs. 24.4%, P<0.001). Graft outcomes were not significantly different. Renal function was similar between the groups at the time of discharge and at 6 months, 1 year, and 2 years after KT. The rate of delayed graft function (DGF) was not significantly different. Risk factors of DGF were significantly different in DDs aged ≥60 years and <60 years. In the multivariable model, male sex (odds ratio: 3.99, 95% confidence interval: 1.42-11.22; P = 0.009) and KDRI (12.17, 2.23-66.34; P = 0.004) were significant risk factors for DGF in DDs aged ≥60 years. In DDs aged <60 years, thymoglobulin induction (2.62, 1.53-4.48; P<0.001) and continuous renal replacement therapy (3.47, 1.52-7.96; P = 0.003) were significant factors. Our data indicated that graft outcomes, including renal function and DGF, were similar for elderly DDs and DDs aged <60 years. Elderly DDs might be considered tolerable donors for KT, with active preoperative surveillance

Comparison of early and late Pneumocystis jirovecii Pneumonia in kidney transplant patients: the Korean Organ Transplantation Registry (KOTRY) Study

© 2022, The Author(s).Late Pneumocystis jirovecii pneumonia (PJP) is not rare in the era of universal prophylaxis after kidney transplantation. We aimed to determine the nationwide status of PJP prophylaxis in Korea and compare the incidence, risk factors, and outcomes of early and late PJP using data from the Korean Organ Transplantation Registry (KOTRY), a nationwide Korean transplant cohort. We conducted a retrospective analysis using data of 4,839 kidney transplant patients from KOTRY between 2014 and 2018, excluding patients who received multi-organ transplantation or were under 18 years old. Cox regression analysis was performed to determine risk factors for early and late PJP. A total of 50 patients developed PJP. The number of patients who developed PJP was same between onset before 6 months and onsets after 6 months. There were no differences in the rate, duration, or dose of PJP prophylaxis between early and late PJP. Desensitization, higher tacrolimus dose at discharge, and acute rejection were associated with early PJP. In late PJP, old age as well as acute rejection were significant risk factors. In conclusion late PJP is as common and risky as early PJP and requires individualized risk-based prophylaxis, such as prolonged prophylaxis for old patients with a history of rejection.N